5 (Spine)

Question 1

Paresis VS plegia? Paraparesis vs quardiparesis?

Answer 1

Para= Legs
Paresis= partial
Plegia= Full paralysis

Question 2

Anterior Spinal Artery Stenosis site?

Answer 2

T2-T4

Question 3

Anterior Spinal Artery Stenosis features?

Answer 3

Bilateral Spastic weakness, movement, Pain and Tempreture loss

Question 4

Sings OF infarction in spinal artery in MRI?

Answer 4

Owl’s eye

Question 5

Brown sequard other name?

Answer 5

Cord hemisection

Question 6

Brown Sequard Causes?

Answer 6

Trauma (stab wound, gunshot)
Spinal tumors (meningioma, neurofibroma, Colon metastasis)
Multiple sclerosis
Ischemia (unilateral infarct)

Question 7

Brown Sequard features?

Answer 7

ipsilateral UMN weakness, proprioception and vibration, contralateral pain and temperature 1-2 levels below lesion

Question 8

Treatment Of brown sequard?

Answer 8

Underlying cause + Dexamethasone in some cases

Question 9

Connus medularis VS Cauda Equina

Answer 9

Conus Medullaris: Sudden bilateral, knee preserved, back pain, anal numbness, UMN (hyperreflexia, distal weakness), urinary fecal incontinence
Cauda equina: Chronic unilateral, No reflex, radicular pain, Saddle/pubic area numbness unilateral, LMN, asymmetric areflexia paraplegia, atrophy, Late urinary incontinence

Question 10

Syringomyelia definition?

Answer 10

Formation of Syrinx in Spinal cord

Question 11

Syringomyelia Causes?

Answer 11

Chiari 1 malformation, Years after car accident/post trauma

Question 12

Syringomyelia Features?

Answer 12

UMN in legs, LMN in hands
Pain temperature sensation impaired( Shawl/hemicape ), accidently burn hands without noticing, horner
position vibration intact

Question 13

Triad of Horner?

Answer 13

Ptosis, Miosis, Anhidrosis

Question 14

DD for Horner?

Answer 14

First: Stroke (lateral medullary syndrome)
Syringomyelia
Multiple sclerosis
Brainstem tumor

Second:
Pancoast tumor
Cervical rib
Thoracic outlet syndrome
Neck or chest trauma
Neck or upper thoracic surgery

Third:
Carotid artery dissection
Cluster headache
Cavernous sinus lesion
Internal carotid artery aneurysm

Question 15

Syringomilia Diagnosis?

Answer 15

MRI ( +brain for chiari malformation)

Question 16

Syringomilia Treatment?

Answer 16

Surgery (Decompression chiari, remove tomor, shunt trauma)

Question 17

What is Syringobulbia?

Answer 17

syrinx extends into the brainstem medulla (bulbar area) involves cranial nerves

Question 18

Features of Syringobulbia?

Answer 18

add Bulbar symptoms: difficulty swallowing, hoarseness, tongue wasting, respiratory issues

Question 19

Neurosyphilis?

Answer 19

Dorsal, loss of proprioception and vibration, Sensory ataxia, areflexia, Argyll Roberston pupil

Question 20

Spondylosis mechanism?

Answer 20

vertebral degeneration/ Spine osteoarthritis

Question 21

Spondylosis Epidemiology?

Answer 21

85% above 60, Under 40: trauma, Rugby,

Question 22

Spondylosis Physiopathology?

Answer 22

Vertebral Bodies, Discs
Joint narrowing, disc bulging, osteophyte, hypertrophy ligament flavum

Question 23

Spondylosis can result in?

Answer 23

radiculopathy or degenerative cervical myelopathy

Question 24

Degenerative cervical myelopathy RF?

Answer 24

Genetics, smoking, occupation ( High axial loading )

Question 25

Degenerative cervical myelopathy cause?

Answer 25

Spondylosis, Disc herniation, Ligament hypertrophy

Question 25

Degenerative cervical myelopathy features?

Answer 25

Pain neck Lhermitte sign, + Limbs, Motor ( digital dexterity like holding fork or buttons, stiffness, gait) sensory (numbness tingling proprioception) autonom ( incontinence ), Hoffman’s sign (gently flicking one finger causes twitching of the rest of that hand’s fingers ), UMN in legs, LMN in arms

Question 26

Degenerative cervical myelopathy is initially misdiagnosed with?

Answer 26

CTS

Question 27

Degenerative cervical myelopathy diagnosis:

Answer 27

MRI

Question 28

Degenerative cervical myelopathy treatment:

Answer 28

urgent referral for decompressive surgery

Question 29

Spinal Stenosis

Answer 29

Claudication, Can bike, shop trolley, improves on sitting leaning forward

Question 30

Transverse Myelitis Causes?

Answer 30

Idiopathic, MS, neuromyelitis optica, MOGAD, Post Infection (HIV HSV CMV EBV VZV influenza echovirus, syphlis lyme) vaccine, SLE, Sjogren

Question 31

Transverse Myelitis featuers?

Answer 31

Rapid onset, Bilateral Spastic paralysis, babinsky +, sensory level + LMN lvl, all sensory modalities, Incontinence,

Question 32

Transverse Myelitis Treatment?

Answer 32

IV corticosteroid, IVIG, Plasmapheresis

Question 33

Poliomyelitis?

Answer 33

(outdated term) MRI: Hyperintense lesion with gadolinium enhancement (inflammation in Transverse myelitis, MS, Neuromyelitis optica, Infection, Tumor, ischemia ) They all tend to be bilateral except for MS and tumors

Question 34

Metastatic spinal cord compression management:

Answer 34

Pain + neurological symptom: MRI within 24h, without neurological: 7days

Question 35

Autonomic dysreflexia

Answer 35

Patients with High cervical cord injury (above T6), Life threatening HTN, may lead to hemorrhagic CVA, Triggered by Fecal/urinary retention afferent sympathetic reflex, remove the cause ( like blocked catheter causing urinary retention ) and give anti HTN