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Clin Med III - Neuro > Spinal Section > Flashcards

Spinal Section Flashcards

1
Q

Rules of PE for the spine

A
  • Can take days to weeks for s/s
  • Check symmetry of R vs L
  • Check bladder function
  • Note level of defect (e.g. T6 means abnormal below that level)
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2
Q

Describe spinal cord contusion

A

Transient dysfunction occasionally without imaging proof (MRI negative)

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3
Q

Order of investigation for spinal cord problem

A
  • ABCs
  • CT scan to define major structural issues (esp in short time periods under unstable conditions)
  • MRI is best for most spinal structural issues BUT can only be done in stable patient
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4
Q

CT vs. MRI in spinal cord evaluation

A
  • CT is good for evaluating an unstable pt quickly but radiation exposure and will only identify major structural issues
  • MRI is best for spinal structural issues but can only be done in a stable patient
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5
Q

What is necessary to define spinal cord parenchyma?

A

MRI

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6
Q

What is necessary to define all inflammatory lesions of the spinal cord?

A

MRI

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7
Q

When in the year is West Nile infection most likely?

A

Late fall

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8
Q

Describe West Nile CNS infection

A
  • 1 out of 150 WN pts

- Can present as any CNS/PNS problems

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9
Q

Infectious diseases that affect the spinal cord

A
  • West Nile
  • Zoster
  • HSV1 and 2
  • CMV
  • HIV
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10
Q

What type of virus is West Nile?

A

Flavi virus

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11
Q

What vascular cord issue can arise from the cervical (vertebral) arteries?

A
  • Acute myelopathy

- Watershed ischemia-t4

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12
Q

What vascular cord issue can occur in the thoracic region?

A

Arises from the aorta (dissection from trauma/CT disease)

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13
Q

Most ischemic spinal cord issues occur where?

A

ACA (anterior)

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14
Q

What is artery dissection usually a/w?

A

Pain - neck, radicular, HA, chest (for thoracic aorta), abdominal or belt (for abdominal aorta)

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15
Q

What should be tested when assessing B12 deficiency?

A

Methylmalonic acid

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16
Q

Where in the spinal cord/column does B12 deficiency cause problems?

A
  1. Optic nerve
  2. Dorsal columns (position, vibration, touch)
  3. Pyramidal tract (motor tract)
  4. Cognition
  5. Peripheral nerve
17
Q

What set of criteria is used to diagnose MS?

A

MacDonald 10

18
Q

What are the MacDonald criteria of MS?

A

-2 attacks 2+ lesions
-2 attacks 1 lesion w/MRI/CSF evidence
ETC ETC

19
Q

What is transverse myelitis?

A

Monophasic cord inflammation which may be mild to complete or hemi

20
Q

How is transverse myelitis diagnosed?

A

Diagnosis of exclusion

21
Q

Difference between MS and transverse myelitis

A
  • MS is progressive disease

- Transverse myelitis is monophasic

22
Q

What is a hereditary disease that affects the spinal cord?

A

Familial spastic paraplegia (simple and complex types)

23
Q

What are examples of vasculitis that affect the spinal cord?

A
  • SLE (which requires 11 criteria)
  • Bechet’s
  • Sjogren’s
24
Q

What are dysmorphic conditions of the spinal cord that will be diagnosed by MRI?

A
  • Teathered cord (below L2)
  • Arachnoid cysts (anywhere)
  • Chiari malformations
  • Duplication of cord
  • Diastematomyelia
25
Q

How does central cord syndrome present?

A
  • Cervical area affected

- Hands weak, but shoulders ok (OR LE weak, but UE ok)

26
Q

What is the only thing that crosses in the spinal cord?

A

Spinothalamic tract (pain and temperature)

27
Q

What is Brown-Sequard syndrome and how does it present?

A
  • Hemi-spinal cord defect

- Ipsilateral plegia, contralateral pain and temp

28
Q

How does an anterior cord lesion present?

A
  • Usually vascular

- Motor does not work, dorsal columns work

29
Q

What is Syrinx?

A

Central cord type problem, MRI can be positive or negative

30
Q

How does conus medullaris present?

A
  • Saddle anesthesia
  • Severe early bowel dysfunction
  • Increased DTRs
  • Toes UP
  • Weak and numb LEs
31
Q

How does cordae equinae present?

A
  • Major deficits in LE motor and sensory
  • Decreased DTRs
  • Toes DOWN
  • Bowel bladder dysfunction
32
Q

What is the key to differentiating conus medullaris vs. cordae equinae?

A

DTRs (increased in CM)
Toes (UP in CM)
**If deficit comes abruptly, spinal shock may disrupt the diagnosis

Clin Med III - Neuro (11 decks)

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