Term
| A lesion in the Corticospinal tract will cause what? |
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Definition
Hyper-reflexia
Spasticity
Babinski Sign
weakness |
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Term
| A lesion to the Posterior columns will cause what? |
|
Definition
Loss of vibration sense
Loss of position sense
Romberg sign |
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Term
| A lesion in the spinothalamic tract will cause what? |
|
Definition
| Loss of Pain and Temperature, sensory level |
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Term
| A lesion in the Anterior Horn cells will cause what? |
|
Definition
Flaccid weakness
hypo-reflexia
fasciculations |
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Term
| A lesion to the Root will cause what? |
|
Definition
Irritation -Lancinating pain
Damage - Numbness and hypo-reflexia |
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Term
| What is the anatomy of the Spinal cord from inside->out? |
|
Definition
Spinal cord parenchyma
Pia Matter
subarachnoid space
subdural space
dura
epidural space
bone |
|
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Term
|
Definition
| pia and subarachnoid space |
|
|
Term
| Where is the T4 sensory level? |
|
Definition
|
|
Term
| Where is the T10 sensory level? |
|
Definition
|
|
Term
| What is the bladder mostly controlled by? |
|
Definition
|
|
Term
| What bladder symptoms are involved in an acute lesion? |
|
Definition
| urinary retention with some overflow incontinence |
|
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Term
| What type of bladder symptoms occur in chronic spinal cord lesions? |
|
Definition
| small spastic bladder, does not completely empty with spasms and urge incontinence |
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Term
| What is the approach for a patient with myelopathy? |
|
Definition
Recognize signs and symptoms
Immediate neuro-radiologic testing
Lumbar puncture if neuro-rad testing negative
Therapy usually IV steroids |
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Term
| Approach to Chronic Myelopathy |
|
Definition
Recognize signs and symptoms
Neuro-radiologic testing
Lumbar puncture
Therapy related to cause of myelopathy |
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Term
| What are the symptoms early in an epidural lesion? |
|
Definition
Motor:
hyperreflexia
Babiski signs
Difficulty walking
Sensory:
hypersensitive to touch
Band/Girdle-like sensation in abdomen
*Urinary Urgency |
|
|
Term
| What are the symptoms of an epidural lesion as it worsens? |
|
Definition
Motor:
Legs are spastic and weak
Brisk reflexes
Babinski signs
Sensory:
Root area - numb ipsilateral
decreased Pain contralateral (spinothalamic)
Partial Brown-Sequard
Definite sphincter dysfunction |
|
|
Term
| What is the final stage of an epidural lesion? |
|
Definition
Motor:
Flaccid Paraplegia, areflexic (acute)
spastic paraparesis (subacute/chronic)
Sensory:
Complete sensory level to all modalities |
|
|
Term
| What is the treatment for severe disc disease? |
|
Definition
|
|
Term
| What is the treatment protocol for spinal cord injury? |
|
Definition
Methylprednisolone 30mg/kg over 1 hr
Followed by 5.4mg/kg/hr over next 23 hrs |
|
|
Term
| What are some causes of spinal cord dysfunction in patients with cancer? |
|
Definition
Epidural cord compression
-Tumor, abcess, hematoma
Intramedullary processes
-metastases, abscess, hematoma, syrinx
Other myelopathies
-radiation, chemotherapy, paraneoplastic
Neoplastic meningitis
Spinal arachnoiditis |
|
|
Term
| What are the most common cancers that metastesis to the spinal column? |
|
Definition
|
|
Term
| What diagnostic approach should be taken with a cancer patient with back pain? |
|
Definition
Treat with Steroids
MRI with gadolinium
Neurosurgical consult
Spinal tap if NO compression |
|
|
Term
| Why is a spinal tap required if there is no evidence of cord compression in a cancer patient with back pain? |
|
Definition
| cancer cells can enter subarachnoid space and cause meningitis and spinal cord injury |
|
|
Term
| Where do most metastatc cancers begin? |
|
Definition
|
|
Term
| Where do most spinal abscesses begin? |
|
Definition
|
|
Term
| What bug is the most common in spinal abcessess? |
|
Definition
|
|
Term
| Who is at highest risk for spine infections? |
|
Definition
IV drug abusers
immunocompromised |
|
|
Term
| What are the symptoms of an Epidural abscess? |
|
Definition
Fever
Pain on percussion
elevated WBC
elevated ESR |
|
|
Term
|
Definition
infection of the vertebral bodies.
