Neurology Quiz: Spinal Cord Compression & Myelitis

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Questions and Answers

What is the most common cause of spinal cord compression?

  • Vertebral causes (correct)
  • Intervertebral disc prolapse
  • Trauma (extradural)
  • Metastatic carcinoma

Which of the following is the most frequent cause of transverse myelitis?

  • Spinal cord infarction
  • Idiopathic myelitis (correct)
  • Multiple sclerosis
  • Vascular origin

What is the percentage of cases of transverse myelitis attributed to vascular origin?

  • 16% (correct)
  • 4%
  • 8%
  • 29%

Which of the following is NOT a cause of spinal cord compression listed in the content?

<p>Epilepsy (B)</p> Signup and view all the answers

What is the percentage of spinal cord compression cases attributed to intramedullary causes?

<p>5% (C)</p> Signup and view all the answers

Which of the following conditions is NOT a possible cause of transverse myelitis as listed in the content?

<p>Scleroderma (E)</p> Signup and view all the answers

What is the approximate percentage of transverse myelitis cases attributed to tumors?

<p>8% (E)</p> Signup and view all the answers

Which of the following is the most common cause of spinal cord compression attributed to vertebral causes?

<p>Intervertebral disc prolapse (B)</p> Signup and view all the answers

Which of these conditions is primarily associated with an abrupt onset of weakness and sensory loss, often with pain, developing over hours to days?

<p>Transverse myelitis due to viruses (B)</p> Signup and view all the answers

What is the typical pattern of motor loss in a thoracic cord lesion?

<p>Spastic paraplegia with a sensory level on the trunk (D)</p> Signup and view all the answers

Which condition is associated with slowly progressive upper motor neuron features affecting the legs more than the arms, with minimal sensory loss?

<p>Hereditary spastic paraplegia (D)</p> Signup and view all the answers

Which of these conditions is NOT typically associated with impaired sphincter function?

<p>Motor neuron disease (A)</p> Signup and view all the answers

What can be done to reduce the incidence of diastematomyelia?

<p>Increased maternal intake of folic acid during pregnancy (C)</p> Signup and view all the answers

Which of these conditions is most likely to be associated with an elevated white blood cell count in the cerebrospinal fluid?

<p>Epidural abscess (D)</p> Signup and view all the answers

Which condition is characterized by relentless progressive lower motor neuron and upper motor neuron features, associated with bulbar weakness?

<p>Motor neuron disease (D)</p> Signup and view all the answers

What is the typical pattern of sensory loss in syringomyelia?

<p>Suspended spinothalamic loss at the level of the lesion with preserved dorsal columns (D)</p> Signup and view all the answers

Which of these conditions is most likely to be associated with a history of cancer?

<p>Paraneoplastic syndrome (C)</p> Signup and view all the answers

Which condition is potentially treatable with folate supplementation?

<p>Diastematomyelia (D)</p> Signup and view all the answers

Which of these conditions is most likely to be associated with a history of excessive dietary zinc intake?

<p>Copper deficiency (A)</p> Signup and view all the answers

Which of these conditions is associated with a gradual onset of motor loss over months or years, often with pain in the cervical segments?

<p>Syringomyelia (A)</p> Signup and view all the answers

Which of these conditions is most likely to be diagnosed based on a characteristic "suspended" sensory loss?

<p>Syringomyelia (C)</p> Signup and view all the answers

Which of these conditions is most likely to be associated with a history of nitrous oxide abuse?

<p>Vitamin B12 deficiency (A)</p> Signup and view all the answers

Which of these conditions is most likely to be treated with surgery?

<p>Glioma, ependymoma (D)</p> Signup and view all the answers

Which of the following conditions is most likely to cause spastic paraplegia with a sensory level on the trunk?

<p>Thoracic cord lesion (D)</p> Signup and view all the answers

What type of weakness is exhibited in the ipsilateral motor function below the level of the lesion in Brown-Sequard syndrome?

<p>Spastic weakness (D)</p> Signup and view all the answers

Which sensory modalities are typically lost ipsilaterally below the level of the lesion in Brown-Sequard syndrome?

<p>Vibration and position sense (D)</p> Signup and view all the answers

What causes the increased deep tendon reflexes observed in Brown-Sequard syndrome?

<p>Lateral column involvement (C)</p> Signup and view all the answers

Which side experiences loss of pain and temperature sensation in Brown-Sequard syndrome?

<p>Contralateral to the lesion (D)</p> Signup and view all the answers

What is the mechanism behind the band of weakness and atrophy noted at the ipsilateral level of the lesion?

<p>Anterior root and anterior horn damage (B)</p> Signup and view all the answers

What happens to deep tendon stretch reflexes in Brown-Sequard syndrome?

