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Neuro and geriatrics > Spinal cord disorders > Flashcards

Spinal cord disorders Flashcards

1
Q

How is the spinal cord arranged?

A

More than 19 different tracts

Ends in the cauda equina

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2
Q

What is the most important descending motor tract?

A

Lateral corticospinal tract

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3
Q

What is that pathway of the lateral corticospinal tract?

A

Begins in cerebral cortex, decussates in pyramids of lower medulla (medulla oblongata) and travels down contralateral side of spinal cord

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4
Q

What are the most important ascending sensory tracts?

A

Fasciculus gracilis
Fasciculus cuneatus
Lateral spinothalamic
Anterior spinothalamic

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5
Q

What is the function of the fasciculus gracilis?

A

Transmits vibration, conscious proprioception, and fine touch sensations from lower body

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6
Q

What is the function of the fasciculus cuneatus?

A

Carries tactile and proprioceptive information for upper limbs and torso

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7
Q

What is the function of the lateral spinothalamic tract?

A

Carries information about pain and temperature

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8
Q

What is the function of the anterior spinothalamic tract?

A

Carries information about touch and pressure

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9
Q

What makes up the dorsal column?

A

Fasciculus gracilis and fasciculus cuneatus

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10
Q

Where does the dorsal column decussate?

A

In the medulla

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11
Q

Where does the anterior spinothalamic tract decussate?

A

Crosses over at level of the spinal cord

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12
Q

Where does the lateral spinothalamic tract decussate?

A

At the level of the spinal cord

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13
Q

What artery is the biggest source of blood supply in the spinal cord?

A

Anterior spinal artery

Supplies 2/3

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14
Q

What are the 11 ways of classifying spinal cord disorders?

A
  1. Traumatic - whiplash, gunshot, stab, haematoma
  2. Degenerative disc disease - cervical/lumbar spondylosis, spinal canal stenosis
  3. Inflammatory - MS, transverse myelitis, NMO
  4. Neoplastic - intrinsic/extrinsic
  5. Infective, HIV, HTLV, abscess, empyema
  6. Vascular - ASA occlusion, spinal dural fistula, vasculitis
  7. Granulomatous - sarcoidosis
  8. Metabolic - vit B12 deficiency
  9. Hereditary - hereditary spastic paraplegia, Fredrich’s ataxia
  10. Other neurodegenerative - ALS
  11. Other - syringomyelia
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15
Q

Give an example of an intrinsic spinal cord tumour

A

Ependymoma

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16
Q

Give an example of an extrinsic spinal cord tumour

A

Meningioma

Metastatic lymphoma

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17
Q

What acute/subacute conditions are spinal cord emergencies?

A 
Bladder/bowel weakness
Saddle anaesthesia
Leg weakness
Constant sensory deficit
Significant pain
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18
Q

How do you assess spinal cord problems?

A

Acute imagine of spine

MRI

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19
Q

What investigations do you do in a traumatic spinal cord issue?

A

MRI

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20
Q

What investigations do you do in degenerative disc disease?

A

MRI

CT

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21
Q

What investigations do you do in inflammatory spinal problems?

A

MRI spine and brain with contrast

LP - OCB and cells

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22
Q

What investigations do you do in neoplastic spinal problems?

A

MRI with contrast

23
Q

What investigations do you do in vascular spinal problems?

A

MRI
Angiography
Vasculitis screen

24
Q

What investigations do you do in granulomatous spinal problems?

A

Serum ACE level
MRI
CXR

25
Q

What investigations do you do in metabolic spinal problems?

A

B12/folate
MMA
Fasting homocysteine levels

26
Q

What investigations do you do in hereditary spinal problems?

A

Genetic panel

27
Q

What investigations do you do in neurodegenerative conditions?

A

EMG

Genetics

28
Q

What are the common causes of a dorsal column lesion?

A

MS
Penetrating injuries
Compression from tumours

29
Q

What will you lose in a dorsal column lesion?

