Spinal Cord Lesions Overview
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Questions and Answers

What is a common symptom of central lumbar stenosis?

  • Loss of coordination in hands
  • Sudden onset extreme pain
  • Gradual onset of numbness and burning pain in calves (correct)
  • Severe headaches

    • What does 'shopping cart sign' refer to in the context of central lumbar stenosis?

  • Relief from pain when seated
  • Sensation of heat in legs while walking
  • Relief from symptoms when leaning forward or bending at the waist (correct)
  • Increased muscle strength while bending forward

    • Which of the following is NOT a symptom associated with central cervical stenosis?

  • Gait clumsiness
  • Subtle loss of hand dexterity
  • Limited range of motion in the neck
  • Sudden loss of vision (correct)

    • What type of changes in the spine does cervical spondylotic myelopathy often lead to?

    <p>Degenerative changes affecting the cervical region (A)</p> Signup and view all the answers

    Which of the following could indicate balance impairment related to spinal conditions?

    <p>Positive Babinski reflex (D)</p> Signup and view all the answers

    What is a potential outcome if a spinal cord lesion occurs below the level of the lesion?

    <p>Generalized spastic weakness (B)</p> Signup and view all the answers

    What posture may aggravate leg pain in patients with central lumbar stenosis?

    <p>Standing with an extended lumbar spine (D)</p> Signup and view all the answers

    Which of the following is commonly associated with cervical stenosis, particularly affecting upper extremities?

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

    What is the typical initial symptom of spinal infection?

    <p>Localized central back pain (A)</p> Signup and view all the answers

    Which of the following findings may indicate the presence of radiculopathy?

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

    In which demographic is Multiple Sclerosis most commonly observed?

    <p>Males vs. Females (3:1 ratio) (C)</p> Signup and view all the answers

    What does the McDonald Criteria for diagnosing MS require?

    <p>Evidence of damage in at least two separate CNS areas (C)</p> Signup and view all the answers

    What is a common later sign of spinal infection?

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

    What might contribute to the relapsing-remitting pattern of Multiple Sclerosis?

    <p>Inflammation with spontaneous recovery (D)</p> Signup and view all the answers

    What is the significance of MRI in diagnosing Multiple Sclerosis?

    <p>Shows 90-95% of patients with plaque development (B)</p> Signup and view all the answers

    Which symptom is associated with cervical cord lesions in MS?

    <p>Lhermitte's phenomenon (A)</p> Signup and view all the answers

    What is an appropriate treatment option for managing symptoms of Multiple Sclerosis?

    <p>Gabapentin for neurological pain (A)</p> Signup and view all the answers

    Which of the following can complicate the progression of Multiple Sclerosis?

    <p>Poor sleep quality (A)</p> Signup and view all the answers

    What is typically observed at the level of the lesion in lower motor neuron signs?

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

    What kind of gait may be observed in patients with cervical central spinal stenosis?

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

    What is the typical position that may provide pain relief for a patient with lumbar spine issues?

    <p>Supine with hip flexion at 90° (D)</p> Signup and view all the answers

    Which of the following symptoms is indicative of syringomyelia?

    <p>Shawl-like sensory loss (D)</p> Signup and view all the answers

    What is a common treatment approach for cauda equina syndrome?

    <p>Immediate referral to A&amp;E (B)</p> Signup and view all the answers

    What can cause a loss of proprioception leading to sensory ataxia?

    <p>Cervical spinal stenosis (B)</p> Signup and view all the answers

    Which imaging technique is primarily used for investigating syringomyelia?

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

    What kind of reflex change can be expected in lower limbs below the level of a lesion?

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

    What indicates a positive Romberg test?

    <p>Difficulty maintaining balance with eyes open (D)</p> Signup and view all the answers

    What is the most common causative factor of syringomyelia?

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

    Which symptom is most closely associated with discitis?

    <p>Severe low back pain (C)</p> Signup and view all the answers

    What surgical procedure is often performed for severe symptoms of syringomyelia or its complications?

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

    What finding would be significant in a physical examination of vertebral osteomyelitis?

    <p>A significant decrease in lumbar spine mobility (C)</p> Signup and view all the answers

    What symptom is common in patients who have cauda equina syndrome?

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

    Flashcards

    Central Lumbar Stenosis

    Narrowing of the spinal canal in the lumbar spine, compressing the spinal cord.

    What causes Central Lumbar Stenosis?

    Overgrowth of ligaments and bone in the lumbar spine, leading to compression of the spinal cord. Often affects both sides.

    Spondylolisthesis

    A condition that occurs when a vertebra slips forward on the vertebra below it. It can be caused by a variety of factors, including degeneration, trauma, or congenital defects.

    Central Cervical Stenosis

    A condition that occurs when the spinal canal in the cervical spine (neck) narrows and compresses the spinal cord.

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    What causes Central Cervical Stenosis?

    Degenerative changes in the cervical spine, such as bone spurs and ligament thickening, often causing neck pain and limited range of motion.