<p>They are depressed (A)</p> Signup and view all the answers

Which clinical feature is associated with damage to the dorsal root and dorsal horn in Brown-Sequard syndrome?

<p>Ipsilateral sensory loss (B)</p> Signup and view all the answers

The loss of pain and temperature sensation begins how far below the level of the transaction or compression in Brown-Sequard syndrome?

<p>One or two segments below the lesion (A)</p> Signup and view all the answers

What is the primary investigation method for evaluating spinal cord compression?

<p>Magnetic resonance imaging (C)</p> Signup and view all the answers

What characteristic finding is associated with Froin syndrome during cerebrospinal fluid analysis?

<p>Normal cell count with elevated protein (A)</p> Signup and view all the answers

In the management of spinal cord compression, what should be considered for benign tumors?

<p>Surgical excision (B)</p> Signup and view all the answers

What does MRI primarily assess in the case of spinal cord conditions?

<p>Structural lesions (C)</p> Signup and view all the answers

What may indicate the need for a needle biopsy when evaluating spinal cord compression?

<p>Suspected secondary tumor (B)</p> Signup and view all the answers

What systemic investigation might be warranted in patients with spinal cord syndrome?

<p>Chest X-ray (D)</p> Signup and view all the answers

During an investigation for intrinsic spinal cord diseases, which diagnostic step is taken first?

<p>Imaging to exclude compressive lesions (D)</p> Signup and view all the answers

Which of the following conditions might show non-specific signal changes on MRI?

<p>Vitamin B12 deficiency (D)</p> Signup and view all the answers

What is necessary for regaining useful function in cases of extradural compression due to malignancy?

<p>Radiotherapy started within 24 hours (B)</p> Signup and view all the answers

Which management strategy is crucial for dealing with spinal cord compression due to malignancy?

<p>Working closely with oncologists and neurosurgeons (D)</p> Signup and view all the answers

What must be avoided in patients with severe spasticity?

<p>Constipation and impaction (B)</p> Signup and view all the answers

After acute paraplegia, what is an immediate management technique for bladder issues?

<p>Abdominal pressure application (B)</p> Signup and view all the answers

What should follow surgical treatment for spinal cord compression due to tuberculosis?

<p>Antituberculous chemotherapy for an extended period (D)</p> Signup and view all the answers

What can chronic kidney disease in patients with spinal cord compression be attributed to?

<p>Urinary retention from bladder issues (A)</p> Signup and view all the answers

Which treatment is suggested for managing severe spasticity?

<p>Botulinum toxin injections (A)</p> Signup and view all the answers

What is critical to prevent in patients at risk of pressure ulcers?

<p>Frequent repositioning and skin inspections (A)</p> Signup and view all the answers

Which of the following is NOT a potential complication that may arise in a patient with paraplegia?

<p>Spinal cord compression (D)</p> Signup and view all the answers

Which of the following describes the most common method of bladder management in paraplegia patients?

<p>Intermittent self-catheterization or reflex bladder emptying (A)</p> Signup and view all the answers

Which of the following strategies is primarily used to manage the potential development of pressure ulcers in patients with paraplegia?

<p>Regular turning and meticulous hygiene (B)</p> Signup and view all the answers

Which statement accurately reflects the role of tendon transfers in patients with paraplegia?

<p>They can potentially improve hand function for patients with weak grip (D)</p> Signup and view all the answers

In the context of managing bowel function in paraplegia patients, what is the primary strategy during the initial phase immediately following the injury?

<p>Manual evacuation (D)</p> Signup and view all the answers

Which of the following is NOT a common site for pressure ulcer development in individuals with paraplegia?

<p>Achilles tendon (B)</p> Signup and view all the answers

Which type of rehabilitation is specifically designed to address the potential for contractures in paraplegia patients?

<p>Passive physiotherapy (D)</p> Signup and view all the answers

What is the significance of the C7 level in the context of self-sufficiency for individuals with paraplegia or tetraplegia?

<p>Individuals with a C7 level or below tend to have a higher likelihood of achieving self-sufficiency (B)</p> Signup and view all the answers

Flashcards

Transverse myelitis

A neurological condition caused by inflammation of the spinal cord.

Multiple sclerosis (MS)

An autoimmune disease affecting the central nervous system, often leading to myelitis.

Idiopathic myelitis

Myelitis with no identified cause.

Vascular origin

Conditions affecting the blood supply leading to myelitis.

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Spinal cord compression

Pressure on the spinal cord that can lead to neurological deficits.

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Vertebral trauma

Injury to the vertebrae that may compress the spinal cord.

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Intervertebral disc prolapse

A bulging disc that can compress spinal nerves and lead to myelitis.

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Metastatic carcinoma

Cancer that has spread to the spinal column, causing compression.

