Diseases of the Spinal Cord and Nerve Roots

Question 1

what is Myelopathy?

Answer 1

any neurologic deficit related to the spinal cord

Question 2

what is myelitis?

Answer 2

infection or inflammation of the spinal cord

Question 3

what is Radiculopathy?

Answer 3

consequence of nerve root damage

Question 4

what is radiculitis?

Answer 4

Inflammation of nerve root

Question 5

what is myeloradiculopathy

Answer 5

Disease involving the spinal cord and nerve roots

Question 6

what are the intrinsic causes of myelopathy or radiculopathy?

Answer 6

Inflammation
Infarction
Infiltration
Infection
Degenerative (neurones)

Question 7

what are the extrinsic causes of myelopathy or radiculopathy?

Answer 7

Degenerative (spine)
Tumour
Extradural, intradural/extramedullary, intramedullary
Vascular abnormalities
Haemorrhage
AVM, dural fistula
Trauma

Question 8

how do you treat extrinsic and intrinsic factors?

Answer 8

extrinsic-surgical

intrinsic-medical

Question 9

what are upper motor neurone signs of disorders affecting the spinal cord or nerve roots

Answer 9

No wasting
↑tone
↑reflexes
Pyramidal pattern of weakness

Question 10

what are lower motor neurone signs of disorders affecting the spinal cord or nerve roots

Answer 10

wasting
↓tone
↓reflexes
weakness

Question 11

what are sensory signs of radiculopathy

Answer 11

dermatomal pattern of sensory loss

Question 12

what does laminated tracts refer to?

Answer 12

any external pressure exerted on spinal cord in region of spinothalamic tracts will first experience a loss of pain and temp sensation in the sacral dermatome of the body

Question 13

name the ipislateral spinal tracts

Answer 13

UMN- Corticospinal

Dorsal columns

Question 14

name the contralateral spinal tracts

Answer 14

spinothalamic also called your ventrolateral/anterolateral tract

Question 15

what would be the signs of a c5 cord lesion?

Answer 15

Wasting of C5 innervated muscles
↑ tone in LL>UL
Reflexes ↓biceps, ↑all lower reflexes
Power ↓C5 innervated  muscles, pyramidal pattern below
Sensory level

Question 16

give some medical causes of myelopathy

Answer 16

Demyelination (MS)
Ischaemic
Transverse Myelitis
Metabolic, B12 deficiency

Question 17

where is a stroke most likely to occur on the spinal cord?

Answer 17

Thoracic cord and very bottom of cord have poor blood supply- most likely to get stroke

Question 18

what are causes of spinal cord ischaemia?

Answer 18

Anything that can throw off a clot/make blood slow or sticky:
Atheromatous disease
Thromboembolic disease 
Arterial dissection 
Systemic hypotension
Hyperviscosity 
Vasculitis

Question 19

what is the clinical presentation of spinal cord stroke?

Answer 19

May have vascular risk factors
Onset may be sudden or over several hours
Pain:
-Back pain/radicular
-Visceral referred pain
Weakness-usually paraparesis 
Numbness and paraesthesia
Urinary symptoms
Retention followed by bladder and bowel incontinence as spinal shock settles

Question 20

which artery is usually affected in spinal cord stroke?

Answer 20

Usually anterior spinal artery

Very rarely posterior spinal artery => dorsal columns spared

Question 21

Occlusion of which artery can present as a partial Brown-Séquard syndrome?

Answer 21

central sulcal artery

Question 22

what is the difference between T1 & T2 MRI?

Answer 22

T1-looks at structure(CSF black)

T2-looks at pathology(CSF white)

Question 23

what is the treatment of spinal cord stroke?

Answer 23

Supportive
Reduce risk of recurrence:
-Maintain adequate BP
-Bed rest
-Reverse hypovolaemia/arrhythmia
OT and physiotherapy
Manage vascular risk factors

Question 24

what is the prognosis of spinal cord stroke?

Answer 24

Unless significant motor recovery in first 24 hours chance of major recovery is low
Pain may be persistent
20% mortality, only 35-40% have more than minimal recovery

Question 25

when does demyelinating Myelitis occur?

Answer 25

Usually part of MS Common cause of medical spinal cord disease Can affect the young

Question 26

what characterises myelitis: multiple sclerosis?

Answer 26

pathological lesions of inflammation and demyelination leading to temporary neuronal dysfunction Affects the white matter of the CNS One or more lesions anywhere

Question 27

describe demyelination myelitis of MS

Answer 27

Partial or incomplete transverse myelitis May be the initial presentation of MS Subacute onset (slower than ischaemia) may be history of previous neurological or ophthalmological episodes

Question 28

what is the treatment of MS myelitis?

Answer 28

Supportive | Methylprednisolone

Question 29

what are the causes of transverse myelitis?

Answer 29

``` Idiopathic Viral: VZV, HSV, CMV, EBV, influenza, echo virus, HIV, hepA, rubella Other infections: Syphilis, measles, Lyme Autoimmune: SLE, sjögren’s syndrome, sarcoidosis Malignancies Post vaccination: Chicken pox, rabies ```

Question 30

what is Pernicious anaemia?

Answer 30

Autoimmune condition in which antibodies to IF prevent B12 absorption

Question 31

how does B12 deficiency affect the nervous system?

Answer 31

Myelopathy-L’hermitte’s Peripheral neuropathy (Brain, Eye/optic nerves, Brainstem, cerebellum)

Question 32

what are the symptoms of B12 deficient myelopathy?

Answer 32

``` Paraesthesia hands and feet, areflexia First UMN sign ↑plantars Degeneration of : -corticospinal tracts→paraplegia -Dorsal columns→sensory ataxia Painless retention of urine ```