Question 1

Causes of spinal cord compression

Accepted Answer

spinal injury (MVA), malignancy (lung, breast, prostate, myeloma) infection (epidural abscess)

Question 2

Symptoms of spinal cord compression

Accepted Answer

gradually worsening, severe local back pain, back pain worse in the recumbent position/ at night Early signs: symmetric lower extremity weakness and hypoactive absent deep tendon reflexes Late signs : bilateral babinski reflex, decreased rectal sphincter tone, paraparesis/paraplegia with increased DTR and sensory loss

Question 3

Management of spinal cord compression

Accepted Answer

emergency MRI IV steroids vs antibiotics neurosurgery, radiation oncology consult

Question 4

when to use intrathecal chemotherapy?

Accepted Answer

only for leptomeningeal (dura, arachnoid and pia mater) metastasis due to certain solid and hematological cancers (breast, lymphoma, leukemia) But not used to tx acute compression

Question 5

Todd's Palsy

Accepted Answer

focal weakness of hand arm or leg after seizure.

Question 6

Toluene inhalation presentation

Accepted Answer

cognitive impairment, flaccid weakness and absent DTR see non anion gap metabolic acidosis and RTA type 1 and hypokalemia.

Question 7

transverse myelitis

Accepted Answer

rare inflammatory disorder causing segmental spinal cord injury.

Question 8

cause of transverse myelitis

Accepted Answer

idiopathic and likely from underlying autoimmune disorder following viral infection (50% of cases)

Question 9

pt presents in spinal shock and with a band like squeezing pain. They will have bowel and bladder dysfunction. After one week they have spasticity, hyperreflexia, Babinski signs and clonus

Accepted Answer

transverse myelitis

Question 10

spinal shock is

Accepted Answer

lower extremity weakness, flaccidity, areflexia, and absent Babinski sign sensory level to all primary sensory modalities a

Question 11

Diagnosis of transverse myelitis is via

Accepted Answer

MRI with contrast shows enhancing cord segments with surrounding edema

Question 12

CSF analysis of transverse myelitis is

Accepted Answer

elevated protein moderate lymphocytosis and normal glucose and NO oligoclonal bands

Question 13

Treatment of transverse myelitis

Accepted Answer

supportive care with PT and IV steroids can help with pts who have an autoimmune component of dx

Question 14

prognosis of transverse myelitis

Accepted Answer

3 month recovery but 40% may have some residual disability

Question 15

Cauda equina syndrome is from

Accepted Answer

affects lumbosacral roots as they exit the spinal cord and caused by a herniated disk or tumor

Question 16

severe unilateral pain in the saddle region that radiates down to the legs with associated asymmetrical lower extremity weakness and proximal or distal

Accepted Answer

cauda equina syndrome

Question 17

features that distinguish cauda equina syndrome vs GBS vs transverse myelitis

Accepted Answer

Cauda equina syndrome - bowel and bladder sphincter weakness GBS- no bowel or bladder sphinter weakness Cauda equina will have severe lancinating or shooting pain in back transverse myelitis no back pain

Question 18

Difference between transverse myelitis from GBS

Accepted Answer

both can have spinal shock with reflexes and Babinski sign will be absent GBS --NO bowel and bladder symptoms or a sensory loss below the spinal segment transverse myelitis --WILL have bowel and bladder symptoms or a sensory loss below the spinal segment

Question 19

Spinal cord infarction will have

Accepted Answer

back pain weakness, loss of sensation and reflexes and autonomic dysfunction and this happens abruptly in minutes to hours.

Question 20

vitamin B12 deficiency will have

Accepted Answer

slow progressive weakness, ataxia and neuropsychiatric disturbances.

Question 21

anterior horn cell (poliomyelitis) injury rather than transverse leukomyelitis thus will have sparing of ascending (pain and temperature and vibration or proprioception) and descending (pyramidal and extrapyramidal motor system and autonomics)

Accepted Answer

how west nile virus works

Question 22

pt has asymmetric flaccid paralysis and extrapyramidal symptoms with fever and maculopapular rash on chest and extremities

Accepted Answer

West Nile virus

Question 23

Treatment of west nile virus

Accepted Answer

supportive and try mosquito prevention programs.

Question 24

diagnosis of west nile virus

Accepted Answer

IgM serology in pts with only fever. CNS symptoms need LP to rule out other etiologies and confirm diagnosis with IgM antibody titer

Question 25

Guillain Barre syndrome

Accepted Answer

progressive and symmetrical ascending paralysis and paresthesias and decreased to absent reflexes and possible respiratory distress. This is a monophasic disease - meaning _after it hits its nadir at 4 weeks pts will slowly have weakness improve._ They will be stable and autonomically should improve. Rates of full recovery can be slow and 80% are able to walk at 6 months No need to repeat any IVIG after reaching the nadir of weakness. Also avoid steroids - can worsen GBS.

Question 26

post polio syndrome

Accepted Answer

See progressive weakness, fatigue, muscle aches and joint pain which worsens abruptly \>50. seen in pts who had history of paralytic polio due to age related drop out of existing motor units.

Question 27

ALS is

Accepted Answer

progressive neurodegenerative dx that happens in men \>40 yrs

Weakness, paralysis, spinal cord compression Flashcards

spinal cord compression, GBS, demyelination, Todd's palsy and toluene solvent inhalation, myasthenia gravis, ALS,

Brainscape's Knowledge GenomeTM

Weakness, paralysis, spinal cord compression Flashcards

spinal cord compression, GBS, demyelination, Todd's palsy and toluene solvent inhalation, myasthenia gravis, ALS,

Brainscape's Knowledge Genome^TM