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    What are the signs of a spinal cord lesion?

    The level of the spinal cord lesion, often leading to flaccidity and reduced reflexes. It can cause muscle weakness and loss of sensation.

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    Babinski Sign

    A reflex test that relies on the plantar stimulation of the foot. A positive Babinski sign indicates an upper motor neuron lesion, such as a spinal cord lesion.

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    Romberg Test

    A test for balance, where the patient stands with feet together and eyes closed. A positive Romberg test indicates a problem with balance, often associated with spinal cord lesions.

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    Spinal Osteomyelitis

    An inflammatory disease of the spine caused by infection that can be bacteria or fungal in origin.

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    Spinal Cord Inflammation

    Inflammation of the spinal cord leading to pain and possible neurological deficits.

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    Multiple Sclerosis (MS)

    A condition where the body's immune system attacks the myelin sheath that protects nerve fibers, leading to neurological and physical impairments.

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    MS Relapse

    An episode of neurological dysfunction in MS, followed by complete or incomplete recovery.

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    Progressive MS

    The gradual worsening of neurological function in MS, where the body's ability to heal myelin is overwhelmed.

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    Lhermitte's Phenomenon

    A characteristic symptom of MS, a sudden electric shock sensation that travels down the back or neck when flexing the neck.

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    Evoked Potentials

    A neurological test that measures the time it takes for the brain to respond to sensory stimulation.

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    Demyelination

    The process of inflammation and damage to the myelin sheath in MS.

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    McDonald Criteria

    A group of criteria used to diagnose MS, considering clinical presentation, evidence of damage in the central nervous system, and exclusion of other possible diagnoses.

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    Disease Modifying Anti-Rheumatic Drugs (DMARDs)

    Drugs that modify the immune system to slow down or stop the progression of autoimmune diseases like MS.

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    Vibration Loss in Cervical Spinal Stenosis

    Reduction of vibration sensation at the distal interphalangeal joint and possibly the medial malleolus. Indicates lower motor neuron involvement at the level of the lesion.

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    Cauda Equina Syndrome

    A condition causing compression of the cauda equina nerve roots. Can result from various causes including tumors, trauma, infection, and disc herniation.

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    Saddle Anesthesia

    Loss of sensation in the area around the anus and genitals, resembling the shape of a saddle. A key symptom of cauda equina syndrome.

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    Bladder Dysfunction in Cauda Equina Syndrome

    Difficulty initiating or stopping urination, often progressing to urinary retention and overflow incontinence.

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    Vertebral Osteomyelitis

    Inflammation of the vertebral body, most commonly affecting the lumbar spine, involving two vertebrae and a disc.

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    Discitis

    Infection of the intervertebral disc, occurring less frequently than vertebral osteomyelitis.

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    Syringomyelia

    A fluid-filled cavity or syrinx developing within the spinal cord. Can extend to the brainstem (syringobulbia).

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    Dissociated Sensory Loss

    A condition characterized by loss of pain and temperature sensation with preserved touch and vibration sensation. Often seen in syringomyelia.

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    Claw Hand

    A type of hand deformity characterized by a curled or claw-like appearance of the fingers due to muscle atrophy and weakness. Often seen in syringomyelia.

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    Cervical Spinal Stenosis

    The narrowing of the spinal canal in the cervical spine, causing pressure on the spinal cord.

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    Balance Impairment in Cervical Spinal Stenosis

    Difficulty with balance tests, often accompanied by a positive Romberg's test, even with eyes open.

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    Muscle Atrophy in Syringomyelia

    Weakness and atrophy of the muscles in the hands, progressing proximally to the forearms and shoulder girdle. Often associated with syringomyelia.

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    15 Second Grip-and-Release Test

    A test used to assess hand dexterity by measuring how many times a patient can open and close their hand in 15 seconds.

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    Conservative Management for Cervical Spinal Stenosis

    A specific type of conservative management for cervical spinal stenosis aimed at reducing pain and improving walking independence.

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    Decompression Surgery for Cervical Spinal Stenosis

    A surgical procedure to relieve pressure on the spinal cord in cases of cervical spinal stenosis.

