Diseases of the spinal cord

Question 1

What are the main motor signs of upper motor neuron disease

Answer 1

No muscle wasting
Increased tone
Increased reflexes, extensor plantar (toe goes up, normal in <6 months)
Pyramidal pattern of weakness

Question 2

Where are motor signs visible from

Answer 2

The area below lesion
Often bilateral

Question 3

What are the sensory signs of spinal cord pathology

Answer 3

Loss of vibration sense
Pain
Temperature
proprioception

Question 4

What are the motor signs in LMN pathologies

Answer 4

Decreased tone
Decreased reflex
Muscle wasting

Question 5

What are expected signs of cord patholgy

Answer 5

Issues with bladder and bowel function.

Question 6

Why are reflexes increased in UMN disease

Answer 6

The UMN usually inhibits spinal reflexes, so disease will prevent this inhibition.

Question 7

What type of response is the extensor plantar

Answer 7

Withdrawl response, lost within 6 months as your learning to walk and upper motor neurons develop

Question 8

What is a pyrammidal pattern of weakness

Answer 8

Upper body: the flexors are stronger than the extensors which extends from fingers to shoulder
Lower Body: extensors > flexors, usually a very straight leg.

Question 9

What is spastic tetraparesis?

Answer 9

When the lesion is in the cervical cord, causing weakness of all 4 limbs

Question 10

What is Spastic paraperisis

Answer 10

When the lesion is in the thoracic region, and both legs are involved

Question 11

what is the difference between spastic tetraparesis and spastic paraparesis?

Answer 11

Tetraparesis: involves weakness of all 4 limbs
Paraparesis: involves weakness of both legs.

Question 12

What type of lesions present as Brown-sequard syndrome

Answer 12

Hemicord lesion

Question 13

How do hemicord lesions presents?

Answer 13

As Brown-sequard syndrome
Pain & temperature: loss in contralateral side to lesion, sensation still in ipsilateral side
Joint, position, vibration & sensation: Loss in ipsilateral side, sensation still in contralateral side to lesion.
UMN weakness in the ipsilateral side to lesion.

Question 14

What is a syrinx

Answer 14

A fluid filled cavity within the spinal cord, tends to affect grey matter very close to the midline

Question 15

What loss will a syrinx cause?

Answer 15

Usually pain and temperature, on the same side as the syrinx
sometimes some motor signs as it expands and involves anterior horn cells

Question 16

what is the condition called when syrinx form

Answer 16

Syringomyelia

Question 17

What can cause loss of pain and temperature sensation

Answer 17

Anterior spinal artery stroke
Syringomeglia

Question 18

What is caused by anterior spinal stroke

Answer 18

Loss of pain and temperature sensation bilaterally below stroke
Still has JPS, vibration sense
Will have UMN weakness as anterior horn cells will be affected by the stroke.

Question 19

Surgical Causes of myelopathy

Answer 19

Tumour
Vascular abnormalities
Degenerative (spine)
Trauma

Question 20

Medical causes of myelopathy

Answer 20

Congenital/genetic

Inflammation
Vascular: ischaemic/haemorrhage
infective
Metabolic: B12 DEFICIENCY
malignant: infiltrative/paraneoplastic
Idiopathic

Question 21

Examples of Congenital/genetic myelopathy

Answer 21

Hereditary paraperisis, spinocerebellar ataxias

Question 22

Examples of Inflammatory Myelopathy

Answer 22

Demyelination (MS)
autoimmune (systemic lupus)
sarcoid

Question 23

Examples of Infective myelopathy

Answer 23

Viral: Herpes simplex/zoster, EBV, CMV (cytomegalovirus), measles, HIV
Bacterial: TB, Lyme, syphilis, brucella
Other: schistosomiasis

Question 24

What are the main investigations for myelopathy

Answer 24

Imaging: MRI
investigating cause: Bloods (B12), CSF (inflammation)

Question 25

Where does the anterior spinal artery originate from, and what does it supplie?

