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Neurology- Clinical > Spinal Disorders > Flashcards

Spinal Disorders Flashcards

1
Q

What are some causes of acute spinal cord compression?

A

Trauma

Tumours

Haemorrhage

Infection

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2
Q

What are some causes of chronic spinal cord compression?

A

Degenerative disease e.g. spondylosis

Tumours

Rheumatoid arthritis

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3
Q

What happens in complete spinal cord injury?

A

Complete loss of function from the affected level downwards

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4
Q

What will complete spinal cord injury cause initially?

What may appear later?

A

A flaccid, arreflexic paralysis known as spinal shock

UMN signs

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5
Q

Describe what pattern of deficits are seen in Brown Sequard syndrome?

A

Ipsilateral loss of motor function

Ipsilateral loss of light touch, vibration and proprioception sensation (dorsal columns)

Contralateral loss of pain and temperature sensation (spinothalamic)

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6
Q

In all spinal injuries which cause dysfunction of motor control - what pattern does this follow?

A

LMN weakness at the level of the lesion

UMN weakness below the level of the lesion

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7
Q

What is usually the cause of a central cord injury?

A

A hyperflexion or extension injury to an already stenotic neck

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8
Q

What happens in central cord syndrome?

A

Bilateral weeakness predominantly in the distal upper limbs

‘Cape like’ spinothalamic (pain and temperature) sensory loss

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9
Q

What is the classic cause of anterior cord injury?

What does this cause?

A

Vascular ischaemic stroke

Bilateral loss of pain and temperature sensation below the level of the lesion

Bilateral loss of motor function

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10
Q

What happens in posterior cord injuries?

A

Bilateral loss of light touch, proprioception and vibration sensation below the level of the lesion

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11
Q

Describe LMN weakness?

Describe UMN weakness?

A

‘Flaccid’ - reduced tone and reflexes

‘Spastic’ - increased tone and reflexes, clonus

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12
Q

What is the purpose of treatment for spinal cord compression?

What are the main steps of management?

A

To prevent further deterioration (does not usually improve things)

Immobilise

Investigation (x-ray/CT/MRI)

Decompress and stabilise surgically

? methyloprednisolone

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13
Q

What is spondylosis?

What is the most common type? What can this lead to?

A

A non-specific term for osteoarthritis or degenerative change affecting the spine

Cervical spondylosis - the most common cause of cervical myelopathy

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14
Q

Narrowing of the spinal canal above the level of L1 due to spondylosis causes what?

Narrowing of the spinal canal below the level of L1 due to spondylosis causes what?

A

Features of myelopathy and/or radiculopathy

Features of radiculopathy, or if the nerve roots responsible for bladder/bowel function are affected - cauda equina syndrome

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15
Q

What is radiculopathy?

What is the most common cause of this?

A

An abnormality which compresses or impinges on a spinal nerve root

A disc prolapse affecting either the lumbar or cervical spine

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16
Q

Describe the general presentation of radiculopathy?

A

LMN weakness affecting the specific myotome

Sensory loss in all modalities affecting the specific dermatome

17
Q

Radiculopathy can cause pain in the area of skin/muscle supplied by that particular nerve root, how is this often described?

What can make it worse?

What is the typical pattern of pain in cervical radiculopathy?

What is the typical pattern of pain in lumbar radiculopathy?

A

Sharp, shooting, burning

Coughing, straining or movement

Neck pain which radiates down the arm

Lower back pain with associated sciatica

18
Q

What is the primary investigation for most spinal problems and what is the purpose of this?

If that didn’t show anything, what would be the next line investigation?

A

MRI - to look for a compressive lesion

Nerve conduction studies

19
Q

What are some treatment options for radiculopathy?

A

Physiotherapy and pain management (NSAIDs/neuropthic painkillers)

Surgery - only used last line, must weigh up risks and benefits

(Remember there is no difference in outcome after 1-2 years)

20
Q

What is the most common cause of cervical myelopathy?

What is the onset like?

Does myelopathy cause unilateral or bilateral symptoms?

Why is this more severe than radiculopathy?

A

Cervical spondylosis

Slow and insidious

Bilateral

The symptoms are irreversible

21
Q

Describe the general presentation of myelopathy?

What is a sign that is almost pathognomonic of cervical myelopathy?

A

LMN features at the level of the lesion

UMN features below the level of the lesion

Generalised hyper-reflexia, especially in the lower limbs

22
Q

What are some pathological reflexes which may be seen in cervical myelopathy?

A

Babinski’s sign (upgoing plantars)

Hoffman’s sign (flick the middle finger causes flexion and adduction of the thumb)

Clonus

23
Q

What is Lhermitte’s sign, which may be seen in cervical myelopathy but also other pathologies?

When does it occur?

A

An uncomfortable electrical sensation which runs down their back and into the limbs

On certain head movements

24
Q

If a patient has a compressive lesion causing cervical myelopathy, what is the management and why?

A

Decompressive surgery - doesn’t make it better but will prevent it getting worse

25
Q

Describe briefly the neurological presentation which is seen in cauda equina syndrome?

A

LMN pattern of weakness affecting the most distal muscles of the leg

Decreased sensation in all sensory modalities of areas supplied by sacral nerve roots - ‘saddle anaesthesia’

Bladder and bowel abnormalities (due to disruption of sacral autonomic fibres)

26
Q

What is the management of cauda equina syndrome?

A

Urgent MRI and decompressive surgery as soon as possible, ideally within 24 hours

27
Q

What is lumbar spinal stenosis?

Who is it generally seen in?

What can it lead to?

A

Narrowing of the central spinal canal

People aged > 50

Spinal claudication

28
Q

What is failed back syndrome?

What are some risk factors for this?

A

People who still complain of neck or back pain following spinal surgery

Diabetes, smoking, high BMI, depression/anxiety

29
Q

What is syringomyelia?

When does this present?

In which segment of the spinal cord is it most common?

What are some clinical risk factors for this?

What are some treatment options?

A

A rare condition in which a cyst forms in the spinal cord

Often in the 30s, but can range from childhood-seventies

Cervical

Traumatic paraplagia (spinal trauma) or Chiari malformations

Surgery or shunting, depending on the cause

30
Q

What are the main neurological clinical features of syringomyelia?

A

LMN features at the level of the lesion (often most pronounced distally)

Loss of pain and temperature sensation in the arms

UMN signs below the level of the lesion

Excessive sweating

Neurology- Clinical (31 decks)

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