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    Study Notes

    Spinal Cord Lesions

    • Central Lumbar Stenosis: Narrowing of the lumbar spinal column, compressing the spinal cord. Ligaments and facet joints overgrow, causing calcification and compression. Affects all dermatomes and myotomes below the affected area.
    • Symptoms (Lumbar): Gradual numbness/paraesthesia, burning/crampy pain in calves, potentially thigh muscles if stenosis is higher. Pain often aggravated by walking and extension, relieved by flexion. May affect balance (steppage gait, wide-based gait), and lead to weakness. Possible acute inflammatory "flare-ups".
    • Signs (Lumbar): Lower motor neuron signs at lesion level (flaccid weakness, hyporeflexia); spastic weakness, hyporeflexia below the level. Aggravation of leg pain with standing and extension, but not sitting. Possible positive Babinski, balance impairment, steppage gait, wide-based gait. Reduced height/kyphosis, hypertonic muscles in lumbar region/reduced lumbar extension, and reduced lateral flexion.
    • Testing (Lumbar): Sensory testing (SMRs, toe/finger proprioception, vibration), reflexes, and ROM. Reduced sensation at affected dermatomes.
    • Central Cervical Stenosis: Neck pain, limited ROM due to degeneration. Subtle loss of hand dexterity/strength (e.g., buttons, writing, texting). Subtle balance problems, gait clumsiness, and needing handrails for stairs (early signs). Paraesthesia and weakness in upper extremities. Radicular pain possible if nerve root is involved (Cervical spondylotic myelopathy).
    • Signs (Cervical): Similar to lumbar stenosis, with possible lower motor neuron signs at the level of the lesion, and upper motor neuron signs below. Important to observe and palpate for loss of height, kyphosis in the cervical spine, and hypertonic muscles related to that area. Possible positive Babinski / Chaddock/ balance issues. Sensory and muscle changes to limbs are possible.

    Syringomyelia

    • Definition: Fluid-filled cavity (syrinx) in the spinal cord. Can extend to the brainstem (syringobulbia).
    • Causes: CSF blockage (e.g., Arnold-Chiari malformation), post-traumatic injury, spinal infection (abscess, transverse myelitis), intramedullary tumors, idiopathic.
    • Onset: Typically in the 30s, slower progression over years, often more acute if syringobulbia.
    • Symptoms: Dissociated sensory loss (e.g., shawl-like distribution), neurogenic pain in neck/shoulders (deep, aching and often severe). Muscle atrophy, especially hands, progressing proximally. Possible claw hand, dysphagia, nystagmus (syringobulbia).
    • Signs: Dissociated sensory loss (e.g., pinprick deficit, intact touch), diminished arm reflexes, spasticity (lower limbs), hyperreflexia (lower limbs), and possible clonus, Babinski. Cranial nerve testing if syringobulbia is suspected.

    Cauda Equina

    • Definition: Compression of the cauda equina.
    • Causes: Tumors, trauma/spondylolisthesis, infection, ankylosing spondylitis (late) lumbar central stenosis (rare), disc herniation.
    • Symptoms: Saddle anesthesia (can you feel it when you wipe yourself after stool?), Bowel and bladder disturbances (difficulty initiating/stopping urination, retention, overflow incontinence), bowel incontinence, sometimes constipation. Unilateral or bilateral sciatica, low back pain, leg weakness, sensory deficits, and reduced/absent leg reflexes.
    • Signs: Sensory (dermatomal changes), muscle (myotomal weakness), and reflex (hypo/areflexia) changes.
    • Treatment: Immediate referral to A&E. Surgical decompression is vital.

    Spinal Infection (Vertebral Osteomyelitis/Discitis)

    • Definition: Infectious disease of the spine (vertebrae, intervertebral discs, adjacent paraspinal tissue)
    • Causes:
      • Vertebral osteomyelitis: Bacterial or fungal infection entering the bloodstream. Common for IV drug users, post trauma/surgery, infections elsewhere in the body.
      • Discitis: Rare, fast spread via bloodstream. Common in children and older adults.
    • Symptoms: Localized spinal pain, insidious pain progression, increased pain with movement. Fever, chills, malaise, weight loss (may be associated with systemic infections). Possible pathological fracture and nerve root compression in later stages.
    • Signs: Fever, severe pain on palpation/percussion, pain on ROM, nuchal/neck rigidity (meningism). Possible para-spinal spasm, SMR if radiculopathy, variable reflexes (absent to clonus, Babinski possible).
    • Treatment: Antibiotics/antifungals, possible surgical decompression/abscess drainage.

    Multiple Sclerosis

    • Definition: Immune-mediated inflammatory disease destroying myelin and axons. Relapsing/remitting pattern.
    • Causes: Unknown, likely genetic predisposition and environmental triggers.
    • Types:
      • Relapsing-remitting (85%): Episodes of neurological dysfunction with recovery.
      • Primary progressive (15%): Gradual progression from onset.
    • Symptoms: Variable symptoms depending on brain/cord areas affected. Early symptoms may include visual problems (optic neuritis), cranial nerve involvement (diplopia, facial sensation loss), gait disturbance, trunk or extremity weakness, Lhermitte's phenomenon (cervical cord), and spinal cord lesions leading to sensory/motor symptoms.
    • Signs: Possible problems (UMN type) with movement, motor signs/muscle weakness, positive Babinski/Chaddock, possible ankle clonus.
    • Treatment: Lifestyle modifications (sleep, exercise), Disease-Modifying Antirheumatic Drugs (DMARDs), symptomatic medications.

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    Description

    This quiz covers the essential aspects of spinal cord lesions, specifically focusing on central lumbar stenosis. It includes symptoms, signs, and effects on gait and muscle strength. Test your knowledge about the ramifications of lumbar stenosis and related conditions.

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