Spine and Nerve Injuries Flashcards
What is cauda equina syndrome?
Nerve roots at the base of the spine are compressed
What is the most common cause of cauda equina syndrome?
Herniated disc L4/5 or L5/S1
What is the presentation of cauda equina?
Saddle anaesthesia
Bilateral sciatica
Incontinence
Bilateral motor weakness in legs
Reduced anal tone on PR exam
What is the gold standard diagnosis for cauda equina?
MRI whole spine to localise lesion
What test indicates a problem at L4?
Femoral stretch test
What is the gold standard management of cauda equina?
Lumbar decompression surgery
What does HORSETAIL stand for in cauda equina?
Orgasm changes
Retention
Sciatica
Erectile dysfunction
Tone changes
Altered sensation
Inability to stop
Leakage
What is carpal tunnel syndrome?
Compression of the median nerve in the carpal tunnel
What is the median nerve roots?
C5-T1
What are some risk factors for carpal tunnel syndrome?
Obesity
Pregnancy
RSI
DM
Acromegaly
What fingers are affected in carpal tunnel?
Thumb
Index
Middle fingers
What muscles can waste in cauda equina?
Thenar
What are some tests for cauda equina?
Phalens - reverse prayer sign causes symptoms
Tinels - tapping over median nerve causes symptoms
Flick sign - patient makes flicking movement of wrist to alleviate symptoms
What is the gold standard test for diagnosis of carpal tunnel?
EMG shows slowed conduction over the median nerve
What is the management of carpal tunnel?
Stretching and wrist splints
Oral prednisolone
Resect transverse carpal ligament
What is damaged in foot drop?
Common peroneal nerve
What is there weakness of in foot drop?
Ankle dorsiflexion
What are the nerve roots of the sciatic nerve?
L4-S3
What does the sciatic nerve split into at the knee?
Tibial and common peroneal
What is charcot marie tooth syndrome?
A group of inherited diseases which affect peripheral motor and sensory nerves
What is the ABCDE aetiology of CMT?
Alcohol
B12 deficiency
Cancer and CKD
Diabetes and drugs
Every vasculitis
What are some presentations of CMT?
High foot arches - pes cavus
Hammer toes
Inverted champagne bottle legs
Claw hand and foot drop
What is anterior cord syndrome?
Damage to the anterior 2/3rd of the spinal cord and posterior part is spared
What is the most common cause of anterior cord syndrome?
Ischaemia of the anterior spinal artery
What is the presentation of anterior cord syndrome?
Bilateral weakness - quadriplegia or paraplegia
Bilateral loss of pain and temperature
Autonomic dysfunction
What are some investigations for anterior cord syndrome?
MRI
LP
ECHO
What are the nerve roots of the radial nerve?
C5-T1
What are the most common causes of radial nerve injuries?
Humerus fractures or excessive pressure on the nerve
What nerve is damaged in claw hand?
Ulnar nerve
What nerve is damaged for winged scapula?
Long thoracic nerve
What are the defects of Brown Sequard?
Ipsilateral loss of position, light touch and vibration at the level of the lesion
Contralateral loss of pain and temperature below the level of the lesion
What is GBS?
Ascending acute demyelinating polyneuropathy following GI/ URT infection, most commonly C. jejuni
What are targeted in GBS?
PNS schwann cells
What are some symptoms of GBS?
Ascending weakness - lower limbs first
Loss of knee jerk
Flaccid paralysis
Facial weakness and droop
Hypotonia
What is the diagnosis for GBS?
Nerve conduction studies show reduced velocity
LP - isolated finding of raised protein
Brighton criteria
What is the management for GBS?
IV immunoglobulins
Plasma exchange
Monitor vital capacity and breathing rate
How does diabetic neuropathy present?
Glove and stocking sensory and/ or pain loss
Proximal weakness
What is the most common type of diabetic neuropathy?
Distal symmetrical sensory neuropathy
What can be offered for pain relief in diabetic neuropathy?
Gabapentin or Pregabalin
What nerve roots are the brachial plexus?
C5-C8 and T1
What is Erb’s palsy?
dermatomal sensory loss in C5-C6 showing waiters tip sign
What is Klumpke’s palsy?
Dermatomal sensory loss in C8-T1 distribution
What is neurofibromatosis?
Loss of function of tumour suppressor genes causing benign tumour growth
What is the inheritance of neurofibromatosis?
Autosomal dominant
What are some presentations of neurofibromatosis?
Cafe au lait spots
Lisch nodules
Scoliosis
HTN
Learning difficulty
Epilepsy
Meningiomas
Posterior lens opacities
Astrocytomas
