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S2.3 Neurology > Spinal Cord Disorders > Flashcards

Spinal Cord Disorders Flashcards

1
Q

What are the expected signs of cord/root pathology?

A

UMN signs

  • no wasting
  • increased tone
  • increased reflexes
  • pyramidal pattern of weakness

LMN

  • decreased tone
  • decreased reflexes, flexor plantar
  • weakness

Sensory

  • myelopathy > sensory level
  • hemicord lesion > Brown-Sequard syndrome
  • radiculopathy > dermatomal

Autonomic
- bladder/bowel

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2
Q

What is Brown-Sequard syndrome? What is the importance?

A

Ipsilateral symptoms - dorsal column

  • decreased vibration
  • decreased position sense
  • weakness

Contralateral (spinothalamic)

  • decreased pain
  • decreased temperature

If patient has syndrome - CANNOT be brain lesion

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3
Q

What is a radiculopathy?

A

Compression of nerve root leading to dermatomal and myotomal deficits

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4
Q

What are the possible causes of a myelopathy/radiculopathy?

A 
Tumour
Vascular abnormalities
Degenerative
Trauma
Inflammation
Infective
Metabolic
Malignancy
Congenital/genetic
Idiopathic
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5
Q

What can cause degenerative myelo/radiculopathies?

A

Disc prolapse
Ligamentum hypertrophy
Osteophyte formation

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6
Q

What are the effects of B12 deficiency?

A

Myelopathy
Peripheral neuropathy
Brain, brainstem, cerebellum problems
Eye/optic nerve problems

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7
Q

What are the symptoms of a B12 deficient myelopathy?

A

Paraesthesia hands and feet, areflexia
First UMN sign extensor plantaris
Degeneration of CST (paraplegia), dorsal columns (sensory ataxia)
Painless retention of urine

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8
Q

What are example causes of spinal cord ischaemia?

A 
Atheroma (aortic aneurysm)
Thromboembolic disease
Arterial dissection
Hypotension
Hyperviscosity
Vasculitis
Venous occlusion
Meningovascular syphilis
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9
Q

Symptoms/Signs of spinal cord ischaemia?

A

Onset may be sudden or over several hours
Pain (back pain/radicular, visceral referred pain)
Weakness (usually paraparesis rather than quadraparesis)
Numbness paraesthesia
Urinary symptoms
Very rarely posterior spinal artery (dorsal columns spared)

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10
Q

Investigations that may be done in suspected spinal cord ischaemia?

A

MRI

Examination

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11
Q

How is spinal cord ischaemia treated?

A

Reduce risk of recurrence

  • maintain BP
  • reverse hypovolaemia/arrhythmia
  • antiplatelets

OT/Physio
Manage vascular risk factors

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12
Q

What are the symptoms of a disc prolapse?

A

Acute pain down leg/arm

Numbness and weakness in distribution of root involved

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13
Q

What are the symptoms of Cauda Equina Syndrome? How is it managed?

A

Bilateral sciatica
Saddle anaesthesia
Urinary dysfunction

Medical emergency
Requires urgent MRI, emergency lumbar discectomy

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14
Q

What is cervical sponylosis? What are the symptoms and management?

A

Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression

Myelopathy and/or radiculopathy
Onset months-years

Conservative if no/mild myelopathy
Surgery for progressive moderate to severe myelopathy

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15
Q

Symptoms/management of Lumbar Spinal Stenosis?

A

Pain down both legs - ‘spinal claudication’

Lumbar laminectomy for treatment

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16
Q

What are the broad different types of spinal tumours?

A

Extra dural (55%)
Intradural (40%
Inframedullary (5%)

17
Q

What are the different types of extradural tumours?

A

Metastases - lung, breast, prostate

Primary bone tumours - chordoma, osteoblastoma, osteoid osteoma

18
Q

What are the different types of intradural tumours?

A

Meningioma
Neurofibroma
Lipoma

19
Q

What are the different types of intramedullary tumours?

A

Astrocytoma
Ependymoma
Teratoma
Haemangioblastoma

20
Q

What are the symptoms of spinal cord tumours? How are they managed?

A

Pain
Weakness
Sphincter disturbance

Urgent MRI if back pain
Surgical decompression
Radiotherapy

21
Q

What are the different types of spinal infections?

A

Osteomyelitis
- within vertebral body

Discitis
- infection of intervertebral disc

Epidural abscess
- in epidural space

22
Q

What are the risk factors for osteomyelitis? Management?

A 
IVDU
Diabetes
Chronic renal failure
Alcoholism
AIDS

Antibiotics or surgery if evidence of neurology

23
Q

Risk factors for epidural abscess? What are common organisms? How is it managed?

A

IVDU
Diabetes
Chronic renal failure
Alcoholism

SA, streptococcus, E coli are common

Anyone presenting with back pain, pyrexia, focal neurology needs urgent MRI
Managed with surgical decompression, long term IV antibiotics

S2.3 Neurology (18 decks)

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