Diseases Of The Spinal Cord Flashcards by Billie jo stephen

What is radiculopathy?

Disease of lower motor neurone
(Out-with the spinal cord)
Damage of the motor root resulting in dermatomal damage

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What is myelopathy?

Damage to the spinal cord usually due to severe compression

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what are signs of upper motor neurone lesion?

no wasting
increased tone (rigidity or spasticity)
hyperreflexia , extensor plantar
pyramidal pattern of weakness

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what are signs of lower motor neurone lesion?

wasting
decreased tone
decreased reflexes, flexor plantar
weakness

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brown-sequard syndrome results from what type of lesion?

hemicord lesion (damage to one half of the spinal cord)

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what is the presentation of brown-sequard syndrome?

causes weakness/paralysis (hemiparaplegia) on one side of the body and loss of sensation on the other side

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what affects does Brown squared syndrome cause on the ipsilateral side?

decrease vibration, joint position sense and weakness

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what affects doesn’t brown seuquard syndrome causes eon the contralateral side?

contralateral loss of pain and temperature

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how can you differentiate between a spinal cord lesion and motor neurone diseasE?

spinal cord lesion will also cause sensory symptoms whereas motor neurone is only motor effects

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what are congenital causes of myelopathy?

fredrick’s ataxia
spinocerebellar ataxia
hereditary paraparesis

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what are the 3 most common causes of myelopathy?

demyelination ie. in MS
ischaemic myelopathy (spinal cord infarction)
Vitamin B12 deficiency

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what is the main blood supply to the spinal cord?

anterior and posterior spinal arteries
anterior S.A branch of the vertebral artery
posterior S.A branch of the inferior cerebellar artery

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what artery is the most common culprit for ischameic myelopathy and at what point int he spinal cord this most common?

the anterior spinal artery

most commonly in the mid thoracic

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what is the clinical presentation of ischaemic myelopathy/spinal cord infarction?

onset may be sudden or over several hours
back pain , radicular pain
visceral referred pain
weakness - paraparesis (usually only weakness of the legs)
numbness and paraesthesia
urinary symptoms

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how would you investigate a suspected spinal cord infarction?

MRI

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what is the treatment/management of a spinal cord infarction/ ishcameic myelopathy?

reduce risk of recurrence;
- maintain BP
- reverse hypokalaemia/arrhythmia
- anti platelet therapy 
manage vascular risk factors
- physiotherapy , OT

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what does the recovery of spinal cord infarction depend on?

the extent of parenchymal damage

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what is the prognosis of spinal cord infarction?

20% mortality, with only 35-40% have more than minimal recovery

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what is the treatment for demyelinating myelitis?

supportive

methylpredinosolone (speeds up recovery from myelitis but not progression of MS)

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what are the main causes of vitamin B 12 deficiency?

gastrectomy - vit B 12 is absorbed in the small intestine by intrinsic factor
pernicious anaemia
veganism

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what affects on the CNS does vitamin B12 cause?

myelopathy - L'hermitte's 
peripheral neuropathy
brain
eyes/optic nerves 
brainstem 
cerebellum

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vitamin B12 can cause degeneration of the corticospinal tract, what symptom would this cause?

paraplegia

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vitamin B12 can cause degeneration of the dorsal columns, what symptom would this cause?

sensory ataxia

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what are the investigations and treatment for vitamin B 12 deficiency?

investigations: FBC, blood film, B12

treatment = intramuscular B12

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how can a gastrectomy cause vitamin B12 deficiency?

Vitamin B12 absorption from the ileum requires intrinsic factor - produced from gastric parietal cells. therefore if someone has a gastrectomy, then Vitamin B12 won't be absorbed to be taken and stored in the liver

