Spinal cord pathologies

Question 1

Brown Sequard syndrome
1) This is also known as what?
2) What are the 3 spinal cord tracts damaged in this condition
3) Name a way this condition present

Answer 1

1) Spinal cord hemisection
2) Dorsal columns, lateral spinothalamic and lateral corticospinal tracts
3) Ipsilateral spastic paresis below lesion, ipsilateral loss of proprioception and vibration sensation, contralateral loss of pain and temperature sensation

Question 2

Subacute combined degeneration of the spinal cord
1) What is it caused by?
2) Name 1 of the 3 things that this results in

Answer 2

1) Vit B12 deficiency
2) Peripheral sensory neuropathy, UMN signs and LMN signs

Question 3

Syringomyelia
1) What happens in this condition?
2) Most causes are associated with what?
3) Name 2 features/symptoms

Answer 3

1) CSF filled cyst (called a syrinx) forms within the spinal cord
2) Chiari malformation
3) Spastic weakness (mainly lower limb), neuropathic pain, Horner’s syndrome, loss of sensation to temperature and pain in trunk and arms but preservation of light touch, vibration and proprioception

Question 4

What is Arnold-Chiari malformation?

Answer 4

Downward displacement, or herniation, of the cerebellar tonsils through the foramen magnum

Question 5

Cauda equina syndrome (CES)
1) What happens in CES?
2) What is the commonest cause?
3) Name another cause
4) Name 2 possible features of CES

Answer 5

1) Lumbosacral nerve roots that extend below the spinal cord are compressed
2) Central disc prolapse (L4/5 or L5/S1)
3) Tumours, infection i.e. abscess, trauma, haematoma
4) Lower back pain, bilateral sciatica, reduced sensation/pins-and-needles in the perianal area, decreased anal tone, urinary dysfunction

Question 6

Cervical spondylosis
1) What is cervical spondylosis?
2) Name 2 clinical features
3) Name a cause

Answer 6

1) General term for age-related wear and tear of the spinal disks in your neck resulting in spinal nerve root compression
2) Neck pain, crepitus on moving neck, radiculopathy - pain/electrical sensation in arms or fingers at the level of compression
3) Nerve root neurofibroma, MS, tumours, subacute combined degeneration of the spinal cord

Question 7

1) How can degenerative cervical myelopathy present?
2) What is Hoffman’s sign?
3) What is the gold standard diagnosis?
4) What should happen to all patients diagnosed with degenerative cervical myelopathy, and why?
5) What is currently the only effective management?

Answer 7

1) Any combination of motor, sensory or autonomic dysfunction. Often carpal tunnel syndrome is incorrectly diagnosed
2) Reflex to test for cervical myelopathy - flicking patients finger, positive result = reflex twitching of other fingers on same hand
3) MRI of cervical spine
4) Urgent referral to spinal specialist service
5) Decompressive surgery