Answer 25

It is a branch of the vertebral artery (upper half), and branch from a lumbar artery (lower half) The anterior half of the spinal cord, which is supplied by sulcal arteries from the anterior spinal artery

Question 26

Where does the posterior originate from

Answer 26

The vertebral arteries as well. the anterior artery branches off before the posterior arteries.

Question 27

Where are anterior spinal artery strokes most common?

Answer 27

where the upper and lower half of the anterior spinal artery meet as there is a watershed area at this point

Question 28

What is the clinical presentation of Spinal cord stroke

Answer 28

may have vascular risk factors Sudden onset/ few hours Pain: Back pain/radicular(radiates to anterior abdomen) Weakness (paraparesis: rather than quadraparesis) Numbness and paraesthesia Urinary symptoms (retention followed by bladder and bowel incontinence as spinal shock settles)

Question 29

Why do spinal stroke patients tend to present with paraparesis, rather than quadraparesis

Answer 29

The thoracic blood flow is very vunerable, therefore ischaemia in this region will only affect the lower limbs

Question 30

what are the signs of spinal cord stroke

Answer 30

Present as Brown-sequard syndrome (usually anterior, dorsal columns spared) Mid thoracic may be spinal shock

Question 31

what is spinal shock

Answer 31

Rapid shut down of spinal cord No UMN signs (take time to develop) Intermediate phase: absent reflex, low tone No extensor plantar

Question 32

What indications can show UMN damage during spinal shock

Answer 32

Sensory changes, sudden onset and weakness.

Question 33

How would you treat spinal cord stroke

Answer 33

Reduce risk of recurrence OT and physiotherapy Manage vascular risk factors Wouldnt thrombolyse spinal cord stroke.

Question 34

How would you reduce recurrence of spinal cord strokes

Answer 34

Maintain adequate BP Reverse Hypovolaemia/arrhythmia Antiplatelet therapy (aspirin, clopidogrel

Question 35

what is the Spinal cord stroke prognosis

Answer 35

Unless significant motor recovery in first 24 hours chance of major recovery is low Pain may be persistent --> significant contributor to disability 20% mortality 35-40% have more than minimal recovery 60% left with significant disbility.

Question 36

What can cause B12 deficiency

Answer 36

Diet (vegans) Pernicious anaemia: autoimmune condition in which antibodies to IF prevent B12 absorption Total gastrectomy, Chron's, tape worms.

Question 37

what is required for B12 absorption

Answer 37

Intrinsic Factor: secreted from stomach, and B12+IF reabsorped in ileum.

Question 38

what aspects of the nervous system will B12 deficiency affect

Answer 38

Myelopathy Peripheral Neuropathy Most common 2 to be affected in early stages Will be affected if left low enough for long enough Brain Eye/optic nerves Brainstem Cerebellum

Question 39

What is paraesthesia

Answer 39

numbess or tingling senstation of hands/feet

Question 40

What are the signs and symptoms of B12 deficiency

Answer 40

Paraesthia hands and feet, areflexia. First UMN sign: extensor plantar Painless rentetion of urine Loss of JPS and vibration sense, relative sparing of pinprick

Question 41

What is Degraded in the spinal cord in B12 deficiency

Answer 41

Corticospinal tracts--> paraplegia Dorsal columns: sensory ataxia

Question 42

what are the investigations for B12 deficiency

Answer 42

FBC/ Blood Film (look for raised MCV, megaloblastic aneamia) B12 B12 metabolites Can have normal FBC and Blood film but low B12

Question 43

What is the treatment for B12 deficient myelopathy

Answer 43

Intramuscular B12 (quicker the better)

Question 44

What half of the spinal cord is usually affected by B12 deficency

Answer 44

The dorsal half

Question 45

B12 deficiency vs Spinal cord stroke

Answer 45

Stroke: usually affects the anterior half B12: usually affects the posterior half