3. ANATOMY Spinal cord: foramen magnum 1st/2nd lumbar vertebrae. Cervical enlargement: C5-T1: gives rise to brachial plexus, innervates UE; L2-S3: gives rise to lumbosacral plexus, Gray matter – central (cell bodies) White matter – peripheral (ascending and descending tracts)
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5. All are true about the anatomy of the spinal cord except : It is 40 cm long Supplied by a single anterior spinal artery & paired vertibral artery The posterior column carry the afferent ascending fibers for properiocetion & vibration & cross at level of medulla In the spinothalamic tract, sacral fibers are represented most medially In corticospinal tract, the fibers cross at level of medulla & cervical fibers are located medially
6. 2) All are true regarding complete spinal cord syndrom except: It is a total loss of sensory, autonomic & voluntary motor innervation distal to the level of the spinal cord injury Deep tendon reflexes my persist The most common cause is trauma 99% of patients with persistent symptoms beyond 24 hrs do not have a functional recovery 1% of patients will have some evident of cord function below the level of injury
7. 3) All are true about spinal shock except : It is the loss of muscle tone & reflexes with complete cord syndrom during the acute phase of injury The intensity of the spinal shock increases with the height of the level in the spinal cord It typically lasts less than 24 hrs Bulbocavernous reflex is present The termination of spinal shock phase of injury is heralded by return of balbocavernous reflex
8. 4) Central cord syndrom, all are true except : It is the post prevalent of the partial cord syndroms Upper extremities are affected more & distal muscles are affected to a greater degree The most common mechanism is motor vehicle crush It is caused most often by hyperextension Elderly are affected more & prognosis is better in patients younger than 50 yrs
9. 5) All are true about Brown- Sequard Syndrom except: Usually, it results from penetration injuries Characterized by ipsilateral motor weakness & vibration / position loss & contralateral pain/ tempreture loss It can be associated with A-V malformation Ipsilateral pain & tempreture loss may be noted 1 – 2 levels above the lesion It has the worst prognosis of any incomplete spinal cord syndroms
10. 6) Regarding anterior cord syndrom, all of the following are true except : Posterior column is preserved Most cases reposted after aortic surgeries It can be caused by hypotension Generally, the prognosis is good
11. 7) Regarding Conus Medullaris & Cauda Equina syndroms , What is false ? It is very difficult to separate the two syndroms clinically Conus Medullaris usually presents with overflow incontinence or sexual dysfunction Usually, Conus Medullaris presents unilaterally Cauda Equina is a LMN picture with hyporeflexia Saddle sensory loss is common in both syndroms
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13. 8) All of the following result from intrinsic lesions in the spinal cord except : Multiple Sclerosis Syrigomyelia Myelopathy Spinal epidural abscess Spinal cord infarction
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15. All are true about MS except : It is a demyelinating disease affecting CNS Presents with patchy motor & sensory findings Presents with UMN picture Oligoclonal bands in CSF are significant only if present in the serum as well Immunosuppresive therapy is the treatment of choice
16. 10) All are true about Transverse Myelitis except : Present with paraplegia , sensory level & sphincter disturbance It is rare & progress slowly Thoracic cord is affected most often & cervical rarely The most essential aspect in management is to role out treatable causes Steroids are of unknown benefit
17. 11) All of the following are true about syringomyelia except ? It is a condition of having a cavity lesion within the substance of the spinal cord Disassociative anesthesia is the classic pattern of sensory deficit CT is the diagnostic tool of choice It is not necessary to perform an emergent imaging if f/u can be arranged It is ass with Arnold – Chiari I Syndrom It is treated with surgical removal If symptoms are progressive
18. 12) Which statement is true about Spinal Epidural Hematoma ? It is common with incidence of 5 per 100000 pts It is not associated with anticoagulation therapy Pain decreases by coughing or sneezing or straining Patients usually present initialy with neurological deficit rather than pain Emergent decompressive laminectomy is the treatment of choice
19. 13) All statements are true about spinal epidural abscess Except : It results from hematogenous spread of infection , mostly bacterial Diabetics , IV drug users & HIV patients are at higher risk Cervical site of infection predominate Spread to subdural space & intraspinal area is uncommon Urgent surgical consultation for decompression is required
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21. If MRI is not available, CT Myelogram should be done
22. Neurological deficit rarely improve if surgical intervention is delayed more than 12 – 36 hrs after onset of paralysis
23. Antibiotics : Vancomycin & Third generation Cephalosporine IVRifampin oral
24. 14) All statements are true about Diskitis Except : The most common causative organism is staph. Aurius It is more common among pediatric age group, < 10 yrs Lumbar spine is the most common site Neurological deficit is common Treated usually with antibiotics & surgery is often not necessary
25. 15) All are true about spinal cord neoplasm Except : Neurological symptoms caused by compression, invasion & distruction of the myelinated tracts by the tumors Metastasis is the most common spinal cord tumers Lumbar region is the most affected Recumbency worsen the pain Severe nighttime pain is charactrestic
