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Neurology > Spinal pathologies > Flashcards

Spinal pathologies Flashcards

1
Q

What are the causes of Brown-Sequard syndrome?

A
  • MS

- Cord compression (usually caused by being stabbed in the back on exam q’s)

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2
Q

What are the features of Brown-Sequard syndrome?

A
  • Ipsilateral pyramidal weakness
  • Ipsilateral dorsal column loss (proprioception)
  • Contralateral spinothalamic loss (pain, temperature)
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3
Q

What are the causes of central cord compression?

A
  • Syrinx

- Intramedullary tumour

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4
Q

What are the features of central cord syndrome?

A
  • Early suspended (cape-like) pain and temperature loss with preservation of dorsal columns
  • Forward extension = pyramidal weakness
  • Lateral extension = ipsilateral Horner’s
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5
Q

What are the causes of anterior cord syndrome?

A

Anterior spinal artery occlusion

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6
Q

What are the features of anterior cord syndrome?

A
  • Areflexic, flaccid paraparesis
  • Sphincter disturbance
  • Pain and temperature loss with dorsal column preservation
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7
Q

What are the causes of anterior horn cell syndrome?

A

Spinal muscular atrophy syndromes

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8
Q

What are the features of anterior horn cell syndrome?

A
  • Diffuse weakness, atrophy, and fasciculations
  • Reduced tone
  • Sensory symptoms absent
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9
Q

What are the causes of combined anterior horn cell pyramidal tract syndrome?

A

ALS

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10
Q

What are the features of combined anterior horn cell pyramidal tract syndrome?

A
  • LMN signs (fasciculations, atrophy, weakness +/- pseudobulbar)
  • UMN signs (upgoing plantars, spasticity +/- bulbar)
  • Preservation of sphincters
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11
Q

What are the causes of posterolateral column syndrome?

A
  • Subacute combined degeneration of the spinal cord

- Friedreich’s ataxia

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12
Q

What are the features of posterolateral column syndrome?

A
  • Dorsal column loss
  • UMN signs (hyperreflexia, upgoing plantars, weakness)
  • Preservation of pain and temperature
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13
Q

What are the causes of posterior column syndrome?

A

Tabes dorsalis (neurosyphilis)

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14
Q

What are the features of posterior column syndrome?

A
  • Dorsal column loss (loss of proprioception and vibrations sensation)
  • +/- lancinating pains (often lower limbs)
  • +/- Lhermitte’s sign
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15
Q

What are the clinical features of radiculopathy at nerve root C5?

A
  • Pain in neck, shoulder, and upper arm
  • Motor weakness of deltoid, supraspinatus, and infraspinatus
  • Supinator reflex abnormalities
  • Sensory disturbance of shoulder and lateral arm
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16
Q

What are the clinical features of radiculopathy at nerve root C6?

A
  • 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
17
Q

What are the clinical features of radiculopathy at nerve root C7?

A
  • 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
18
Q

What are the clinical features of radiculopathy at nerve root C8?

A
  • 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
19
Q

What are the causes of cauda equina syndrome?

A
  • Herniated disc compressing L5/S1 (most common)
  • Tumours
  • Spondylolisthesis
  • Abscess
  • Trauma
20
Q

What are the clinical features of cauda equina?

A
  • Saddle anaesthesia
  • Urinary retention/incontinence
  • Faecal incontinence
  • Asymmetric sensory loss, pain, and/or weakness in legs
  • Reduced anal tone
  • Hyporeflexia
21
Q

What is the first-line imaging modality in suspected cauda equina?

A

MRI

22
Q

What is the management of cauda equina syndrome?

A

Requires neurosurgical input for lumbar decompression surgery

23
Q

What is the main difference between conus medullaris syndrome and cauda equina?

A
  • 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
24
Q

What are the clinical features of degenerative cervical myelopathy (DCM)?

A
  • 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

25
Q

What is the imaging modality of choice for DCM?

A

MRI

26
Q

What is the management of DCM?

A

Surgical decompression

27
Q

What are the clinical features of lumbar stenosis?

A
  • Anterior thigh pain
  • Pain on standing
  • Neurogenic claudication with distance
  • Numbness/paraesthesia
  • Improvement on bending forward
  • Worse on walking down stairs
28
Q

What is the imaging modality of choice for lumbar canal stenosis?

A

MRI

29
Q

What is the management of lumbar canal stenosis?

A
  • Conservative –> rest, analgesia, lumbar corset, physio, epidural steroid injections
  • Surgery
30
Q

What are the indications for surgery in lumbar canal stenosis?

A
  • Failure of conservative measures
  • Pain
  • Significant motor defect
  • Sphincter disturbance
31
Q

What are the causes of syringomyelia?

A
  • Cerebellar ectopia (Chiari malformation)
  • Intramedullary tumours
  • Trauma
32
Q

What spinal tracts are typically affected in syringomyelia?

A
  • Ventral horns

- Spinothalamic tract

33
Q

What are the clinical features of syringomyelia?

A
  • 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
34
Q

What is the imaging modality of choice in syringomyelia?

A

MRI brain and spine with contrast (gadolinium)

35
Q

What is the management for syringomyelia?

A
  • Surgical decompression of the foramen magnum

- Syringo- arachnoid or syringo-pleural shunt

Neurology (46 decks)

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