causes weakness of bones, collapse of vertebral body and subsequent cord compression |
|
|
Term
| What neurologic syndrome of osteomyelitis results from TB? |
|
Definition
|
|
Term
| What is the 2nd most common cause of spinal tumor? |
|
Definition
|
|
Term
| Where are spinal meningiomas located? |
|
Definition
Thoracic Spine
intradural, extramedullary |
|
|
Term
| Who classically gets spinal meningiomas? |
|
Definition
|
|
Term
| What are the most common intradural extramedullary mass? |
|
Definition
|
|
Term
| What are the types of Nerve Sheath Tumors? |
|
Definition
Schwannoma
neurofigroma
ganglioneuroma
neurofibrosarcoma(rare) |
|
|
Term
| What type of tumor has a classic Dumbell shape? |
|
Definition
|
|
Term
| What are the beginning symptoms of a central cord lesion? |
|
Definition
Pain in Shoulders
Loss of pain and temperature
Crossing spinothalamic tracts |
|
|
Term
| How does a central cord lesion progress? |
|
Definition
Lesion extends to Dorsal Root Entry Zone - Loss of Reflexes in arms
Continued loss of pain and temperature
Horner's syndrome - loss of sympathetic
Vibration and Joint position sense preserved (posterior columns late)
Legs spastic paraparesis, babinski signs and hyper-reflexia |
|
|
Term
| What is dissociated sensory level? |
|
Definition
| Vibration and joint position sense are preserved compared to pain and temperature. |
|
|
Term
| What is the final progression of a central cord lesion? |
|
Definition
Worsening symptoms
Sacral Sparing
May involve face due to sensory nucleus of the trigeminal nerve |
|
|
Term
| What kind of central cord syndrome is a large espanding space in the spinal cord? |
|
Definition
|
|
Term
| What is the second most common spinal cord tumor overall and the most common cord tumor in children? |
|
Definition
|
|
Term
| What are the symptoms of Anterior apinal aretey syndrome (Artery of Adamkiewicz? |
|
Definition
Loss of pain and temp - spinothalamic
Weakness - corticospinal function
(Intact Posterior Column) |
|
|
Term
| What can Arterial-venous malformations cause? |
|
Definition
| Anterior spinal artery syndrome |
|
|
Term
| What is Transverse myelitis? |
|
Definition
Acute neurologic conditions
Acute or subacute motor, sensory and sphincter disturbance
Spinal segmental sensory disturbance with defined upper limit
No evidence of compression
Absence of neurlogic disease |
|
|
Term
| What are the symptoms of Brown-Sequard hemi-section syndrome? |
|
Definition
Ipsilateral:
spastic paralysis below level of lesion
Hyperreflexia, Babinski signs
Loss of vibration and joint position sense
Contralateral:
Loss of pain and Temperature |
|
|
Term
| How does B12 deficiency present in the spinal cord? |
|
Definition
| Subacute combined degeneration |
|
|
Term
| What are the symptoms of Subacute combined degeneration of the spinal cord? |
|
Definition
Spastic weakness of lower extremities
Decreased sensation to vibration and position
Romberg's sign
Ataxia
Babinski signs and hyperreflexia
Peripheral neuropathy |
|
|
Term
| What is a neurologic complication of HIV? |
|
Definition
|
|
Term
| What are the symptoms of Vacuolar myelopathy? |
|
Definition
Progressive spastic paraparesis
Sensory ataxia and incontinence
Vacuolation and myelin pallor |
|
|
Term
| What is a complication of neurosyphilis? |
|
Definition
|
|
Term
|
Definition
Posterior column dysfunction Loss of vibration and joint position sense Romberg sign
(due to Syphilis) |
|
|
Term
| What are the Top 10 Things to remember about myelopathy? |
|
Definition
1. Acute myelopathies are neurologic emergencies
2. Spinal cord ends at L1/L2
3. Back pain in cancer patients is an emergency until proven otherwise
4. Myelopathies can progress quickly
5. Don not dely neuroradiologic testing
6. Ask patients where it hurs
7. Percuss the vertebral column
8. Steroids almost always in acute
9. Make Patient Walk
10. Remember basic neuroanatomy |
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