Diseases of the spinal chord and nerve roots

Question 1

Spinal chord damage name

Answer 1

Myelopathy

Question 2

Myolitis meaning

Answer 2

Damage of the spinal chord due to inflammation

Question 3

Damage to spinal chord affects which motor neurone?

Answer 3

Upper motor neurone

Question 4

What are the signs of umn signs?

Answer 4

-> sustained muscle mass (initially at least)
-> Tensed up muscles (high tone)
-> rigidity
-> brisk, increased relexes

Question 5

Why do you get increased reflexes in UMN lesion?

Answer 5

Because the inhibition and modification comes form the UMN and can be very profound

Question 6

UMN lesion - what plantar reflex?

Answer 6

extensor - because this is our innate response (as in baby - away from pain), however, in adults and children we learn to walk and so out UMN change this to a flexor response.

Question 7

UMN lesion: do we get flexors/extension of arms and legs?

Answer 7

Arms = flexion, legs = extension

Usually whichever muscle is strongest wins

Question 8

Foot postiision umn lesion

Answer 8

slight inversion

Question 9

Spinal chord ususally bi/uni lateral?

Answer 9

usually bilateral lesion

Question 10

What is a brown sequard syndrome?

Answer 10

hemi section of the spinal chord, causing:
-motor and vibraion, fine touch, tactile discrimination and proproception loss ipsilateral to the lesion.
-umn affected so umn symptoms
-pain and temperature loss on the contralateral side.

Question 11

What is syringimyelia?

Answer 11

when there is a small cyst like lesion in the spinal chord, pressing on the spinothalamic tract crossing over and so leading to loss of temperature and pain sensations .

Question 12

Where is the inflammation in MS - what is spared?

Answer 12

Inflammation in the dorsal chord, meaning that the spinalthalamic tracts might still be spared.

Question 13

Spinal stroke - cmmmon symptoms

Answer 13

commonly affects the front of the column and so affects the motor and also the spinothalamic tracts as they cross over and move anteriorly

Question 14

What is the consequence on the bladder/bowels if the spinal chord has been damaged?

Answer 14

If you lose the spinothalamic tract to the bladder/bowl then you will get a loss of sensation, which can lead to bladder becoming overfilled, infections not being picked up etc.

Question 15

Intrinsic vs extrinsic spinal chrd injuries?

Answer 15

intrinsic = disease of the spinal chord

extrinsic - coming at it outwith the spinal chord eg meningeal tumour etc

Question 16

Key causes of myelopathy

Answer 16

Vascular
Vit B21 deficiency
Infection (viral, bact - TB/lymes/syphillis, brucella)
Genetic
Inflammation (MS, autoimmune, sarcoid)
malignant
ideopathic

Question 17

SPinal chord symptoms - investiations

Answer 17

MRI, blood tests - full blood and CSF

Question 18

What is the spinal chord supplied by?

Answer 18

anterior and posterior spinal arteries

Question 19

What can cause a spinal stroke?

Answer 19

The same things that can cause a normal stroke, but especially aortic dissection

Question 20

What are the signs of a spinal chord stroke?

Answer 20

“sudden” loss of motor function/sensation/weakness below a certain level. (may also take several hours for onset)

Back pain/around level

urinary issues

Question 21

Anterior or posterior spinal artery usually affected?

Answer 21

usually anterior psinal artery.

Otfen mid thoracic

Question 22

What is spinal shock?

Answer 22

It si when it presents like a lower motor neuron lesion initially eg floppy limbs, loss of reflexes

Question 23

What is the treatment of a spinal chord stroke?

Answer 23

Nothing acutely… wait, see then manage…

manage recurrance risk and vascular factors:
-maintain bp
-antiplatelet therapy (aspirin/clopidogrel)
-get out of any arryhtmias if they are in any

-OT and physio

Question 24

How is B12 absorbed and what canb lead to deficiency?

Answer 24

With intrinsic factor then in the illium

If no intrinsic facor: eg gsatrectomy, chron’s
pernicious anaemia (antibodies to intrinsic facor)

vegan (diet)

Question 25

What does B12 deficincy affect?

Answer 25

Brain, nerves, spinal chord etc (most of the nervous system)

Question 26

How do we investigate B12 deficiency

Answer 26

Hard to directly measure and know what is adequet amount.

-MCV, FBC, B12 and it’s metabolites

Question 26

B12 deficincy affects anterior/posterior part of the spinal chord?

Answer 26

posterior