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2a neuro > Spinal cord pathology - myelopathy + cauda equina + sciatica > Flashcards

Spinal cord pathology - myelopathy + cauda equina + sciatica Flashcards

1
Q

What is myelopathy?

A

Spinal cord compression

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2
Q

What spinal cord levels makes the spinal cord?

A

C1 -> L1/2

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3
Q

What is the cauda equina?

A

L3 –> conus medullaris and cauda equina (lumbar and sacral nerve roots)

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4
Q

What are the 2 types of paralysis and what do they indicate?

A
  • Hemiplegia: one side of body (brain lesion)
  • Paraplegia: both legs (cord lesion)
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5
Q

What are the main tracts?

A

DCML
Spinothalamic
Corticospinal

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6
Q

Which tracts are sensory?

A

DCML
Spinothalamic

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7
Q

Which tract is motor?

A

Corticospinal

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8
Q

What type of tract is DCML?

A

Ascending
Dorsal root –> medulla then decussates

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9
Q

What is DCML responsible for?

A

Fine touch
2 point discrimination
Proprioception

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10
Q

What type of tract is spinothalamic

A

Ascending
Decussates 1-2 spinal levels above dorsal entry

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11
Q

What is spinothalamic tract responsible for?

A

Pain and temp

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12
Q

What type of tract is corticospinal?

A

Descending UMN
Decussates at medulla –> ventral root

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13
Q

Do sensory spinal cord lesions show ipsilateral or contralateral signs?

A

Ipsilateral

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14
Q

Do motor spinal cord lesions show ipsilateral or contralateral signs?

A

Contralateral

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15
Q

What spinal cord level is the knee jerk?

A

L3/4

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16
Q

Which spinal cord level is the big toe jerk?

A

L5

17
Q

Which spinal cord level is the ankle jerk?

A

S1

18
Q

Define myelopathy/spinal cord compression

A

Compression of C1-L1/2

19
Q

What are causes of spinal cord compression?

A
  • Vertebral body neoplasms (main cause- metastases from lung, breast, RCC, melanoma)
  • Spinal pathology (eg disc prolapse/herniation)
20
Q

What are symptoms of spinal cord compression?

A
  • Progressive leg weakness w/ UMN signs:
  • eg contralateral hyperreflexia, Babuski +ve, spasticity
  • Sensory loss BELOW lesion (ascending sends info up)
  • Sphincter involvement uncommon (late very bad sign)
21
Q

What investigations do you do for spinal cord compression?

A

MRI of spinal cord ASAP (risk of permanent damage if not)
CXR if malignancy suspected

22
Q

How do you treat spinal cord compression?

A

Neurosurgery (laminectomy, microdiscectomy)

23
Q

Define cauda equina syndrome

A
  • Compression below conus medullaris
24
Q

Describe the pathophysiology of cauda equina syndrome

A
  • surgical emergency where the nerve roots of the cauda equina at the bottom of the spine are compressed
  • The cauda equina is a collection of nerve roots that travel through the spinal canal after the spinal cord terminates around L2/L3
25
Q

What are causes of cauda equina syndrome?

A

→ Herniated disc - most common (occurs in 2% lumbar herniation)
→ tumours - mets
→ spondylolisthesis - anterior displacement of vertebra out of line with one below
→ Abscess infection
→ trauma

26
Q

What are the signs and symptoms for cauda equina syndrome?

A

→ Bilateral or severe motor weakness in the legs w/ LMN signs (ipsilateral hypotonia, fasciculations, hyporeflexia)
→Saddle anaesthesia (loss of sensation in the perineum – around the genitals and anus)
→ Loss of sensation in the bladder and rectum (not knowing when they are full) + sphincter involvement common
→ Urinary retention or incontinence
→ Faecal incontinence
→ Bilateral sciatica
→ Reduced anal tone on PR examination

27
Q

What investigations do you do for cauda equina syndrome?

A

MRI cord (diagnostic)
Testing nerve roots/reflexes

28
Q

How do you treat cauda equina syndrome?

A
  • Neurosurgery ASAP (eg. microdiscectomy, spinal fixation, spinal cord decompression)
  • Immobilise spine
29
Q

What is sciatica?

A
  • L5/S1 lesion due to spinal or non spinal causes
30
Q

What is a spinal cause of sciatica?

A

IV disc herniation/prolapse

31
Q

What are non spinal causes of sciatica?

A

Piriformis syndrome, tumours, pregnancy

32
Q

What are symptoms of sciatica?

A
  • Pain from buttock down lateral leg –> pinky toe
  • Weak plantarflexion + absent ankle jerk
33
Q

How do you diagnose sciatica?

A

Exam: can’t do straight leg raise test without pain

34
Q

What investigations do you do for sciatica?

A

MRI

35
Q

How do you treat sciatica?

A

Analgesia + physiotherapy
Neurosurgery

2a neuro (33 decks)

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