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Year 2 > NeURO: Part 7 > Flashcards

NeURO: Part 7 Flashcards

1
Q

Where does the cord end

A

L1/L2 (conus medullar is)

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2
Q

Where do we take lumbar puncture

A

L4

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3
Q

What is the Cauda Equina

A

Lumbar and sacral nerve roots

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4
Q

Define paraplegia

A

Paralysis of BOTH LEGS ALWAYS caused by spinal cord lesion

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5
Q

Define Hemiplegia

A

Paralysis of ONE SIDE of body caused by lesion of th brain

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6
Q

What side of the body do upper motor neurones effect

A

CONTRALATERAL to lesion

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7
Q

Where is a lesion in upper motor neurone located

A

ABOVE anterior horn cell (spinal cord, brainstem and motor cortex)

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8
Q

Signs of upper motor neurones

A
  1. SPASTICITY (increased muscle tone)
  2. Weakness
  3. Hyperreflexia
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9
Q

What is Spasticity

A

INCREASED Muscle tone where the faster you move, the greater the resistance

CLASP-KNIFE manner

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10
Q

Why is there weakness in upper motor neurone

A

Flexors are generally weaker than extensors in legs

Extensors are weaker than flexors in arms

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11
Q

In relation to the site of lesion, where are lower motor neurone signs seen (which part of th body)

A

IPSILATERAL to lesion

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12
Q

Where is lesion found in lower motor neurone disease

A

ANTERIOR horn cell or distal to anterior horn (plexus, peripheral nerve)

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13
Q

Signs of lower motor neurone disease

A
  1. DECREASED muscle tone
  2. WASTING (atrophy) + FASCICULATIONS
  3. Weakness that corresponds to muscles supplied by involved cord segment, nerve root, part of plexus or peripheral nerve
  4. HYPOREFLEXIA
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14
Q

What are FASCICULATIONS

A

Spontaneous involuntary twitching

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15
Q

What symptoms suggest a root problem in lower motor neurone disease

A
  1. Back pain + sciatica
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16
Q

What is sciatica

A

Pain radiating from the back to down th buttocks

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17
Q

What causes sciatica

A

Manual lifting (anything that causes lower back pain)

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18
Q

What suggests cord disease in lower motor neurone

A

Weakness of biceps with absence of biceps reflex

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19
Q

What suggests cord disease in upper motor neurone

A

Weakness of legs suggests lesion is below that level

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20
Q

Define spondylolisthesis

A
  1. Slippage of one vertebra over the one below
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21
Q

What nerve root is compressed in spondylolisthesis

A

Nevre root comes out ABOVE the disc and so root affected is the one BELOW disc herniation (L4/5 herniation leads to L5 root compression)