A

Ipsilateral loss of light touch, vibration, proprioception generalised below level of lesion

30
Q

What are the common causes of a fasciculus cuneatus lesion?

A

MS
Penetrating injuries
Compression from tumours

31
Q

What will you lose in a fasciculus cuneatus lesion?

A

Ipsilateral loss of light touch, vibration and proprioception below lesion

32
Q

What are the common causes of lateral corticospinal tract lesions?

A

Penetrating injuries
Lateral compression from tumours
MS

33
Q

What will you lose in a lateral corticospinal tract lesion?

A

Ipsilateral UMN signs - spastic paralysis, hyperreflexia, babinski, clonus, hypertonia generalised below lesion

34
Q

What are the common causes of lateral spinothalamic tract lesions?

A

MS
Penetrating injuries
Compression from tumours

35
Q

What will you lose in a lateral spinothalamic tract lesion?

A

Contralateral loss of pain and temperature

36
Q

What are the common causes of a lesion of the anterior grey and white commissures?

A

Post-traumatic contusion
Syringomyelia
Intrinsic spinal cord tumours

37
Q

What will you lose in a lesion of the anterior grey and white commisures?

A

Pain and temperature sensation impaired bilaterally

38
Q

What is central cord syndrome?

A

Lesion of anterior grey and white matter commisures

39
Q

What are the common causes of brown sequard syndrome?

A

Penetrating injuries
Lateral compression from tumours
MS

40
Q

What lesions will you get in Brown-Sequard syndrome?

A

Dorsal column
Lateral corticospinal tracts
Lateral spinothalamic tracts

41
Q

What will you lose in Brown-Sequard syndrome?

A

Ipilateral loss of light touch, vibration, proprioception, UMN signs
Contralateral loss of pain and temperature

42
Q

What lesions will you get in a transverse cord lesion?

A

Doral column
Lateral corticospinal
Lateral spinothalamic

43
Q

What will you lose in a transverse cord lesion?

A

Bilateral loss of light touch, vibration, proprioception
Bilateral UMN signs
Bilateral loss of pain and temperature

44
Q

What are the common causes of transverse cord lesions?

A

Trauma
Tumours
Transverse myelitis
MS

45
Q

What is posterior cord syndrome?

A

Complete transection of dorsal columns

46
Q

What are the common causes of posterior cord syndrome?

A

Trauma
Compression from posteriorly located tumours
MS
Vit B12 deficiency

47
Q

What will you lose in posterior cord syndrome?

A

Bilateral loss of light touch, vibration and proprioception

48
Q

What is anterior cord syndrome?

A

Complete transection of lateral corticospinal and spinothalamic tracts

49
Q

What will be the symptoms of anterior cord syndrome?

A

Bilateral UMN signs and LMN signs

Absence of pain and temperature sensation bilaterally

50
Q

What are the common causes of anterior cord syndrome?

A

Anterior spinal artery infarct
Trauma
MS

51
Q

What can cause a hemi-section of the cord by extra-medullary compression?

A 
Intervertebral disc protrusion
Spinal cord tumours - meningiomas
Metastatic deposits
Abscess
Transverse myelitis
MS
Sarcoidosis
52
Q

What can cause cauda equina?

A

Compressive - discs, tumours (primary and secondary)
Non-compressive - inflammatory, infiltrative, granulomatous
Vascular - spinal dural fistula

53
Q

What are the signs of cauda equina?

A

SPINE

  • Saddle anaesthesia
  • Pain/paralysis
  • Incontinence of bladder/bowel
  • Numbness
  • Emergency
54
Q

How do you manage spinal cord disorders?

A 
Manage cause - exclude emergencies
Some are untreatable
Manage complications
- Weakness
- B/B dysfunction
- Spasticity
- Pain
- Pressure areas
- Mobility

Neuro and geriatrics (21 decks)

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