Spinal cord disorders

Question 1

How is the spinal cord arranged?

Answer 1

More than 19 different tracts

Ends in the cauda equina

Question 2

What is the most important descending motor tract?

Answer 2

Lateral corticospinal tract

Question 3

What is that pathway of the lateral corticospinal tract?

Answer 3

Begins in cerebral cortex, decussates in pyramids of lower medulla (medulla oblongata) and travels down contralateral side of spinal cord

Question 4

What are the most important ascending sensory tracts?

Answer 4

Fasciculus gracilis
Fasciculus cuneatus
Lateral spinothalamic
Anterior spinothalamic

Question 5

What is the function of the fasciculus gracilis?

Answer 5

Transmits vibration, conscious proprioception, and fine touch sensations from lower body

Question 6

What is the function of the fasciculus cuneatus?

Answer 6

Carries tactile and proprioceptive information for upper limbs and torso

Question 7

What is the function of the lateral spinothalamic tract?

Answer 7

Carries information about pain and temperature

Question 8

What is the function of the anterior spinothalamic tract?

Answer 8

Carries information about touch and pressure

Question 9

What makes up the dorsal column?

Answer 9

Fasciculus gracilis and fasciculus cuneatus

Question 10

Where does the dorsal column decussate?

Answer 10

In the medulla

Question 11

Where does the anterior spinothalamic tract decussate?

Answer 11

Crosses over at level of the spinal cord

Question 12

Where does the lateral spinothalamic tract decussate?

Answer 12

At the level of the spinal cord

Question 13

What artery is the biggest source of blood supply in the spinal cord?

Answer 13

Anterior spinal artery

Supplies 2/3

Question 14

What are the 11 ways of classifying spinal cord disorders?

Answer 14

1. Traumatic - whiplash, gunshot, stab, haematoma
2. Degenerative disc disease - cervical/lumbar spondylosis, spinal canal stenosis
3. Inflammatory - MS, transverse myelitis, NMO
4. Neoplastic - intrinsic/extrinsic
5. Infective, HIV, HTLV, abscess, empyema
6. Vascular - ASA occlusion, spinal dural fistula, vasculitis
7. Granulomatous - sarcoidosis
8. Metabolic - vit B12 deficiency
9. Hereditary - hereditary spastic paraplegia, Fredrich’s ataxia
10. Other neurodegenerative - ALS
11. Other - syringomyelia

Question 15

Give an example of an intrinsic spinal cord tumour

Answer 15

Ependymoma

Question 16

Give an example of an extrinsic spinal cord tumour

Answer 16

Meningioma

Metastatic lymphoma

Question 17

What acute/subacute conditions are spinal cord emergencies?

Answer 17

Bladder/bowel weakness
Saddle anaesthesia
Leg weakness
Constant sensory deficit
Significant pain

Question 18

How do you assess spinal cord problems?

Answer 18

Acute imagine of spine

MRI

Question 19

What investigations do you do in a traumatic spinal cord issue?

Answer 19

MRI

Question 20

What investigations do you do in degenerative disc disease?

Answer 20

MRI

CT

Question 21

What investigations do you do in inflammatory spinal problems?

Answer 21

MRI spine and brain with contrast

LP - OCB and cells

Question 22

What investigations do you do in neoplastic spinal problems?

Answer 22

MRI with contrast

Question 23

What investigations do you do in vascular spinal problems?

Answer 23

MRI
Angiography
Vasculitis screen

Question 24

What investigations do you do in granulomatous spinal problems?

Answer 24

Serum ACE level
MRI
CXR

Question 25

What investigations do you do in metabolic spinal problems?

Answer 25

B12/folate MMA Fasting homocysteine levels

Question 26

What investigations do you do in hereditary spinal problems?

Answer 26

Genetic panel

Question 27

What investigations do you do in neurodegenerative conditions?

Answer 27

EMG | Genetics

Question 28

What are the common causes of a dorsal column lesion?

Answer 28

MS Penetrating injuries Compression from tumours

Question 29

What will you lose in a dorsal column lesion?