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22
Q

What is Olisthesis

A

Spondylolisthesis that shows displacement in any direction

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23
Q

What is anterolisthesis

A

Displacement anteriorly

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24
Q

What vertebra is affected in anterolisthesis

A

L5

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25
What causes spondylolisthesis
1. Degenerative anterolisthesis due to ligamentum flavour weakness and facet arthritis
26
What is the ligamentous flavour
Connect the laminae of adjacent vertebrae Elasticity to preserve upright posture after flexion
27
Define spondylosis
Degenerative disc disease due to ANY disease
28
What causes spondylosis
YEARS of abnormal constant pressure (sports, repetitive trauma or poor posture) causing body to form new bone to distribute weight (pressure is being applied to vertebrae and discs between them)
29
What is a myotome
Group of muscles that is innervated by a single spinal nerve
30
What myotome is innervated by C5
Shoulder abduction/bicep jerk
31
What myotome is innervated by C6
Elbow flexion/supinator jerk
32
What myotome is innervated by C7
Elbow extension/triceps jerk
33
What myotome is innervated by L3/4
Knee extension/knee jerk
34
What myotome is innervated by L5
Ankle dorsiflexion
35
What myotome is innervated by S1
Ankle plantar flexion/ankle jerk
36
Define myelopathy
Compression of spinal cord resulting in upper neurone signs and symptoms dependant on where the compression is
37
What s the most common cause of acute compression
Vertebral body neoplasms
38
What causes vertebral body neoplasms
Secondary malignancy from lung, breast, prostate, myeloma and lymphoma
39
What happens to the disc in pathology
Herniation and prolapse
40
What happens in disc herniation
Centre of disc (nucleus pulpous) moves out through annulus (outer part of disc) = pressure on nerve root and pain
41
What happens in disc prolapse
Nucleus pulposus moves and presses against annulus but doesn't escape outside annulus Causes bulge in disc which pressures on nerve root = pain but less than herniation
42
What is an epidural abscess
Collection of puss in epidural space which presses on nerve root causing paralysis
43
What else can cause spinal cord compression
HAEMATOMA (warfarin) | TUMOUR
44
Clinical presentation of myelopathy
1. Spinal or root pain precedes leg weakness and sensory loss 2. Progressive weakness of legs CONTRALATERAL 3. Signs of UMN: CONTRALATERAL spasticity and hyperreflexia 4. Bladder sphincter involvement: hesitancy, frequency and painless retention 5. SENSORY LOSS below level of lesion 6. LMN signs AT level and UMN below level
45
Extra Clinical presentation seen in cervica cord lesion
ARM WEAKNESS
46
Clinical presentation in Sciatica
S1 NERVE ROOT COMPRESSOIN: | Sensory loss/pain in back of thigh/leg/lateral aspectt of little toe
47
Clinical presenttaion in L5 nerve root compression
Sensory loss/pain in lateral thigh/leg and medial side of big toe
48
Differential diagnosis of Myelopathy
1. Transverse myelitis 2. MS 3. Cord vasculitis 4. Trauma 5. Dissecting aneurysm
49
How is myelopathy diagnosed
DO NOT DELAY IMAGING AT ANY COST 2. MRI - gold standard 3. BIOPSY/ SURGICAL EXPLORATION 4. FBC 5. CXR
50
Why should Imaging (MRI) be done straight away
Irreversible paraplegia may occur if cord is not decompressed
51
Role of MRI in myelopathy
Identifies cause and site of compression
52
Role of biopsy in myelopathy
Nature of mass
53
What would I be looking for in FBC
1. ESr 2. B12 3. U+E 4. Syphylis 5. LFT 6. PSA
54
Role f CXR in myelopathy
Malignancy or TB
55
Treatment of malignancy causing myelopathy
IV DEXAMETHASONE and radiotehrapy/chemotherapy
56
Role of IV DEXAMETHASONE
Reduces inflammation/oedema around malignancy and improves outcome
57
How is epidural abscess treated
Surgically decompressed and antibiotics given
58
Treatment of myelopathy when cord herniation or prolapse is present
1. EPIDURAL steroid injection for leg pain 2. LAMINECTOMY (removal of lamina tissue between discs to relief pressure and symptoms 3. MICRODISECTOMY (removal of herniated tissue from disc
59
What is the Cauda Equine syndrome
1. Where nerve bundles in caudal equine are damaged
60
Most common cause of Cauda Equina syndrome
Lumbar disc herniation at L4/5 or L5/S1 ``` ALSO: Tumours Trauma Infection Spondylolisthesis Post-op haematoma ```
61
Pathophysiology of cauda equina syndrome
1. Nerve root compression distal to termination of spinal cord at L1/2 Usually large central disc herniations at L4/5 and L5/S1 levels
62
What roots are compressed in cauda equina syndrome
S1-S5
63
Clinical Presentation of Cauda Equina syndrome
1. Leg Weakness is FLACCID and AREFLEXIC (LMN) not spastic and hyperreflexic 2. Sciatic pain, numbness and tingling from lower back to legs and lateral small toe 3. Bilateral sciatica 4. Saddle anaesthesia 5. Bladder/BOwel dysfunction 6. Erectile dysfunction 7. Variable leg weakness that is FLACCID + AREFLEXIC
64
Differential Diagnosis of Cauda Equina Syndrome
1. Conus medullar is syndrome 2. Vertebral fracture 3. Peripheral neuropathy 4. Mechanical back pain
65
Diagnostics of Cauda Equina syndrome
1. MRI (to find lesion) 2. Knee flexion (L5-S1) 3. Ankle planter flexion test (S1-S2) 4. Straight leg raising (L5,S1) 5. Femoral stretch test (L4 root problem)
66
Treatment of Cauda Equina Syndrome