if there radiculopathy of C5 what symptoms would this cause?

``` = damage to the C5 spinal root decreased power in C5 innervated muscles wasting of the C5 innervates muscle decreased reflex of bicep muscle but increased reflexes below C5 increased tone in legs > arms ```

is muscle wasting a symptom of upper motor neurone or lower motor neurone lesion?

lower motor neurone

in which spinal cord/root pathology causes back pain and what is its pattern like?

ischaemic spinal cord / spinal cord infarction | radicular pain - radiates out along the course of the spinal nerve

what does paraparesis mean?

partial paralysis of the lower limbs

what does paraesthesia mean?

burning/tingling sensation

what does paraplegia mean?

impairment of the motor or sensory function of the lower limbs

would u find extensor plantar in an UMN or LMN lesion?

extensor plantar = UMN

would you find flexor plantar in UMN or LMN lesion?

flexor plantar = LMN

What is radiculopathy and what is the presentation like?

Damage of the nerve root - unilateral - single myotome - single dermatome - decreased reflexes - LMN

What is myelopathy and what does it present like?

Damage to the spinal cord - bilateral - motor and sensory level - UMN

Would damage to a peripheral nerve cause unilateral or bilateral symptoms? Would this be motor, sensory or both?

Unilateral | Motor and sensory deficit

If a patient presents with signs such as clonus, up going plantars and brisk reflexes, what type of lesion would you suspect ?

Spinal cord lesion / myelopathy / UMN

What are the long tract signs of myelopathy?

``` Brisk reflexes Increased tone Up going plantars Clonus Hoffmans signs Proprioception impairement ```

Does myelopathy cause a possitive Babinski’s sign?

Yes | UMN show possitive sign whereas LMN doesn

Does radiculopathy cause fasciculations

No, nerve root compression doesnt cause fasciculations | UMN (myelopathy) causes fasciculations

What are the 5 main ligaments in the vertebral column?

``` Anterior longitudinal Posterior longitudinal Ligamentum flavum Interspinal ligament Supraspinous ligament ```

Would upper or lower motor neurone cause brisk reflexes?

UMN

Disc prolapse tends to occur in what age group?

Younger patients

What is the main feature of a disc prolapse?

Acute onset pain

Does a disc prolapse cause myelopathy or radiculopathy?

If central herniation = myelopathy | If lateral herniation = radiculopathy

What is the presentation of a lateral disc herniation ?

Acute onset pain down leg/arm of side affected | Weakness and numbness in distrubution of nerve root involved

What is the management of a disc prolapse?

Rehabillitation Nerve root injection Lumbar/cervical discectomy

What are the red flag symptoms of causes equina syndrome?

Bilateral sciatica Saddle anaesthesia Urinary dysfunction

What is the treatment for cauda equina syndrome?

Emergency lumbar discectomy

What age group are degenerative spinal diseases commonly found in?

Older patients

What is cervical spondylosis?

Umbrella term for degenerative change in the cervical spine that leads to spine and nerve root compression

What is the presentation of cervical spondylosis?

Can presentwith either radiculopathy or myelopathy | Speed of onset if usually months to years

What is the management of cervical spondylosis?

Conservative if no/mild myelopathy | Surgery for progressive moderate/severe myelopathy

What is lumbar spinal stenosis?

Spinal canal narrows and compresses the nerves at the lumbar vertebrae

What is the presentation of lumbar stenosis?

Pain down both legs ‘spinal claudication’ Pain eases with sitting down or bending forwards Worse on walking / standing

What is the treatment for lumbar stenosis?

Lumbar laminectomy

Metastases to the spinal cord are usually ; | Extra dural ? Intramural ? Intramedullary ?

Extra dural

What is the triad presentation of a malignant cord compression?

Pain Weakness Sphincter dysfunction.

What is the management for a malignant spinal cord compression?

Surgical decompression | Radiotherapy

What are the 3 main spinal infections?

Osteomyelitis Discitis Epidural abscess

What are the risk factors for osteomyelitis?

IV drug abusers Alcoholics Diabetic Chronic renal failure

What are the causative organisms of osteomyelitis?

Staph aureus Streptococcus E. coli

What is the triad presentation of osteomyelitis?

Pain Pyrexia Focal neurology

What is the management of osteomyelitis?

Urgent surgical decompression | Long term IV antibiotics

What is discitis?

Infection of the intervertebral disc

Describe the clinical presentation of vitamin a B12 deficient myelopathy

Paraesthesia of hands and feet Hyporeflexia Extensor plantar (first UMN sign) Degeneration of the corticospinal tract causing paraplegia Degeneration of the dorsal columns causing sensory ataxia Painless retention of urine

What sign suggests myelopathy caused by vitamin B12 deficiency?

L’hermittes | Flex your neck and you get a rush of electricity down your back

Diseases Of The Spinal Cord Flashcards

(67 cards)