Spinal pathologies Flashcards
What are the causes of Brown-Sequard syndrome?
- MS
- Cord compression (usually caused by being stabbed in the back on exam q’s)
What are the features of Brown-Sequard syndrome?
- Ipsilateral pyramidal weakness
- Ipsilateral dorsal column loss (proprioception)
- Contralateral spinothalamic loss (pain, temperature)
What are the causes of central cord compression?
- Syrinx
- Intramedullary tumour
What are the features of central cord syndrome?
- Early suspended (cape-like) pain and temperature loss with preservation of dorsal columns
- Forward extension = pyramidal weakness
- Lateral extension = ipsilateral Horner’s
What are the causes of anterior cord syndrome?
Anterior spinal artery occlusion
What are the features of anterior cord syndrome?
- Areflexic, flaccid paraparesis
- Sphincter disturbance
- Pain and temperature loss with dorsal column preservation
What are the causes of anterior horn cell syndrome?
Spinal muscular atrophy syndromes
What are the features of anterior horn cell syndrome?
- Diffuse weakness, atrophy, and fasciculations
- Reduced tone
- Sensory symptoms absent
What are the causes of combined anterior horn cell pyramidal tract syndrome?
ALS
What are the features of combined anterior horn cell pyramidal tract syndrome?
- LMN signs (fasciculations, atrophy, weakness +/- pseudobulbar)
- UMN signs (upgoing plantars, spasticity +/- bulbar)
- Preservation of sphincters
What are the causes of posterolateral column syndrome?
- Subacute combined degeneration of the spinal cord
- Friedreich’s ataxia
What are the features of posterolateral column syndrome?
- Dorsal column loss
- UMN signs (hyperreflexia, upgoing plantars, weakness)
- Preservation of pain and temperature
What are the causes of posterior column syndrome?
Tabes dorsalis (neurosyphilis)
What are the features of posterior column syndrome?
- Dorsal column loss (loss of proprioception and vibrations sensation)
- +/- lancinating pains (often lower limbs)
- +/- Lhermitte’s sign
What are the clinical features of radiculopathy at nerve root C5?
- Pain in neck, shoulder, and upper arm
- Motor weakness of deltoid, supraspinatus, and infraspinatus
- Supinator reflex abnormalities
- Sensory disturbance of shoulder and lateral arm
What are the clinical features of radiculopathy at nerve root C6?
- Pain in lateral forearm, thumb, and index finger
- Motor weakness of biceps and brachioradialis
- Biceps reflex abnormalities
- Sensory disturbance of lateral forearm, thumb, and index finger
What are the clinical features of radiculopathy at nerve root C7?
- Pain in posterior arm, dorsum, forearm, middle finger
- Motor weakness of triceps, wrist and finger extensors
- Triceps reflex abnormalities
- Sensory disturbance of posterior forearm, middle finger
What are the clinical features of radiculopathy at nerve root C8?
- Pain in shoulder, medial forearm, ring, and little fingers
- Motor weakness of thumb flexor, and intrinsic muscles of the hand
- Sensory disturbance of medial hand, ring, and little fingers
What are the causes of cauda equina syndrome?
- Herniated disc compressing L5/S1 (most common)
- Tumours
- Spondylolisthesis
- Abscess
- Trauma
What are the clinical features of cauda equina?
- Saddle anaesthesia
- Urinary retention/incontinence
- Faecal incontinence
- Asymmetric sensory loss, pain, and/or weakness in legs
- Reduced anal tone
- Hyporeflexia
What is the first-line imaging modality in suspected cauda equina?
MRI
What is the management of cauda equina syndrome?
Requires neurosurgical input for lumbar decompression surgery
What is the main difference between conus medullaris syndrome and cauda equina?
- Conus medullaris is where the spinal cord ends at ~L2, therefore in the syndrome the lesion is higher up
- Conus medullaris syndrome presents at bilateral and symmetric pattern with urinary and faecal incontinence being early symptoms
What are the clinical features of degenerative cervical myelopathy (DCM)?
- Numb, clumsy hands
- Paraesthesia in hands and feet
- Spasticity of the legs
- Bladder symptoms (late)
*Patients are often misdiagnosed with carpal tunnel syndrome before correct diagnosis is made
What is the imaging modality of choice for DCM?
MRI
What is the management of DCM?
Surgical decompression
What are the clinical features of lumbar stenosis?
- Anterior thigh pain
- Pain on standing
- Neurogenic claudication with distance
- Numbness/paraesthesia
- Improvement on bending forward
- Worse on walking down stairs
What is the imaging modality of choice for lumbar canal stenosis?
MRI
What is the management of lumbar canal stenosis?
- Conservative –> rest, analgesia, lumbar corset, physio, epidural steroid injections
- Surgery
What are the indications for surgery in lumbar canal stenosis?
- Failure of conservative measures
- Pain
- Significant motor defect
- Sphincter disturbance
What are the causes of syringomyelia?
- Cerebellar ectopia (Chiari malformation)
- Intramedullary tumours
- Trauma
What spinal tracts are typically affected in syringomyelia?
- Ventral horns
- Spinothalamic tract
What are the clinical features of syringomyelia?
- Cough and positional headache due to pathology near foramen magnum
- LMN weakness in hands and arms
- Dissociated sensory loss (cape distribution) affecting spinothalamic sensation but sparing posterior columns
- i.e. affects pain and temperature sensation
What is the imaging modality of choice in syringomyelia?
MRI brain and spine with contrast (gadolinium)
What is the management for syringomyelia?
- Surgical decompression of the foramen magnum
- Syringo- arachnoid or syringo-pleural shunt
