Which symptoms do patients with spinal cord problems present with?
Sensory - pain, abnormal sensations
Motor - weakness, sphincter and sexual dysfunction
If the arms are involved, which segment of the spine is likely to be involved?
Cervical
If a spinal cord prolapse is central, ___ motor neurons are more likely to be involved.
upper
If a spinal cord problem is lumbar in origin, which limbs will be involved?
Lower limbs
Which chart can be used to diagnose the level of a spinal cord injury?
ASIA chart
Which motor neurons are affected by a lateral prolapse?
Lower motor neurons (LMNs)
Where does pain occur in cervical disc prolapses?
Arms (tends to be)
Which section of the spine does disc prolapse most often occur in?
Lumbar
Are upper motor neurons found in the lumbar spine?
No, so if a patient has problems in the lower limbs but they’re typical of UMN lesions (see table), the problem is higher up
What is spinal / neurogenic claudicstion?
Pain caused by a narrowing of spine, putting pressure on nerve roots
often compared to vascular but v different
Spinal claudication must not be mistaken for ___ claudication.
vascular
What can be checked to differentiate spinal claudication from vascular claudication?
Peripheral pulses
What is the triad of symptoms in cauda equina syndrome?
Saddle anaesthesia
Leg pain
Bowel/bladder dysfunction (painless retention and loss of anal tone)
What type of incontinence do patients with advanced cauda equina get?
Overflow incontinence
too late to treat
Which types of sensation should you test for in suspected cauda equina syndrome?
Light touch
Pin prick
Which spinal nerves are compressed in cauda equina syndrome?
S2 - 4
Pudendal nerve roots
How are patients with suspected cauda equina investigated?
Urgent MRI scan
Pain in which spinal region is a red flag?
Thoracic region
What are general red flag cancer symptoms?
Weight loss
Fever
Night sweats
Pain which patients notice at ___ is a red flag.
night
What is cervical myelopathy?
Progressive compression of the spinal cord in the cervical spine due to disc prolapse
Are the symptoms of cervical myelopathy unilateral or bilateral?
Bilateral
Which motor neurons are affected in cervical myelopathy?
UMNs
Which group of patients tend to develop cervical myelopathy?
Elderly
What are the symptoms of cervical myelopathy?
‘Numb, clumsy hands’ -> bilateral, difficulty performing ADLs
Gait problems -> falls
Describe
a) Babinski’s
b) Hoffman’s
c) Lhermitte’s
signs, which can all be seen in cervical myelopathy.
a) Toes extend on stroking the plantar surface of the foot
b) Thumb, index and middle fingers flex when the nail of middle finger is tapped
c) Patient experiences ‘electric shock’ sensation on neck flexion
Does surgery for cervical myelopathy reverse the symptoms?
No, only halts progress
What is the conservative treatment for a disc prolapse?
Analgesia
Physiotherapy
Does surgery make any difference to the final outcome of most disc prolapses?
No
Tends to speed up recovery, but most patients end up in the same place two years later
Surgery for back pain has a lot of potential ___.
complications
What is failed back syndrome?
Chronic back pain following surgery
What is an upper motor neuron?
What is its path?
Motor neuron connecting the brain (motor cortex) to the spinal cord (at the level of the muscle the next neuron will supply)
What is a lower motor neuron?
What is its path?
Motor neuron connecting the spinal cord (anterior horn) to the muscle itself
How is muscle tone affected in upper motor neuron disease?
Muscle tone increases
(Hypertonia)
How is muscle tone affected in lower motor neuron disease?
Decreased muscle tone
(Hypotonia)
What is a consequence of decreased muscle tone in lower motor neuron disease?
Atrophy
What is a fasciculation?
Brief muscle twitch
In which type of motor neuron disease are fasciculations seen?
Lower motor neuron disease
Describe how reflexes change in upper motor neuron disease.
Brisk reflexes
i.e hypersensitive reflexes due to impaired descending controls from the UMNs
Describe how reflexes change in lower motor neuron disease.
Decreased / Absent reflexes
because the reflex arc relies on LMNs, which are damaged
What is the plantar reflex?
When sole of the foot is stroked, toes should FLEX
What is the Babinski reflex?
In which type of motor neuron disease is it found?
When sole of foot is stroked, toes EXTEND (abnormal)
Upper motor neuron disease
What is clonus?
In which neurological disease is it sometimes seen?
Involuntary, rhythmic muscle contractions
Epilepsy (see: juvenile myoclonic epilepsy)
Clonus can be a feature of (UMN / LMN) disease.
Which common neurological disease may have clonus as one of its symptoms?
UMN disease
Epilepsy (juvenile myoclonic epilepsy)