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Acute spinal cord syndrome investigation

Process of examining acute spinal cord issues using imaging and tests.

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MRI for spinal cord compression

Magnetic Resonance Imaging is the preferred method to assess spinal cord compression severity.

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Froin syndrome

Condition indicated by normal cell count but high protein in CSF after a complete spinal block.

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Plain X-rays in spinal assessment

Initial imaging technique that may show bone damage and soft tissue changes.

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Intrinsic spinal cord diseases

These are internal conditions affecting the spinal cord that require imaging to rule out compression.

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Management of spinal cord compression

Treatment approach based on the underlying cause, such as benign tumors needing surgery.

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Needle biopsy for diagnosis

A procedure performed to obtain tissue samples, especially when a tumor causes compression.

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CSF analysis

Examination of cerebrospinal fluid to identify abnormalities and conditions such as vitamin B12 deficiency.

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Brown Sequard Syndrome

A neurological condition caused by a hemisection of the spinal cord leading to specific motor and sensory deficits.

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Ipsilateral motor signs

Motor signs observed on the same side as the spinal cord lesion, including weakness and increased reflexes.

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Contralateral sensory loss

Loss of pain and temperature sensation on the opposite side of the spinal cord lesion.

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Deep tendon reflexes increased

Enhanced reflex responses observed below the level of the spinal cord lesion due to upper motor neuron lesion.

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Babinski sign

An abnormal reflex indicating damage to the lateral corticospinal tract, where the big toe extends when the sole is stimulated.

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Dorsal root sensory loss

Loss of all sensory modalities on the ipsilateral side due to damage to sensory nerve roots.

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Lateral spinothalamic tract

Pathway responsible for transmitting pain and temperature sensations, damaged in Brown Sequard syndrome.

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Muscle atrophy and fasciculations

Muscle shrinkage and twitching that occur due to anterior horn or anterior root damage.

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Extradural compression

The most common cause of spinal cord compression due to malignancy in developed countries.

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Prognosis of extradural compression

Generally has a poor prognosis but can regain function if treated quickly.

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Radiotherapy initiation

Treatment effectiveness improves if initiated within 24 hours of severe weakness onset.

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Surgical treatment for tuberculosis

Spinal cord compression due to tuberculosis may require surgery, followed by chemotherapy.

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Treatment of traumatic lesions

Specialized neurosurgical treatment is required for traumatic vertebral injuries.

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Bladder management post-injury

Patients may self-catheterize or develop reflex emptying but need to prevent urinary retention.

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Bowel management

Avoid constipation and impaction, often treated with muscle relaxants like baclofen.

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Skin care importance

Crucial for preventing pressure ulcers, particularly in immobile patients.

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Meningioma

A type of tumor that develops from the protective layers of the brain and spinal cord.

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Epidural Abscess

A collection of pus in the epidural space, often due to infection.

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Diastematomyelia

A congenital disorder where the spinal cord is split into two hemicords.

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Anterior Spinal Artery Infarct

Loss of blood flow to the anterior part of the spinal cord causing motor and sensory deficits.

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Spinal AVM

A vascular malformation in the spinal cord leading to various neurological symptoms.

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Syringomyelia

Formation of a fluid-filled cyst within the spinal cord.

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Clinical Features of Compression

Signs such as pain, sensory disturbances, and motor weakness due to spinal cord compression.

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Upper Motor Neuron Signs

Signs indicating damage to the pathways that convey impulses from the brain to the spinal cord.

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Lower Motor Neuron Signs

Signs indicating damage to the neurons that connect spinal cord to muscles.

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Spinal Reflex

Involuntary response to a stimulus involving the spinal cord.

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Pain Location in Compression

Pain is often localized over the spine or in nerve root distribution.

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Sensory Loss Pattern

Paresthesia, numbness, or cold sensation that spreads proximally from limbs.

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Impaired Sphincter Function

Difficulty with bladder or bowel control due to spinal cord issues.

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Myelopathy

Any neurologic deficit caused by compression or damage to the spinal cord.

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Traumatic Paraplegia

Paralysis of the lower half of the body usually due to spinal injury.

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Self-Sufficiency in Rehabilitation

Patients with lower-level injuries can regain independence.

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Pressure Ulcers

Injuries to skin and underlying tissue due to prolonged pressure.

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Bladder Management

Strategies used for managing urinary retention in paraplegic patients.

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Bowel Function

Management of constipation and bowel evacuation post-injury.

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Skin Care

Preventing pressure ulcers through cleanliness and movement.

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Tendon Transfer Operations

Surgical procedures to improve hand functionality in weak patients.

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Passive Physiotherapy

Physical therapy to prevent muscle contractures when patient can't move.