Answer 29

Ipsilateral loss of light touch, vibration, proprioception generalised below level of lesion

Question 30

What are the common causes of a fasciculus cuneatus lesion?

Answer 30

MS Penetrating injuries Compression from tumours

Question 31

What will you lose in a fasciculus cuneatus lesion?

Answer 31

Ipsilateral loss of light touch, vibration and proprioception below lesion

Question 32

What are the common causes of lateral corticospinal tract lesions?

Answer 32

Penetrating injuries Lateral compression from tumours MS

Question 33

What will you lose in a lateral corticospinal tract lesion?

Answer 33

Ipsilateral UMN signs - spastic paralysis, hyperreflexia, babinski, clonus, hypertonia generalised below lesion

Question 34

What are the common causes of lateral spinothalamic tract lesions?

Answer 34

MS Penetrating injuries Compression from tumours

Question 35

What will you lose in a lateral spinothalamic tract lesion?

Answer 35

Contralateral loss of pain and temperature

Question 36

What are the common causes of a lesion of the anterior grey and white commissures?

Answer 36

Post-traumatic contusion Syringomyelia Intrinsic spinal cord tumours

Question 37

What will you lose in a lesion of the anterior grey and white commisures?

Answer 37

Pain and temperature sensation impaired bilaterally

Question 38

What is central cord syndrome?

Answer 38

Lesion of anterior grey and white matter commisures

Question 39

What are the common causes of brown sequard syndrome?

Answer 39

Penetrating injuries Lateral compression from tumours MS

Question 40

What lesions will you get in Brown-Sequard syndrome?

Answer 40

Dorsal column Lateral corticospinal tracts Lateral spinothalamic tracts

Question 41

What will you lose in Brown-Sequard syndrome?

Answer 41

Ipilateral loss of light touch, vibration, proprioception, UMN signs Contralateral loss of pain and temperature

Question 42

What lesions will you get in a transverse cord lesion?

Answer 42

Doral column Lateral corticospinal Lateral spinothalamic

Question 43

What will you lose in a transverse cord lesion?

Answer 43

Bilateral loss of light touch, vibration, proprioception Bilateral UMN signs Bilateral loss of pain and temperature

Question 44

What are the common causes of transverse cord lesions?

Answer 44

Trauma Tumours Transverse myelitis MS

Question 45

What is posterior cord syndrome?

Answer 45

Complete transection of dorsal columns

Question 46

What are the common causes of posterior cord syndrome?

Answer 46

Trauma Compression from posteriorly located tumours MS Vit B12 deficiency

Question 47

What will you lose in posterior cord syndrome?

Answer 47

Bilateral loss of light touch, vibration and proprioception

Question 48

What is anterior cord syndrome?

Answer 48

Complete transection of lateral corticospinal and spinothalamic tracts

Question 49

What will be the symptoms of anterior cord syndrome?

Answer 49

Bilateral UMN signs and LMN signs | Absence of pain and temperature sensation bilaterally

Question 50

What are the common causes of anterior cord syndrome?

Answer 50

Anterior spinal artery infarct Trauma MS

Question 51

What can cause a hemi-section of the cord by extra-medullary compression?

Answer 51

``` Intervertebral disc protrusion Spinal cord tumours - meningiomas Metastatic deposits Abscess Transverse myelitis MS Sarcoidosis ```

Question 52

What can cause cauda equina?

Answer 52

Compressive - discs, tumours (primary and secondary) Non-compressive - inflammatory, infiltrative, granulomatous Vascular - spinal dural fistula

Question 53

What are the signs of cauda equina?

Answer 53

SPINE - Saddle anaesthesia - Pain/paralysis - Incontinence of bladder/bowel - Numbness - Emergency

Question 54

How do you manage spinal cord disorders?

Answer 54

``` Manage cause - exclude emergencies Some are untreatable Manage complications - Weakness - B/B dysfunction - Spasticity - Pain - Pressure areas - Mobility ```