Spinal Cord

Question 1

If a patient has a sensory level T10, where is the spinal cord lesion?

Answer 1

T7/T8

Question 2

Compressive causes myelopathy (5)

Answer 2

Tumor
Disc prolapse
Vertebral collapse
Haemorrhage
Abscess

Question 3

6 non-compressive causes myelopathy

Answer 3

Infections
Demyelinating diseases
Metabolic conditions
Vascular problems
Neoplasm
Hereditary

Question 4

Name 6 infections that can cause myelopathy

Answer 4

TB
Syphilis
Herpes
Bilharzia
HIV
HIV associated: toxoplasma, varicella, CMV

Question 5

Name 3 demyelinating diseases that can cause myelopathy

Answer 5

Multiple sclerosis
Neuromyelitis optica (de vic’s)
Acute demyelinating encephalomyelitis (ADEM)

Question 6

Name a metabolic condition that can cause myelopathy

Answer 6

Vit B12 deficiency

Question 7

Name a vascular problem that can cause myelopathy

Answer 7

Anterior spinal artery occlusion (there is only 1)

Question 8

Name 4 neoplasms that may cause myelopathy

Answer 8

Primary: astrocytoma, ependymoma, lymphoma
Secondary: metastasis eg prostate

Question 9

Which signs are classically present in a spinal cord syndrome? (4)

Answer 9

UMN leg weakness
Sphincter disturbance
Severe backache and fever = possible epidural abscess
Sensory disturbance legs
Emergency!

Question 10

Where might the lesion be in the spinal cord if the patient is unable to sit up?

Answer 10

At least up to T8

Question 11

Clinical pointers to a vertebral body/ extradural disease? (4)

Answer 11

Backache
Neuralgic pains (sharp shooting in a nerve distrib)
Vertebral tender
Vertebral spinous process step/kyphosis

Question 12

Transection of the cord presentation (3)

Answer 12

Weak below lesion
Spinothalamic fallout below lesion
Loss of post column sensation below lesion

Question 13

Causes of transection spinal cord

Answer 13

Usually trauma: ant dislocation of one vertebra on another

Viral /post-viral eg after exanthemous infection

Question 14

Anterior spinal artery syndrome presentation

Answer 14

Weak below lesion UMN (corticospinal)
Spinothalamic sensory fallout below lesion
Posterior columns intact

Question 15

Central cord Syndrome presentation (7)

Answer 15

Suspended sensory level (cape-like sensory loss)
Dissociated sensory deficit (preserved fine touch + proprio, selective loss pain + temp)
DORSAL COLUMN SPARED. Corticospinal + spinothalamic damaged
Sphincters affected early
Sacral sensory sparing
Weakness UMN below lesion
LMN signs at level of lesion
Symmetrical
UL first, later LL

Question 16

Causes central cord syndrome (4)

Answer 16

Syrinx (syringomyelia-cyst)
Tumours
Demyelination
Granulomas

Question 17

Posterolateral cord syndrome presentation (3)

Answer 17

Spasticity below lesion
Post column fallout below lesion
Spinothalamic spared

Question 18

Causes posterolateral cord syndrome ( 4)

Answer 18

HIV
B12 deficiency! ( with or without pernicious anemia)
Trauma
Hereditary: friedreich’s ataxia

Question 19

Causes hemi section cord or Brown- Séquard syndrome (3)

Answer 19

Trauma :assymetrical central disc prolapse common
Tumours: myeloma of vertebral body, metastasis
Demyelination: MS common

Question 20

Cauda equina syndrome presentation (6)

Answer 20

Asymmetrical and painful
Perianal and “saddle” paraesthesia!
Bowel, bladder, sexual dysfunction
Associated:lower back pain, radiculopathy/sciatica, paraesthesia LL and perianal / saddle, weakness LL LMN, decreased or absent reflexes

Question 21

Conus medullaris syndrome presentation (4)

Answer 21

Saddle anaesthesia S1-S5
Loss bladder reflex: urinary retention
Loss bowel reflex: incontinence
LL motor weak, paraesthesia, numb- mixed upper and lower motor neurone unlike cauda equina (LMN)

Question 22

Name 2 broad causes of myelopathy

Answer 22

• Compressive
• non- compressive