Spinal Cord Pathologies

Question 1

Progressive Spastic Paraparesis - Clinical features

Answer 1

Can be acute or subacute

• Bilateral weakness
• Marked Spasticity
• Affecting lower limbs
• Extensor plantar response

Question 2

What are the causes of Progressive Spastic Paraparesis

Answer 2

• B12 deficiency (SACD)
• Copper deficiency
• Cervical Spondylotic myelopathy
• Hereditary
• MND
• Primary Progressive MS

Question 3

What additional clinical features does PSP caused by B12 deficiency have

Answer 3

• Peripheral neuropathy

- Dorsal column dysfunction (high stepping gait)

Question 4

What is the diagnostic investigation for Progressive Spastic Paraparesis

Answer 4

MRI

Question 5

Transverse Myelitis - Clinical Features

Answer 5

• Similar to cord compression
• Acute weakness
• Ascending sensory level

Question 6

What are some causes of Transverse myelitis

Answer 6

• Post infection
• Parainfectious complications (mycoplasma etc)
• First presentation of MS

Question 7

What are the clinical features of anterior spinal artery thrombosis

Answer 7

• Flaccid paraparesis
• Loss of bladder function
• Preserved dorsal column
  (fine touch, vibration, proprioception)

Question 8

How do you manage anterior spinal artery thrombosis

Answer 8

• No treatment

- Recovery poor

Question 9

Where are disc prolapses the most common

Answer 9

L4/L5 + L5/S1

Question 10

What signs are associated with disc prolapse

Answer 10

• Reduced straight leg raised

- Diminished reflexes

Question 11

Disc Prolapse - Management

Answer 11

Can require laminectomy

Question 12

What is the pathophysiology of syringomyelia

Answer 12

• Cervical cord enlarges into large fluid-filled cavity
• Due to raised ICP causing mild herniation of tonsils
• Causes damage to local structures

Question 13

What are the clinical features of syringomyelia + relate them to the structures damaged

Answer 13

Damage to spinothalamic tract

• loss of pain + temperature sensation
• acute, severe pain

Damage to corticospinal tract
- Spastic weakness

Damage to anterior horn cells
- muscle wasting

Question 14

Syringomyelia - Investigations

Answer 14

MRI

Question 15

Syringomyelia - Management

Answer 15

May require surgical drainage

Question 16

What causes Spinal shock

Answer 16

• Transection of spinal cord at cervical/upper thoracic level
• Leads to loss of autonomic vasomotor control

Question 17

What is the management of Spinal Shock

Answer 17

Substantial Fluid replacement