1. REFER to neurosurgeon ASAP to relieve pressure or risk irreversible paralysis 2. Microdiscectomy (removal of part of the disc) 23. Epidural steroid injection 4. Surgical spine fixation 5. Spinal fusion
67
Complications of microdiscectomy
Tears dura
68
Why is surgical spine fixation done
If vertebra slips
69
Role of spinal fusion
Reduce pain from motion and nerve root inflammation
70
Define MS
Chronic autoimmune, T-cell mediated inflammatory disorder of CNS in which there are multiple plaques of demyelination within the brian and spinal cord, occurring sporadically over years
71
What cells are attacked in MS
Oligodendrocytes NOT Schwann Cells of PNS
72
What gender is effected by MS
FEMALES
73
Age presentation of MS
20-40
74
Risk factors for MS
1. Exposure to EBV in childhood 2. Low levels of sunlight or Vit D (less lesions are seen on MRi in established MS) 3. Female 4. WHite
75
Pathophysiology of MS
1. Autoimmune mediated demyelination at multiple CNS sites to oligodendrocyte cells 2. T cell activate B cells to produce auto-antibodies against myelin 3. T cells cross BBB causing a cascade of destruction to neuronal cells in the brain 4. Myelin tries to regenerate but new myelin is less efficient and is temperature dependant when exposed to high heat conduction decreases 5. Repeated demyelination causes axonal loss and incomplete recovery between attacks
76
Where are plaques of demyelination found
``` perivenular Optic nerves Ventricles of brian Corpus callous Brainstem and cerebellar connections Cervical cord (corticospinal tract and dorsal columns) ```
77
Why are Schwann cells unaffected in MS
Different antigens to oligodendrocytes
78
What causes relapse + remitting MS
Poor demyelination healing after an attack
79
Why is movement and sensation impaired in MS
Many areas of the neurone develop scar tissue which slows conduction signals
80
What is relapse and remitting MS
Periods of good health and remission followed by sudden symptoms Accumulate disability over time if they do not fully recover after relapses
81
What follows on from relapsing and remitting MS
Secondary progressive MS
82
What is secondary progressive mS
Worsening of symptoms with very few remissions
83
What is primary progressive MS
Gradually worsening disability without relapses or remissions Presents later and fewer inflammatory changes on MRi
84
Clinical presentation of MS
1. 20-40 2. Initially mono symptomatic 3. Worsens with heat/excercise 4. Unilateral optic neuritis (pain in one eye on movement and reduced central vision) 5. Numbness and tingling of limbs 6. Leg weakness 7. Brainstem demyelination symptoms 8. Cerebellar symptoms (ataxia) 9. Trigeminal neuralgia 10. Constipation 11. Spasticity and weakness 12. Intention tremors 13. Bladder dysfunction 14. Sexual dysfunction 15. Cognitive decline 16. Amnesia
85
Signs of brainstem demyelination
1. Diplopia 2. Vertigo 3. Facial numbness 4. Dysarthria/ dysphagia 5. Loss of proprioception
86
Differential diagnosis of MS
1. Hereditary spastic paraplegia 2. Cerebral variant of SLE 3. Sarcoidosis 4. HIV
87
How is MS diagnosed
1. Requires TWO or more attacks in different parts of the CMS (2 lesions at different points in time) 2. Exclude differentials with FBC 3. MRI scan of brian and spinal cord - GOLD 4. Lumbar puncture 5. Electrophysiology
88
Role of MRI scan in MS
1. Shows periventricular lesions 2. Discrete white matter abnormalities 3. Scattered plaques
89
Role of lumbar puncture in MS
1. CSF examination shows oligoclonal IgG bands | 2. CSF cell count raised
90
Role of Electrophysiology
Delayed nerve conduction suggests demyelination
91
Primary treatment of MS
1, Encourage stress-free life (reduces lesions) | 2. Poor diet and sun exposure = vit D
92
Treatment of ACUTE relapses of mS
1. IV METHYLPREDNISOLONE (shorten relapse) - -----FREQUENT relapses) 2. SC INTERFERON 1B or 1A to reduce relapses by 30% in Relapse + remitting MS 3. Monoclonal antibodies
93
What monoclonal antibodies are given in frequent relapsing and remitting MS
1. IV ALETUZUMAB 2. IV NATALIZUMAB 3. DIMETHYL FUMARATE
94
Role of iV ALETUZUMAB
CD52 monoclonal antibody that targets T cells
95
Role of IV NATALIZUMAB
Acts against VLA-4 receptors that allow immune cells to cross the BBB (reduces number of immune cells that can enter the CNS)
96
Symptomatic treatment of MS spasticity
1. Physiotherapy 2. BACLOFEN 3. TIZANIDINE 4. BOTOX INJECTIONS 5. DOXAZOSIN (for incontinence) 6. Stem cell transplant
97
What is Baclofen
GABA analogue that reduces Ca@+ influx
98
What is Tizanidine
Alpha 2 agonist
99
What is Botox injection
Reduces ACh in neuromuscular junction = less spasticity
100
Cons of botox
Only lasts 2-12 weeks
101
How is urinary incontinence treated in MS
1. Intermittent self-catheterisation | 2. DOXASOSIN (anti-cholinergic alpha blocker
102
What causes death in MS
Aspiration pneumonia
103
Define myasthenia Gravis
Autoimmune disease against AChR in neuromuscular junction
104
What gender is affected in Myasthenia Gravis
FEMALES than males
105
Peak incidence of MG in females
30
106
Peak incidence of MG in males
60
107
What diseases are associated with MG for females
pernicious anaemia SLE Rheumatoid arthritis THYMIC HYPERPLASIA
108
What disease is associated with MG in men
THYMIC ATROPHY THYMIC CTUMOUR rheumatoid arthritis SLE
109
What causes transient MG
D-PENICILLAMINE treatment | Wilson's disease

Year 2 (155 decks)

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