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Neuro block 2 > spinal cord dysfunction. stuff I forget > Flashcards

spinal cord dysfunction. stuff I forget Flashcards

1
Q

causes of spinal cord dysfunction in pts w/ cancer:

  1. epidural cord compression? (3 HAT)
  2. intramedullary? (4 HAMS)
  3. other myelopathies: (3- CPR)
  4. 2 more causes(AM itis)
A
  1. epidural: H-hematoma, A- abscess, T-tumor
  2. intramedullary- HAMS- H- hematoma, A-absces, M-mets, S-syrinx
  3. other: CPR- chemotherapy, paraneoplastic, radiation
  4. AM itis - spinal arachnoiditi, neoplastic meningitis.
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2
Q

epidural myelopathy often due to ______.

what are the 3 most common etiologies?

what happens w/cancer?

A

metastatic cancer

: lung, breat, prostate

cancer enters vertebral bodies –> weakens it–> expands–> compresses cord

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3
Q

what to do if suspicious of spinal cord compression?(3 steps here)

A
  1. tx w/steroids first (dexamethasone)
  2. spinal MRI w/gadolinium
  3. follow pt slowly
  4. neurosurgery consult.
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4
Q

when is a spinal tap required in a cancer pt w/back pain(esp in thoracic region)?

A
  1. spinal tap reuired if NO EVIDENCE of cord compression by imaging techniques
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5
Q

infections of spinal cord can –>spinal cord compresssion.

order.

MC cause of infectious spondylitis?

A

S. Aureus (usually hematogenous)

diff in kids: disc space –> vertebrae

adults: subchondral vertebral body –> disc space

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6
Q

most metastastic cancer begins in _______

most spinal abscess begin in_________

MC patient with spnal abscess?

A

cancer: vertebral body
abscess: disc space

MC pt = IV drug user w/staph aureus infection. MRI = choice test.

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7
Q

fever, pain on percussion, elevated white count, elevated ESR with risk factors of: IV drug use, HIV immunosuppression are indiciative of?

A

epidural abscess

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8
Q

what is an infection of the vertebral bodies that causes following:

weakness fo bones —> collapse of vertebral body–> subsequent cord compression

A

osteomyelitis

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9
Q

what presetns as

X-ray: destruction of disc space and adjacent end plates of vertebrae

CT scan: paraspinous abscess in addition to bony destruction

kyphposis

_red rods of CSF (Ziehl-Neelsen stain) _

A

TB- Pott’s disease

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10
Q

what presents as:

2nd most cancer of spinal tumor

middle-aged woman w/thoracic spine tumor that is intramedullary and extramedullary bone ersion, lesion that is isointencse w/cord on T1 and T2WI, moderate contrast enchancement +/- dural tail.

A

spinal meningioma

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11
Q

dumbell shaped extramedullary + intramedullary tumor in middle aged adult

A

schwannnoma and neurofibroma

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12
Q

lesion that MC presents as central cord syndrome?

A

syrninx

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13
Q

tumor of spinal cord w/multisegmental enlargement.

A

spinal cord astrocytoma

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14
Q

3 vascular disease of spinal cord?

A

Aneurysm

AVM

infarct much less common in brain

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15
Q

vascular supply of spinal cord?

how may arteries?

which arteries supplies 70% of cord?

where is water shed zone?

A

one anterior, two posterior arteries

Anterior spinal artery of ADAMKIEWITZ supplies 70% of cord

“water shed zone” at peripheray of central gray matter

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16
Q

describe how lesion to artery of Adamkiewicz(great radicular artery presents)

A

provides blood to ant 2/3 of cord. lesion = xSpinothalamic tract(lost pain and temp), xCST (weakness), but INTACT posterior column function(vibration and position sense)

17
Q

what are two acute non-compressive myelopathies

A

transverse myelitis

Nueromyelitis optica

18
Q

what are the acute(4) and chronic symptoms of spinal cord transection

A

ACUTE = SPINAL SHOCK

ACUTE = 1. flaccid paralysis

  1. complete sensory level to ALL MODALITIES
  2. loss of bladder, bowel, and sexual function
  3. Autonomic malfunction.

CHRONIC = NO SHOCK; spastic paralysis w/symp of acute.

19
Q

what is described by following:

  1. rare-stab wound: sometimes seen in myelitis
  2. on side of lesion: ipislateral spastic paralysis(after spinal shock) below level of lesion
  3. HYPER-reflexia and Babinski signs (xCST)
  4. Ispilateral loss of vibration and position sense (xposterior columns)
  5. _contralateral loss of pain and temp _
A

Brown-sequard hemi-section syndrome.

20
Q

Spastic weakness of lower extremeities

decreased sensation to vibration and positiion

ROMBERG SIGN

non-cerebellar ataxia

BABINSKI and HYPERREFLEXIA

May also cause peripheral neurpathy (mixed signs)

A

subacute cominbed degeneration of spinal cord (eg due to B12 def- pernicious anemia)

B12 def will present as subacute cominbed with invovlement of CORTICOTSPINAL and POSTERIOR COLUMN + dementia and peripheral neuropathy

21
Q

how do you tx B12 def?

A

IM vit B12 injection

22
Q

what presents as following:

  1. develop parapersis
  2. CNS infiltrated by monocytes
  3. CNS demyelination and axonal degeneration (CST>>>POSTERIOR COLUMN)
  4. CSF shows oligoclonal bands and IgG
A

HTLV-1 associated myelopathy/tropical spastic paraparesis

CD4+ T lymphocytes reserviour

23
Q

what presents as following:

neurologic complication of late AIDs

progressive spastic parapareis - hyperreflexia, extensor plantar responses

sensory ataxia and incontinence

resembles B12 def

A

vacuolar myelopathy associated with late AIDS

get vacuolation and myelin pallor (post and lateral columns)

24
Q
  1. what causes tabes dorsalis?
  2. what part of spina cord affected?
  3. what sign is positive
A
  1. complication of neurosyphillis
  2. posterior column dysfunction
  3. loss of vibration and joint position sense
  4. ROMBERG sign
25
Q

top ten things:

  1. _______ = neurologic emergency
  2. spinal cords ends at ______
  3. back pain in whom is emergency?
  4. what can progress quickly?
  5. do not delay what type of testing?
  6. ask pt what?
  7. what do you need to percuss?
  8. what tx is ndicated in acute myelopathies?
  9. what should you make pt do?
  10. remember basic neuro anatomy
A
  1. acute myelopathy = emergency
  2. L1/L2
  3. cancer pt.
  4. myelopathies
  5. neuroradiologic
  6. where it hurts
  7. vertebral column
  8. STEROIDS
  9. WALK

Neuro block 2 (9 decks)

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