Week 129 - Spinal Cord Compression (Provisional)

Question 1

What does the suffix -paresis mean?

Answer 1

Weakness.

i.e. Hemiparesis - Weakness on one side of body.

Question 2

What does the suffix -plegia mean?

Answer 2

Paralysis.

i.e. Paraplegia, paralysation of both legs.

Question 3

What does the root myelo- mean?

Answer 3

Pertaining to the spinal cord, e.g. myelitis (inflammation of the spinal cord).

Question 4

What does the root Radiculo- mean?

Answer 4

Pertaining to the nerve root, e.g. radiculopathy (damage to the nerve root)

Question 5

What does the root myo- mean?

Answer 5

Pertaining to muscle.

Question 6

What is responsible for the initiation of gait?

Answer 6

• Frontol Lobes
• Basal Ganglia

Question 7

Which four things are responsible for stepping/movement?

Answer 7

• Motor Cortex
• Nerves
• Spinal Cord
• Muscles

Question 8

What are responsible for posture control?

Answer 8

• Brain Stem
• Cerebellum
• Vestibular system
• Visual System
• Muscle Stretch Receptors
• Proprioception

Question 9

What is the pattern seen in muscle wasting disease?

Answer 9

• Tends to affect proximal muscles.
• Reflexes preserved.
• Affected muscles may be wasted or hypertrophied.

Question 10

What is an upper motor neurone?

Answer 10

These are nerves that originate in the motor cortex or brain stem and carry information to the lower motor neurones.

Question 11

What is a lower motor neurone?

Answer 11

These are nerve cells that arrise from the anterior horn cell or cranial nerve nuclei in the brainstem, to innervate skeletal muscle.

Question 12

What are the best distinguishing features for identifying whether a lesion is UMN or LMN?

Answer 12

Tone and reflexes.

Question 13

With an upper motor neurone lesion what would expect from tone?

Answer 13

• Pyramidal weakness -
Legs-
-Extensor spacicity
- Flexor weakness

Arms-

• Flexor spacicity
• Extensor weakness

Question 14

What would you expect to occur to reflexes as a result of an UMN lesion?

Answer 14

• Hyper-reflexia as no inhibition.

Question 15

What would you expect from a LMN lesion in terms of tone and reflexes?

Answer 15

• Both reduced due to dennervation/loss-of pathway.

Question 16

What are the two ascending sensory tracts of the spinal column and what do they carry?

Answer 16

• Spinothalamic- Pain and Temperature
• Dorsal column- Soft touch, proprioception and vibration

Question 17

Where do the two sensory ascending tracts desucate?

Answer 17

• Spinothalamic - at level of entry.
• Dorsal column - In the medulla

Question 18

What are the two motor spinal tracts? What are their major functions?

Answer 18

• Pyramidal tracts- Carry direct signals to motor neurones.
- Corticospinal- Carries 90% of pre-ganglionic motor neurones to somatic origins.

• Extrapyramidal tracts- Responsible for modulation of motor signals

Question 19

Where do the two motor tracts of the spine dessucate?

Answer 19

• Corticospinal - Dessucate in the medulla.

Question 20

What is the blood supply of the spinal cord?

Answer 20

• 1 anterior spinal artery and 2 posterior spinal arteries.

Question 21

What is the implication of their being 1 anterior spinal artery?

Answer 21

• Occlusion of haemarrhoge may result in the loss of the corticospinal and spinothalamic tracts.

Question 22

What is Cauda Equina syndrome?

Answer 22

• Compression of lumbar and sacral nerve roots (LMN) within cauda equina.
• Requires **urgent **decompression.

Question 23

What are the **red flag **symptoms for Cauda Equina syndrome?

Answer 23

• Urinary retention
• Faecal incontinence
• Saddle Anaesthesia

Question 24

What are the cerebral signs of an UMN lesion?

Answer 24

• Unilateral, Associated sensory symptoms, Dysphasia, Personality changes, seizures.

Question 25

What are the brain stem signs of an UMN lesion?

Answer 25

• Diplopia, dysphagia, dysarthria, cranial nerve symptoms, sensory nerve symtpoms.

Question 26

What are the spinal cord signs of an UMN lesion?

