10: Spinal cord and root dysfunction Flashcards

(44 cards)

1
Q

Which symptoms do patients with spinal cord problems present with?

A

Sensory - pain, abnormal sensations

Motor - weakness, sphincter and sexual dysfunction

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2
Q

If the arms are involved, which segment of the spine is likely to be involved?

A

Cervical

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3
Q

If a spinal cord prolapse is central, ___ motor neurons are more likely to be involved.

A

upper

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4
Q

If a spinal cord problem is lumbar in origin, which limbs will be involved?

A

Lower limbs

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5
Q

Which chart can be used to diagnose the level of a spinal cord injury?

A

ASIA chart

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6
Q

Which motor neurons are affected by a lateral prolapse?

A

Lower motor neurons (LMNs)

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7
Q

Where does pain occur in cervical disc prolapses?

A

Arms (tends to be)

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8
Q

Which section of the spine does disc prolapse most often occur in?

A

Lumbar

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9
Q

Are upper motor neurons found in the lumbar spine?

A

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

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10
Q

What is spinal / neurogenic claudicstion?

A

Pain caused by a narrowing of spine, putting pressure on nerve roots

often compared to vascular but v different

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11
Q

Spinal claudication must not be mistaken for ___ claudication.

A

vascular

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12
Q

What can be checked to differentiate spinal claudication from vascular claudication?

A

Peripheral pulses

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13
Q

What is the triad of symptoms in cauda equina syndrome?

A

Saddle anaesthesia

Leg pain

Bowel/bladder dysfunction (painless retention and loss of anal tone)

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14
Q

What type of incontinence do patients with advanced cauda equina get?

A

Overflow incontinence

too late to treat

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15
Q

Which types of sensation should you test for in suspected cauda equina syndrome?

A

Light touch

Pin prick

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16
Q

Which spinal nerves are compressed in cauda equina syndrome?

A

S2 - 4

Pudendal nerve roots

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17
Q

How are patients with suspected cauda equina investigated?

A

Urgent MRI scan

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18
Q

Pain in which spinal region is a red flag?

A

Thoracic region

19
Q

What are general red flag cancer symptoms?

A

Weight loss

Fever

Night sweats

20
Q

Pain which patients notice at ___ is a red flag.

21
Q

What is cervical myelopathy?

A

Progressive compression of the spinal cord in the cervical spine due to disc prolapse

22
Q

Are the symptoms of cervical myelopathy unilateral or bilateral?

23
Q

Which motor neurons are affected in cervical myelopathy?

24
Q

Which group of patients tend to develop cervical myelopathy?

25
What are the symptoms of **cervical myelopathy**?
**'Numb, clumsy hands'** -\> bilateral, difficulty performing ADLs **Gait problems** -\> falls
26
**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**
27
Does surgery for **cervical myelopathy** reverse the symptoms?
**No**, only halts progress
28
**What is the conservative treatment for a disc prolapse?**
**Analgesia** **Physiotherapy**
29
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
30
**Surgery for back pain** has a lot of potential \_\_\_.
**complications**
31
What is **failed back syndrome**?
**Chronic back pain** following **surgery**
32
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)**
33
What is a **lower motor neuron**? What is its path?
**Motor neuron connecting the spinal cord (anterior horn) to the muscle itself**
34
How is **muscle tone** affected in **upper motor neuron** **disease?**
**Muscle tone increases** | (Hypertonia)
35
How is **muscle tone** affected in lower motor neuron disease?
**Decreased muscle tone** | (Hypotonia)
36
What is a consequence of **decreased muscle tone** in **lower motor neuron** **disease?**
**Atrophy**
37
What is a **fasciculation**?
**Brief muscle twitch**
38
In which type of motor neuron disease are **fasciculations** seen?
**Lower motor neuron disease**
39
Describe how **reflexes** change in **upper motor neuron disease**.
**Brisk reflexes** i.e hypersensitive reflexes due to impaired descending controls from the UMNs
40
Describe how **reflexes** change in **lower motor neuron** disease.
**Decreased / Absent reflexes** because the reflex arc relies on LMNs, which are damaged
41
What is the **plantar reflex**?
When **sole of the foot is stroked, toes should FLEX**
42
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**
43
What is **clonus**? In which neurological disease is it sometimes seen?
**Involuntary, rhythmic muscle contractions** **Epilepsy** (see: juvenile myoclonic epilepsy)
44
**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)