Spinal cord syndromes

Question 1

Neurological presentation of poliomyelitis

Answer 1

affects anterior horns resulting in lower motor neuron signs

Question 2

Presentation of brown-sequard syndrome

Answer 2

1. Ipsilateral spastic paresis below lesion
2. Ipsilateral loss of proprioception and vibration sensation
3. Contralateral loss of pain and temperature sensation

Question 3

Tracts affected in brown sequard syndrome

Answer 3

1. Lateral corticospinal tract
2. Dorsal columns
3. Lateral spinothalamic tract

Question 4

Tracts affected by subacute degeneration of spinal cord secondary to vitamin b12 and E deficiency

Answer 4

1. Lateral corticospinal tracts
2. Dorsal columns
3. Spinocerebellar tracts

Question 5

Presentation of subacute degeneration of spinal cord secondary to vitamin b12 and E deficiency

Answer 5

1. Bilateral spastic paresis
2. Bilateral loss of proprioception and vibration sensation
3. Bilateral limb ataxia

Question 6

Presentation of dorsal column lesions

Answer 6

Loss vibration and proprioception

Tabes dorsalis, SACD

Question 7

Presentation of spinothalamic tract lesions

Answer 7

Loss of pain, sensation and temperature

Question 8

Presentation of central cord lesions

Answer 8

Flaccid paralysis of the upper limbs

Question 9

Cause of osteomyelitis in IVDU

Answer 9

Staph aureus

Question 10

Cause of osteomyelitis in immunocompromised

Answer 10

Fungal infections

Question 11

Presentation of spinal cord infarction

Answer 11

Dorsal column signs (loss of proprioception and fine discrimination

Question 12

Presentation of cord compression

Answer 12

UMN signs
Malignancy
Haematoma
Fracture

Question 13

Risk factors for degenerative cervical myelopathy(DCM)

Answer 13

Smoking
Genetics
Occupation(high axial loading)

Question 14

DCM symptoms

Answer 14

Pain
Loss of motor function
Loss of sensory function causing numbness
Loss of autonomic function

Question 15

Test to assess for degenerative cervical myelopathy

Answer 15

Hoffman’s sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient’s hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

Question 16

Treatment of cervical myelopathy

Answer 16

Decompressive surgery

Question 17

Most typical causative organism - spinal epidural abscess

Answer 17

Staphylococcus aureus

Question 18

Presentation of spinal epidural abscess

Answer 18

fever
back pain
focal neurological deficits according to the segment of the cord affected.

Question 19

What is cauda equina syndrome

Answer 19

lumbosacral nerve roots that extend below the spinal cord are compressed

Question 20

Causes of cauda equina syndrome

Answer 20

the most common cause is a central disc prolapse
this typically occurs at L4/5 or L5/S1
other causes include:
tumours: primary or metastatic
infection: abscess, discitis
trauma
haematoma

Question 21

Features of CES

Answer 21

low back pain
bilateral sciatica
reduced sensation/pins-and-needles in the perianal area
decreased anal tone
urinary dysfunction

Question 22

Mx of CES

Answer 22

surgical decompression

Question 23

What is autonomic dysreflexia

Answer 23

occurs in patients who have had a spinal cord injury at, or above T6 spinal level

Question 24

What can trigger autonomic dysreflexia

Answer 24

most commonly triggered by faecal impaction or urinary retention (but many other triggers have been reported) cause a sympathetic spinal reflex via thoracolumbar outflow

Question 25

Features of autonomic dysreflexia

Answer 25

unbalanced physiological response, characterised by extreme hypertension, flushing and sweating above the level of the cord lesion, agitation, and in untreated cases severe consequences of extreme hypertension have been reported, e.g. haemorrhagic stroke.

Question 26

Mx of autonomic dysreflexia

Answer 26

removal/control of the stimulus and treatment of any life-threatening hypertension and/or bradycardia.