Answer 26

• Bilateral, sexual/bladder/bowel dysfunction, sensory signs.

Question 27

What are the anterior horn cell signs of a LMN lesion?

Answer 27

• Weakness, wasting, arreflexia.

Question 28

What are the Neuro-muscular junction signs of a LMN lesion?

Answer 28

• **Fatiguable weakness, ** specific distribution, possible autonomic symptoms.

Question 29

What are the muscle signs of a LMN lesion?

Answer 29

Wasting, occasional pain, frequently proximal distribution.

Question 30

What is motor neurone disease?

Answer 30

A disease causing the wasting of the anterior horn cells, resulting in LMN and UMN symptoms.

Question 31

What is the aetiology of motor neurone disease?

Answer 31

Unknown, but atrophy of the anterior horn cells occurs in all forms and the corticospinal tracts also sclerose.

• Leads to wasting of motor neurones and muscles, cerebral atrophy may also be associated.

Question 32

What are the UMN signs of motor neurone disease?

Answer 32

• Spastic paraparesis, brisk jaw jerk, dysarthria.

Question 33

What are the lower motor neurone signs of motor neurone disease?

Answer 33

Weakness, Wasting, Fasiculations

Dysarthria, Dysphagia

Respiratory failure

Question 34

What is Myasthenia Gravis?

Answer 34

Autoimmune disease, where antibodies are produced against nicotinic acetylcholine receptors at neuromuscular junctions.

Results in muscle weakness and fatiguability.

Question 35

What are the symptoms of Myasthenia Gravis?

Answer 35

• Muscle fatiguability which may affect:

• Eyes
• Bulbar
• Respiratory
• Limbs paticulary proximal muscles

• Sudden or gradual onset and muscles may suffer intermitently.

Question 36

What is the ‘peek’ test?

Answer 36

This is used to assess muscle fatiguability, such as seen in Myasthenia Gravis.

Eyes are closed, sclera can begin to be seen as eyelids weaken.

Question 37

What investigations can be performed for Myasthenia Gravis?

Answer 37

• Serology - Antibodies
• Neurophysiology - Muscle fatigue assessed by electrical stimulation.
• Edrophonium test.

Question 38

What are the treatment options for Myasthenia Gravis?

Answer 38

• Acetylcholine esterase inhibitors.
• Immunosupressive drugs.
• Antibody treatment.
• Surgery - Thymus removed, in thymal mediated MG.

Question 39

What is muscular dystrophy?

Answer 39

A collection of inherited disorders of muscle structure (e.g. Duchennes, Beckers).

Resulting in progressive wasting and weakness.

Question 40

What is the pathophysiology of muscular dystrophy?

Answer 40

• Genetic problem producing flawed ‘dystrophin glycoprotein-complex’
- Responsible for anchoring of muscle fibres.

Question 41

What are the signs and symptoms of muscular dystrophy?

Answer 41

• Progressive weakness and wasting.
• Proximal > Distal.
• Poor balance, scoliosis, drooping of eye-lids.

Question 42

What are the investigations for muscular dystrophy?

Answer 42

• Elevated serum Creatinine Kinase (Released by muscle breakdown).
• DNA testing
• Muscle Biopsy

Question 43

What is the development and symptoms of statin-induced myopathy?

Answer 43

• Asymptomatic rise in creatinine phosphatase, causing myalgia and myositis, eventually muscle breakdown.

• Muscle pain/tenderness
• Proximal muscle weakness

Question 44

What is polymositis?

Answer 44

• Acquired condition where cytotoxic T-cells destroy muscle fibres.
• Causing proximal weakness, myalgia and increased serum CK.
• Treated with immunosupressants.

Question 45

What is dermatomyositis?

Answer 45

• Acquired condition where antibodies attack capillaries and arterioles in muscle and skin etc.
• Causes, Proximal weakness, myalgia and characteristic rash and fever.
• Treated with immunosupressants.

Question 46

What is Inclusion Body Myositis?

Answer 46

• Elderly onset acquired inflammatory pathology.
• Gradual onset of weakness of knee, ankle, finger flexors, and swallowing.
• Poor response to immunosupression.