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Study Notes

Paraplegia Overview

  • Paraplegia is weakness or paralysis affecting both legs, caused by spinal cord damage.
  • It can manifest as spastic (increased muscle tone) or flaccid (decreased muscle tone) paraplegia.
  • Sensory and autonomic dysfunction may also be involved.
  • Severity, course, and associated symptoms depend on the spinal cord damage level and type.

Learning Outcomes

  • Describe clinical features of Brown-Séquard syndrome.
  • Describe the aetiology, clinical characteristics, investigations, and management of paraplegia.

Brown-Séquard Syndrome - Clinical Features

  • Ipsilateral (same side as lesion):
    • Spastic weakness
    • Increased deep tendon reflexes
    • Babinski sign
    • Loss of vibration, proprioception, and other sensory modalities below the lesion level
  • Contralateral (opposite side to lesion):
    • Loss of pain and temperature sensation below the lesion level

Brown-Séquard Syndrome - Clinical Signs

  • Ipsilateral below lesion level:
    • Motor deficit
    • Spastic weakness
    • Deep tendon reflexes increased
    • Babinski sign
    • Loss of Vibration, Position, Proprioceptive sensation.
  • Contralateral below lesion level:
    • Sensory deficit
    • Loss of Pain and Temperature Sensation.
  • Ipsilateral at lesion level:
    • Motor/Sensory deficit.
    • Spastic weakness
    • Depression of deep tendon stretch reflexes.
    • Loss of all sensory modalities.

Paraplegia Etiology

  • Traumatic (73%):
    • Motor vehicle accidents (55%)
    • Falls (34%)
    • Gunshot wounds (8%)
    • Diving accidents (2%)
    • Sports injuries (1%)
  • Non-traumatic (27%):
    • Spinal tumors (29%)
    • Spinal stenosis (29%)
    • Transverse myelitis (18%)
    • Vascular origin (16%)
    • Spinal arachnoiditis (5%)
    • Meninges (intradural) (extramedullary) (15%)

Paraplegia Etiology (Compressive)

  • Non-compressive (12%):
    • Multiple sclerosis
    • Idiopathic myelitis
    • Sarcoidosis
    • Spinal cord infarction
    • HTLV myelopathy
    • Radiation myelopathy
    • NMOSD
    • HIV-associated vacuolar myelopathy
    • Vitamin B12 deficiency myelopathy
  • Other causes of spinal cord compression:
    • Trauma, extradural
    • Intervertebral disc prolapse
    • Metastatic carcinoma (breast, prostate, bronchus)
    • Myeloma
    • Tuberculosis
    • Tumors (meningioma, neurofibroma, ependymoma, metastasis, lymphoma, leukaemia)
    • Epidural abscess

Investigation of Acute Spinal Cord Syndrome

  • Magnetic resonance imaging (MRI) of the spine or myelography
  • Plain X-rays of the spine
  • Chest X-ray
  • Cerebrospinal fluid (CSF) analysis
  • Serum vitamin B12 levels

Spinal Cord Compression

  • MRI is the investigation of choice to define the extent of compression and associated soft tissue abnormalities.
  • Plain X-rays reveal bony destruction and soft-tissue abnormalities.
  • Myelography shows:
    • Normal cell count with very elevated protein (Froin syndrome) in complete spinal block.
  • Needle biopsy may be needed to diagnose a secondary tumor.

Paraplegia Management - General Care

  • Bladder management
    • Urinary retention can result
    • Patients may self-catheterize
    • Reflex bladder emptying may be helped by abdominal pressure
    • Early treatment of urinary tract infections (UTIs) is crucial.
  • Bowel management
    • Constipation and impaction must be avoided.
  • Skin care
    • Inspection for pressure ulcers, especially in high-risk areas (sacrum, iliac crests, heels).
    • Meticulous skin care and regular turning/positioning.
  • Lower Limbs
    • Passive physiotherapy to prevent contractures, and treat spasms.
    • Muscle relaxants (baclofen, botulinum toxin injections) for severe spasticity (flexors or extensors).

Paraplegia Management - Specific

  • Benign tumors should be surgically removed for better chances of recover
  • Extradural compression due to malignancy has a poor prognosis.
  • Function can be restored through radio-therapy if treatment is administered within 24 hours of onset of weakness or sphincter dysfunction.
  • Spinal Cord Compression due to tuberculosis requires surgical treatment followed by anti-tuberculosis chemotherapy for an extended period.

Paraplegia Management - Specific Conditions

  • Inflammatory causes: Inflammatory-steroids
  • Subacute combined degeneration: Vitamin B12
  • Multiple sclerosis: Disease-Modifying Therapies

Paraplegia Management - Rehabilitation

  • Many patients recover self-sufficiency, especially if the injury level is at C7 or below
  • Specialists spinal rehabilitation units are often needed.
  • Support from a specialist team is needed to include psychological and sexual needs

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