Neurological injuries: Spine

Question 1

Where are spinal injuries most common?

Answer 1

Cervical spine (most mobile)

Question 2

Why do you need to assess the rest of the spine in cervical spine fracture?

Answer 2

10% of patients will have a second non-contiguous vertebral column fracture

Question 3

Which tracts can be tested clinically?

Answer 3

Dorsal
Corticospinal
Spinothalamic

Question 4

What does the spinothalamic tract carry?

Answer 4

Pain and temperature

Question 5

What does the corticospinal tract carry?

Answer 5

Voluntary motor

Question 6

What does the dorsal tract carry?

Answer 6

Balance
Propriocepion
Vibrations
Light touch

Question 7

Which tracts decussate at the medulla?

Answer 7

Lateral corticospinal

Dorsal

Question 8

Effect of severed cord on b-p-v-l and voluntary motor (from lateral corticospinal)?

Answer 8

Ipsilateral loss as the dorsal and lateral corticospinal tracts decussate at the medulla

Question 9

Effect of severed cord on pain and temperature?

Answer 9

Contralateral loss as the spinothalamic tract decussates as soon as it enters the spinal cord

Question 10

Bicep reflex comes from which nerve roots?

Answer 10

C5/6

Question 11

Tricep reflex comes from which nerve roots?

Answer 11

C7/8

Question 12

Knee reflex comes from which nerve roots?

Answer 12

L3/4

Question 13

Ankle reflex comes from which nerve roots?

Answer 13

S1/2

Question 14

Muscle strength grading 5?

Answer 14

Normal power

Question 15

Muscle strength grading 4?

Answer 15

Movement possible against gravity and some resistance

Question 16

Muscle strength grading 3?

Answer 16

Movement possible against gravity

Question 17

Muscle strength grading 2?

Answer 17

Movement when gravity excluded

Question 18

Muscle strength grading 1?

Answer 18

Flicker of contraction

Question 19

Muscle strength grading 0?

Answer 19

No strength

Complete paralysis

Question 20

Motor neurone disease (amyotrophic lateral sclerosis):

Answer 20

Affects both upper (corticospinal) and lower motor neurones resulting in mixed UMN and LMN signs

Question 21

Poliomyelitis:

Answer 21

Affects anterior horns resulting in lower motor neurone signs

Question 22

What causes Brown-Sequard syndrome?

Answer 22

Lesion is a hemi-section of the spinal cord

Question 23

Which tracts are affected in Brown-Sequard syndrome and what is the result?

Answer 23

Lateral corticospinal - ipsi spastic paresis below lesion
Dorsal columns - ipsi loss of b-p-v-l below lesion
Lateral spinothalamic - contra loss of pain and temp

Question 24

What causes subacute combined degeneration of the spinal cord?

Answer 24

Deficiency in vitamins B12 and E

Symptoms are bilateral

Question 25

Which tracts are affected in subacute combined degeneration of the sc and what is the result?

Answer 25

Lateral corticospinal - bilateral spastic paresis below lesion Dorsal columns - bilateral loss of b-p-v-l below lesion Spinocerebellar tracts - bilateral limb ataxia

Question 26

Differential between subacute combined degeneration of the spinal cord and Friedrich's ataxia?

Answer 26

Friedrich's ataxia has all of the same symptoms and tract damage as subacute + intention tremor

Question 27

Which tracts are affected in anterior spinal artery occlusion and what is the result? (anterior cord syndrome)

Answer 27

Lateral corticospinal - bilateral spastic paresis below lesion Lateral spinothalamic - bilateral loss of pain and temp

Question 28

Which tracts are affected in syringomyelia and what is the result?

Answer 28

Ventral horns - flaccid paresis (intrinsic hand muscles) | Lateral spinothalamic - loss of pain and temperature

Question 29

Which tracts are affected in MS and what is the result?

Answer 29

Asymmetrical varying mixture of tracks resulting in combination of motor, sensory and ataxia symptoms

Question 30

Effect of central cord syndrome?

Answer 30

Upper limb weakness (motor fibres to upper limbs are more centrally located than to lower limbs)

Question 31

What causes anterior cord syndrome?

Answer 31

Thrombus in anterior spinal artery that supplies the anterior 2/3 of the spinal cord

Question 32

What is neurogenic shock?

Answer 32

Damage to the sympathetic chain and loss of vasomotor tone causing hypotension, bradycardia, hot flushing and priapism (painful and persistent erection of the penis) Can be fatal

Question 33

Features of spinal shock:

Answer 33

Reversible loss of reflexes below level of the spinal cord injury Occurs immediately after the injury but only lasts days to months

Question 34

Cauda equina syndrome is a...

Answer 34

Neurological emergency

Question 35

What is cauda equina syndrome?

Answer 35

Compression of the nerve roots distal to L1

Question 36

Causes of cauda equina syndrome?

Answer 36

Prolapsed disc Bony fragments Tumour Abscess

Question 37

Symptoms of cauda equina syndrome?

Answer 37

Severe pain in anal sphincter, bladder and legs Incontinence of bowel and bladder + retention Perianal and bladder numbness Erectile dysfunction Leg weakness and absence of lower limb reflexes

Question 38

When is full in-line spinal immobilisation indicated? | 8 things

Answer 38

``` Spinal pain Significant distracting injuries Intoxicated Confused/uncooperative Reduced GCS Hand/foot weakness or loss of sensation Priapism History of past spinal problems ```

Question 39

What are the 3 X-ray views for the cervical spine?

Answer 39

AP Lateral Open mouth Peg (odontoid process)

Question 40

What are the two X-ray views for thoracic-lumbar spine?

Answer 40

AP | Lateral

Question 41

What imaging should be done for suspected spinal cord injury?

Answer 41

MRI

Question 42

Which joints should be specifically examined in c. spine X-ray/CT?

Answer 42

Occipital-atlanto-axial joint | Joint between atlas and axis

Question 43

What causes Hangman's fracture?

Answer 43

Neck hyper-extended by the weight of the whole body (i.e. hanging)

Question 44

What is a Hangman's fracture?

Answer 44

Bilateral fracture of C2 pedicles Prevertebral soft tissue swelling Anterior dislocation of the C2 vertebral body

Question 45

What is a Jefferson fracture?

Answer 45

Fractures of the anterior and posterior arches of C1 when diving into shallow water

Question 46

Types of odontoid process fracture:

Answer 46

``` I = Tip II = Body III = Base ```