Spinal Cord Problems

Question 1

what tract is responsible for fine, precise movement

Answer 1

corticospinal

Question 2

what tract is responsible for fine touch + proprioception

Answer 2

dorsal column

Question 3

what tract is responsible for pain + temperature sensations

Answer 3

spinothalamic

Question 4

what is affected in a complete cord transection

Answer 4

all modalities

- loss of motor + sensory divisions

Question 5

what initially happens after complete cord transection

Answer 5

“spinal shock” – flaccid areflexic paralysis

- loss of tone, loss of reflexes

Question 6

later symptoms of complete cord transection

Answer 6

UMN signs

• increased tone
• spasticity
• hyperreflexia

Question 7

what is Brown Sequard syndrome

Answer 7

cord hemisection

Question 8

symptoms of Brown Sequard syndrome

Answer 8

ipsilateral paralysis
ipsilateral loss of proprioception + fine touch
contralateral loss of pain + temperature sensation

Question 9

what causes central cord syndrome

Answer 9

hyperextension / flexion injury to an already stenotic spine

Question 10

presentation of central cord syndrome

Answer 10

bilateral arm weakness

cape like spinothalamic sensory loss

Question 11

presentation of anterior cord syndrome

Answer 11

bilateral weakness + loss of pain + temperature sensation

- spares Dorsal column

Question 12

presentation of posterior cord syndrome

Answer 12

only affects dorsal column – loss of fine touch + proprioception

Question 13

what is spinal stenosis

Answer 13

narrowing of the spinal canal due to spinal degeneration

Question 14

causes of spinal stenosis

Answer 14

osteophyte formation
bulging of intervertebral disks
facet joint hypertrophy
subluxation

Question 15

symptoms of spinal stenosis

Answer 15

neurogenic claudication

• leg pain on exertion
• improved with walking uphill

gradual bilateral leg weakness

Question 16

what is syringomyelia

Answer 16

cyst formation in the spinal cord

Question 17

what causes syringomyelia?

what age does it present?

Answer 17

blocked CSF circulation
- Arnold-Chiari malformation predisposes
mean age of 30

Question 18

symptoms of syringomyelia

Answer 18

slowly progressive spinothalamic sensory loss (pain + temp)

wasting / weakness of arms

Question 19

what is spondylosis

Answer 19

loss of water from nucleus pulposis of disc

Question 20

what is sciatica

Answer 20

compression of sciatic nerve roots (L4-S3)

Question 21

symptoms of sciatica

Answer 21

unilateral buttock + leg pain that radiates to foot

• sharp / shooting pain
• worse with straight leg raise ‘sciatic stretch test’

numbness + parasthesia

Question 22

presentation of degenerative cervical myelopathy

Answer 22

pain in neck/ upper/lower limbs
loss of motor function – dexterity problems, arm/leg weakness, gait abnormality, balance problems
loss of sensory function – numbness
loss of autonomic function

Question 23

investigation for degenerative cervical myelopathy

Answer 23

MRI

Question 24

treatment of degenerative cervical myelopathy

Answer 24

surgical decompression

- urgent referral to spinal/neuro surgery