Spinal Cord Diseases

Question 1

what upper motor neuron signs would you expect to see in spinal cord pathology?

Answer 1

> no wasting
increased tone
increased reflexes
pyramidal pattern of weakness

Question 2

what lower motor neuron signs would you expect to see in cord or root pathology?

Answer 2

> decreased tone
decreased reflexes
flexor plantar
weakness

Question 3

what would a hemicord lesion present with?

Answer 3

brown-sequard syndrome

Question 4

describe the ipsilateral affects of brown-sequard syndrome

Answer 4

> decreased vibration
decreased joint position sense
weakness

Question 5

describe the contralateral affects of brown sequard syndrome

Answer 5

> decreased pain sensation

> decreased temperature

Question 6

what is radiculopathy?

Answer 6

dermatomal sensory loss

Question 7

give an example of how the autonomic system is affected in spinal cord/root pathology

Answer 7

bladder and bowel control

Question 8

what would the signs be for a C5 cord lesion?

Answer 8

> wasting of C5 innervated muscle
increased tone
reflexes decreased in biceps and increased in lower levels
decreased power to C5 innervated muscles, pyramidal pattern below
sensory level

Question 9

what can cause myelopathy/radiculopathy surgically?

Answer 9

surgical (extrinsic):
> tumour
> vascular abnormalities
> degenerative
> trauma

Question 10

name some medical causes of myelopathy

Answer 10

> inflammation (demyelination and autoimmune)
> vascular (ischaemic/haemorrhage)
> infective
> metabolic
> malignant/infiltrate
> congenital/genetic
> idiopathic

Question 11

what can cause spinal cord ischaemia?

Answer 11

> atherothrombosis
> thromboembolism
> arterial dissection
> systemic hypotension
> vasculitis
> venous occlusion
> endovascular procedure
> decompression sickness
> meningovascular syphilis

Question 12

how may spinal cord stroke present?

Answer 12

> onset sudden or over few hours
> pain: back, visceral
> weakness: parapresis
> numbness/ paraesthesia
> urinary symptoms (incontinence)

Question 13

what artery is usually involved in a spinal cord stroke?

Answer 13

anterior spinal artery

Question 14

what treatment is available for spinal cord stroke?

Answer 14

> reduction of risk: BP maintaince, reverse hypovolaemia, antiplatelet therapy
OT and physiotherapy
manage vascular risk factors

Question 15

what is the prognosis for spinal cord stroke?

Answer 15

> function return depends on degree of parenchymal damage
unless significant motor recovery in first 24 hours major recovery chance is very low
20% mortality

Question 16

what is demyelinating myelitis characterised by?

Answer 16

pathological lesions of inflammation and demyelination leading o temporary neural dysfunction. affect the white matter of the CNS

Question 17

describe the onset of demyelinating myelitis

Answer 17

subacute

Question 18

what may there be in the history of demyelinating myelitis?

Answer 18

previous neurological or ophthalmological episodes

Question 19

what is the treatment for MS myelitis?

Answer 19

supportive

methylpredinosolone

Question 20

what does B12 absorption relay on?

Answer 20

intrinsic factor

Question 21

what secretes intrinsic factor?

Answer 21

gastric parietal cells

Question 22

what is pernicious anaemia?

Answer 22

an autoimmune condition in which antibodies to intrinsic factor prevent b12 absorption

Question 23

what can b12 deficiency be a complication of?

Answer 23

> total gastrectomy
crohns
tape worms

Question 24

describe the effects of B12 deficient myelopathy

Answer 24

> paraethesia
extensor plantars
degeneration of cortical spinal tracts and dorsal columns
painless retention of urine

Question 25

what investigations would you carry out for b12 deficiency myelopathy?

Answer 25

> FBC

> blood film

Question 26

what is the treatment for B12 deficient myelopathy?

Answer 26

intramuscular B12