spinal cord sydromes

Question 1

what is polio ?

Answer 1

an RNA virus that destructs the anterior horn
LMN lesion - so causes flaccid paralysis

Question 2

what is the classic presentation associated with polio ?

Answer 2

unvaccinated child that has febrile illness , with neuro illness that present 4 to 5 days later
associated with weakness more in the legs than in the arms
flaccid muscle tone
usually one leg is much smaller than the other

Question 3

what are the vaccines used to fight polio ?

Answer 3

salk vaccine - killing intramuscularly
Sabin vaccine - live attenuated oral

Question 4

what is the feature in the polio vaccine that counts for their efficacy ?

Answer 4

neutralizing antibodies in the circulation

Question 6

what is werdnig hoffman disease?

Answer 6

it is a s type of spinal muscular atrophy , the mosyt severe form of it
associated with diffuse muscle atrophy and the classic finding is tongue fasiculations
floppy baby syndrome

Question 7

what is the prognosis of werdnig hoffman disease ?

Answer 7

death in a few months

Question 8

what is multiple sclerosis ?

Answer 8

t cell mediated autoimmune disease against oligodendrocytes , usually in white woman in 20-30 year range

Question 9

what is the most common presentation associated with MS ?

Answer 9

optic neuritis and INO
relapsing remitting manner

Question 10

what is amyotrophic lateral sclerosis ?

Answer 10

combines UMN and LMN disease where there is degeneration of the anterior horn cells and the lateral corticospinal tract
with no sensory symptoms

Question 11

what type of incontinence is associated with MS ?

Answer 11

urge incontinence

Question 12

is MS UMN or LMN ?

Answer 12

UMN so is associated with hyperreflexia and a positive babinski sign

Question 13

what is the common cause of death associated with ALS ?

Answer 13

aspiration pneumonia

Question 14

what is the treatment for ALS ?

Answer 14

riluzole , decrease glutamate release

Question 15

what are the causes of familial cases of ALS ?

Answer 15

zinc copper superoxide dismutase defeciency
increased free radical release
SOD1 mutation

Question 16

what is the classic presentation of ALS ?

Answer 16

50 year old patient that has arm weakness
some flaccid muscle some spastic muscles
dysphagia
no sensory symptoms

Question 17

how is polio transmitted ?

Answer 17

feco oral transmission

Question 18

what is the pathology associated with ASA occlusion ?

Answer 18

anterior spinal artery occlusion is associated with loss of all except posterior columns , so only vibration and proprioception is intact

Question 19

what is the initial presentation of ASA occlusion ?

Answer 19

iniitially spinal shock
flaccid bilateral paralysis below the lesion
weeks later

spastic paralysis below the level of the lesion
bilateral loss of pain and temperature below the lesion

Question 20

what is the most common cause associated with ASA occlusion ?

Answer 20

aortic aneurysm repair

Question 21

what does the ASA supply ?

Answer 21

the anterior 2/3 of the spinal tract
corticospinal tract
spinothalamic tract
anterior horn cells

no dorsal column supply - thats the posterior spinal artery

Question 22

what is tabes dorsalis ?

Answer 22

degenration of the dorsal column due to syphillus , leading to bilateral loss of vibration and proprioception

Question 23

what are the positive findings associated with tabes dorsalis ?

Answer 23

ataxia ( wide based gate) with a positive romberg test
argyll robertson pupil
shooting pain
charcot joint

Question 24

what is syringiomyelia ?

Answer 24

fluid filled cavity within the spinal cord that usually happens between C2 and T( , results in a loss of pain and temperature in a cape like fashion ( from C5 to T4)

Question 25

what malformation is associated with syringomyelia ?

Answer 25

chiairi malformation I kyphoscoliosis

Question 26

what structure is compressed in syringomyelia ?

Answer 26

anterior white commissure

Question 27

where can syringomyelia expand to ?

Answer 27

can expand to the anterior horn cells - LMN or lateral horn - give horner syndrome

Question 28

what is subacute combined degeneration ?

Answer 28

neurological degeneration of the spinocerebellar tract corticospinal tract dorsal column (SCD) B12 deficiency

Question 29

what is the classic presentation associated with SCD ?

Answer 29

problems walking in high risk groups can present as reversible dementia

Question 30

what is brown sequard syndrome ?

Answer 30

loss of half of the spinal cord due to trauma or tumor

Question 31

what is the presentation of brown sequard syndrome ?

Answer 31

at the site of lesion there is loss of all sensations along with LMN signs below the level of the lesion there are UMN signs and loss of vibration and proprioception on the contralateral side of the lesion there is loss of pain and temperature

Question 32

when is horner syndrome associated with brown sequard syndrome ?

Answer 32

when the level of the lesion is above T! due to affection of the oculosympathetic pathway

Question 33

where is the cauda equina ?

Answer 33

nerves below the conus medullaris

Question 35

what is the cause of cauda equina and what are the associated findings ?

Answer 35

cause is usally due to herniation of the disc or metastasis to the spine presents with asymmetric saddle anesthesia urinary retention LL neuro findings severe lower back pain

Question 36

what is conus medullari syndrome ?

Answer 36

injury to T12 to L2

Question 37

what is the classic presentation associated with conus medullaris syndrome ?

Answer 37

perianal anesthesia sudden onset of bilateral leg weakness impotence