Spinal Cord Lesions

Question 1

What are motor descending pyramidal tract
- Pass through pyramid of medulla

What is pattern of weakness

Answer 1

Anterior and Lateral corticospinal = 90%
Also corticobulbar

Extensor weaker in arms and flexor in legs

UMN originate at either motor cortex or brain stem nuclei
Travel to anterior horn cell in spinal cord at target level

Question 2

What are extra pyramidal motor tracks

- Don’t pass through pyramid

Answer 2

Rubrospinal
Reticulospinal
Vestibulospinal

Question 3

What are sensory descending tracts in dorsal column

Answer 3

Gracile fasiculus

Cuneate fasicullus

Question 4

Sensory spinocerebelllar

Answer 4

Anterior

Posterior

Question 5

Sensory spinothalamic

Answer 5

Anterolteral tract
Lateral
Anterior

Question 6

What causes pure motor signs

Answer 6

MND

Poliomyelitis

Question 7

How does motor neurone present

Answer 7

Corticospinal tracts

UMN and LMN signs

Question 8

What does poliomyelitis affect

Answer 8

Anterior horn cell

LMN signs

Question 9

How can sensory present

Answer 9

Dorsal column

Spinothalamic

Question 10

If spinothalamic affected what are the signs

Answer 10

Loss of pain, temp and sensation

Question 11

If dorsal column affected what are the signs

Answer 11

Loss of proprioception and vibration

Question 12

What affects dorsal

Answer 12

Tabes dorsalis - late consequence of syphillis
SACD
Spinal cord infarction

Question 13

What happens if spinothalamic lesion

Answer 13

Loss of pain, temp and sensation

Question 14

What causes combined UMN and LMN signs

Fred
Tabby
Cat 
Seeks 
Mice

Answer 14

Fredreich ataxia
Tabes dorsalis (syphillis) 
Cervical + lumbar spondylosis
SACD- B12
Motor neurone disease 

Alnord chiari malformato / syndomyelia

Question 15

What is Brown Squared

Answer 15

Spinal cord hemisection

Question 16

What tracts are affected

Answer 16

Lateral corticospinal
Dorsal
Lateral Spinothalamic

Question 17

What does it lead too

Answer 17

Ipsilateral spastic paralysis below lesion (corticospinal) + UMN signs
Ipsilateral loss of proprioception and vibration (dorsal)
Ipsilateral sensory loss
Contralateral loss of pain and temp (spinothalamic)

Question 18

What does cord compression lead too

Answer 18

UMN signs

Question 19

What can cause

Answer 19

Malignancy
Haematoma
Fracture

Question 20

What causes subacute combined degeneration of spinal cord (SCAD)

Answer 20

B12 / thiamine deficiency

• Pernicious - Ab against intrinsic factor
• Chron’s
• Gastrectomy

Question 21

What tracts are affected

Answer 21

Lateral corticospinal
Dorsal
Spinocerebellar

Question 22

What does it cause

Answer 22

Bilateral spastic paralysis
Bilateral loss of proprioception and vibration - usually first
Distal paraesthesia after
Bilateral limb ataxia
UMN and LMN signs in leg - extensor plantar / absent knee / absent ankle reflex (hyporeflexia)
Painess urine retention
Pain and temp often remain intact

Question 23

What does Fredreich’s ataxia cause

Answer 23

Same as above

Also cerebellar ataxia signs

Question 24

What is syringomyelia

Answer 24

Collection of cerebrospinal fluid in spinal cord

Symptoms may be static for years but worsen fast e.g. on coughing or sneezing

Question 25

What can cause

Answer 25

Tumour Trauma Arnold Chiari malformation

Question 26

What tracts are affected

Answer 26

Antero-Lateral spinothalamic as fluid in middle of cor where this tract passes

Question 27

What does it cause

Answer 27

``` Progressive slow neuro signs Flaccid paralysis (typically hand) Loss of pain and temp but preserved touch / vibration Wasting and weakness of hands Cape like distribution Paraesthesia Hyporeflexia Neuropathic pain Upgoing plantar Bladder. / bowel Horner due to compression of sympathetic but rare ```

Question 28

What is classic presentation

Answer 28

Burning hand without realising

Question 29

What happens if not Rx

Answer 29

Scoliosis

Question 30

How do you Dx

Answer 30

Spine MRI for tumour | Brain MRI for CHairi

Question 31

How do you Rx

Answer 31

Treat cause | Shunt

Question 32

How does MS present

Answer 32

Asymmetrical combination of motor, sensory and ataxia signs

Question 33

What tracts affecting in anterior spinal artery occlusion

Answer 33

Lateral corticospinal | Lateral spinothalamic

Question 34

What does it cause

Answer 34

Bilateral spastic paresis | Bilateral loss of pain and temp

Question 35

What is Alnord Chiari malformation

Answer 35

Downward displacement of cerebral tonsil through foramen magnum Congenital Trauam

Question 36

What does it cause

Answer 36

Synrigmyelia Non-communicating hydrocephalus Headache

Question 37

What is Fredreich's ataxia

Answer 37

AR trinucleotide disorder that causes spinocerebellar degeneration Anticipation

Question 38

How does it present

Answer 38

Present teens UMN and LMN signs e.g. absent ankle jerk + extensor plantar + Ataxia ``` Other Kyphoscolisosis Optic atrophy HOCM DM Associated with WPW ```

Question 39

What is Telangiectasia ataxia

Answer 39

AR defect in gene for DNA repair + immunodeficiency

Question 40

What does it cause

Answer 40

``` Early childhood Abnormal movement Ataxia Telangiectasia IgA deficient so recurrent infection ```

Question 41

What is Leg term risk

Answer 41

Leukaemia