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3a neurology > Myelopathy and radiculopathy > Flashcards

Myelopathy and radiculopathy Flashcards

1
Q

Give 2 causes of spinal cord compression

A
  • Vertebral body neoplasms - metastases
  • Disc prolapse/ herniation
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2
Q

Spinal tumours can be secondary to metastatic disease such as…(3)

A

Lung cancer
Breast
Prostate
Kidney
Thyroid

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3
Q

Give 5 symptoms of spinal cord compression

A
  • Back/ neck pain
  • Progressive weakness - unsteady gait
  • UMN signs
  • Bladder/ bowel incontinence - late Sx
  • Numbness/ tingling of toes/ fingers
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4
Q

What is normally the first symptom that presents in spinal cord compression

A

Back pain

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5
Q

State 3 things that could exacerbate the back pain in a spinal cord compression

A
  • Lying down
  • Coughing
  • Straining
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6
Q

Give 2 RFs for spinal cord compression

A
  • Known cancer
  • > 40
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7
Q

What is the gold standard investigation for a spinal cord compression

A

Gadolinium enhanced MRI spine - cause and site of compression

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8
Q

When is the gold standard investigation for a spinal cord compression contraindicated and what is the alternative imaging offered

A
  • CI - Px with implanted pacemaker or claustrophobia etc
  • CT myelography is alternative
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9
Q

How is spinal cord compression managed (3)

A
  • IV dexamethasone ASAP
  • Radiotherapy
  • Surgery: decompression
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10
Q

When are corticosteroids contraindicated in treatment of spinal cord compression

A

Confirmed or significant suspicion of lymphoma

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11
Q

Why is spinal cord compression considered a medical emergency

A

Can lead to paralysis

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12
Q

What spinal nerves combine to form the sciatic nerve?

A

L4-S3

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13
Q

What areas of sensation does the sciatic nerve supply?

A

Lateral lower leg and foot

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14
Q

Which muscle groups receive motor function from the sciatic nerve?

A

Posterior thigh, lower leg, and foot.

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15
Q

What are 2 causes of sciatica

A
  • Disc herniation/ prolapse at L4/5 or L5/S1
  • Spinal stenosis
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16
Q

What type of pain characterises sciatica

A

Unilateral pain from the buttock radiating down the back of the thigh to below the knee or feet, often described as “electric” or “shooting” pain.

17
Q

Besides pain, what other symptoms are associated with sciatica?

A
  • Paraesthesia
  • numbness
  • motor weakness - foot drop
  • Reflexes may also be affected depending on the affected nerve root
18
Q

How is sciatica diagnosed

A
  • Clinical exam
  • MRI spine - GS
19
Q

How is sciatica managed

A
  • Physio
  • Analgesia
  • Group exercise
  • Amitriptyline
  • Surgery if chronic
20
Q

What is cauda equina syndrome (CES)?

A

A surgical emergency involving compression of the nerve roots at the bottom of the spine

21
Q

What are the primary causes of CES

A
  • MC - disc prolapse at the L4/5 or L5/S1 level and spinal canal stenosis
  • Less commonly, it can result from issues in higher discs, tumours, infections, or trauma.
22
Q

What are some typical symptoms and signs of Cauda Equina Syndrome

A
  • Bladder dysfunction
  • low back pain
  • bilateral/ unilateral sciatica
  • lower limb weakness
  • bowel dysfunction
  • Saddle anaesthesia
23
Q

What functions are supplied by the nerves of the cauda equina?

A

*Sensation - lower limbs, perineum, bladder, and rectum.
* Motor - lower limbs, anal and urethral sphincters.
* Parasympathetic innervation of the bladder and rectum.

24
Q

How is cauda equina investigated

A
  • MRI lumbar spine (CT if CI) ASAP - visualisation of lesion
    Post op:
  • DRE - reduced tone
  • Urodynamic tests
25
Q

How is CES treated (2)

A
  • Decompression surgery ASAP
  • Bladder and bowel management
26
Q

What is spinal stenosis

A

Refers to narrowing of part of the spinal canal that results in compression of the spinal cord and nerve roots

27
Q

What part of the spine does spinal stenosis typically affect

A
  • Lumbar (mc)
  • cervical
28
Q

State 3 types of spinal stenosis

A

*Central stenosis - narrowing of central spinal cord
* Lateral - narrowing of nerve roots canals
* Foramina stenosis - narrowing of intervertebral foramina

29
Q

Give 5 causes of spinal stenosis

A
  • Congenital
  • Degenerative changes (mc)
  • Herniated discs
  • Spondylolisthesis
  • Trauma e.g. fractures
30
Q

Define spondylolisthesis

A

Anterior displacement of a vertebra out ofline with the one below

31
Q

Give 3 RFs for spinal stenosis

A
  • Age >40
  • Acromegaly
  • Previous back injury
32
Q

Give 4 symptoms of lumbar stenosis

A

*Intermittent neurogenic claudication
* Back pain
* Pain radiating down leg
* Stooped posture when walking

33
Q

Describe the onset of symptomsin lumbar stenosis

A

Gradual

34
Q

What is the impact of posture on lumbar stenosis symptoms

A
  • Absent at rest and when seated
  • Worsens with standing and walking
  • Improved by bending forward
35
Q

What is the gold standard imaging investigation for diagnosing spinal stenosis and what would a positive finding be

A
  • MRI (T2 weighted)
  • Compression of the neural elements and soft tissue
36
Q

Excluding the GS imagery, what other investigations can be done to aid diagnosis of spinal stenosis

A
  • Plain XR - degenerative changes
  • CT if MRI is CI
37
Q

How is spinal stenosis treated

A
  • Analgesia - NSAIDs
  • Prednisolone 1 week
  • Decompressive laminectomy ( if Sx persist over 3m)

3a neurology (13 decks)

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