Pathology Quiz > Spine > Flashcards

Spine Flashcards

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1
Q

Types of open spinal dysraphism

A

Myelomeningocele
Myelocele/schisis
Hemimyelomeningocele

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2
Q

Types of closed spinal dysraphism WITH a subcutaneous mass

A

Lipomyelocele/schisis
Lipomyelomeningocele
Myelocystocele
Meningocele

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3
Q

Types of closed spinal dysraphism WITHOUT a subcutaneous mass

A

Filar/intradural lipoma
Tight filum terminale
Persistence of terminal ventricle
Dorsal dermal sinus
Diastematomyelia
Caudal regression syndrome
Limited dorsal myeloschisis

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4
Q

Two mechanisms which lead to spinal dysraphism

A

Primary bony defect (abnormal axial mesoderm) with secondary CNS abnormalities

Failure of closure of the neural tube with secondary mesenchymal tissue defects.

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5
Q

Main risk factor for spinal dysraphism

A

Folate deficiency in early pregnancy

Neural tube closure is normally complete by 28 weeks.

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6
Q

What is the difference between open and closed spinal dysraphism?

A

Open: cord and its covering communicate with the outside, no skin or tissues covering the sac

Closed: cord is covered by other normal mesenchymal elements

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7
Q

Most common type of open spinal dysraphism

A

Myelomeningocele

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8
Q

Association with all myelomeningoceles

A

Chiari II malformation (myelomeningocele is considered part of the spectrum)

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9
Q

Marker for myelomeningocele

A

Raised maternal AFP

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10
Q

Associations of myelomeningocele

A

Chiari II malformation (with all myelomeningoceles)

Aneuploidy (18 edwards, 13 patau), syringomyelia, arachnoid cysts, tethered cord

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11
Q

Most common location of myelomeningocele

A

Lumbosacral spine

Followed by thoracolumbar, lumbar and cervical

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12
Q

Difference between lipomyelocele and lipomyelomeningocele?

A

Both involve a neural placode of elongated spinal cord attaching to lipomatous tissue which is in continuity with dorsal subcutaneous fat through a spinal dysraphic defect.

Lipomyelocele - placode-lipoma interface within the canal.

Lipomeylomeningocele - placode-lipoma interface outside of the canal.

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12
Q

Association with lipomyelomeningocele

A

Tethered cord (always)

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13
Q

Mildest form of spinal dysraphism

A

Spina bifida occulta

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14
Q

Associations with dorsal dermal sinus

A

Inclusion cysts (intraspinal dermoid/ epidermoid)

Split cord malformations
Lipomyelocele
Filum terminale lipoma

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15
Q

What cells form and what cells line epidermoid cysts?

A

Congenitally ectodermal cells form as an inclusion cyst. Implantation of epidermal cells from lumbar puncture.

Lined by stratified squamous epithelium.

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16
Q

Causes of epidural and subdural spinal haematomas

A

Spontaneous (anticoagulation)
Trauma
Iatrogenic
Spinal arteriovenous malformation
Spinal tumours
Pregnancy

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17
Q

Are spinal epidural or subdural haematomas more common?

A

Spinal epidural haematomas

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18
Q

Most common location in the spine of epidural haematomas?

A

Cervicothoracic

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19
Q

Are epidural haematomas venous or arterial bleeds?

A

Venous

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20
Q

Do spinal cord compression symptoms develop faster in epidural or subdural haematomas?

A

Subdural

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21
Q

What is the most common incomplete spinal cord syndrome (usually from trauma)?

A

Central cord syndrome

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22
Q

Important features of central cord syndrome

A

Small lesions affect spinothalamic tract crossing in the anterior white commisure, leading to bilateral pain and temperature sensation change at the affected level

Large lesions also affect the corticospinal, dorsal column and spinal grey matter, resulting in UMN symptoms below the level, LMN symptoms at the level

Upper limbs are more central, thus affected more

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23
Q

Important features of Brown-Sequard syndrome

A

Hemicord syndrome with ipsilateral loss of proprioception/touch and UMN spastic paralysis below lesion

Contralateral loss of pain and temperature 2-3 levels below level of lesion

Ipsilateral loss of motor and sensory function at level of injured segments

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24
Most common cause of anterior cord syndrome?
Anterior spinal cord ischaemia
25
Important features of anterior cord syndrome
Complete motor paralysis below lesion (anterior horn and corticospinal tract) Loss of pain and temperature at and below lesion (spinothalamic tract) Autonomic, bladder and bowel dysfunction
26
What is the difference between cauda equina and conus medullaris syndrome?
Conus medullaris has both UMN and LMN deficits (cauda equina only has LMN deficits)
27
Important features of cauda equina syndrome
Perianal and saddle paresthesia Bowel, bladder and /or sexual dysfunction. Variably present - lower back pain, radiculopathy/ sciatica, paraesthesia/ weakness of lower limbs, reduced/ absent reflex.
28
Causes of insufficiency fracture
Osteoporosis Disrupted bone mineral homeostasis: hyperparathyroidism, DM, osteomalacia Bone remodelling: Paget disease, osteopetrosis Collagen formation: Marfan disease, fibrous dysplasia Glucocorticoids, chemotherapy, radiation therapy
29
Typical ages for spinal cord infarction
Children - from trauma or iatrogenic Adults - from atherosclerosis
30
Causes of spinal cord infarction
Idiopathic Trauma Atherosclerosis, aortic aneurysm, thrombosis, dissection, vertebral artery dissection/occlusion
31
Anterior spinal artery syndrome symptoms
Bilateral symptoms due to midline anterior spinal artery Paralysis below affected level (flaccid, later spastic) Pain and temperature sensory loss. Relative sparing of proprioception and vibration Anterior is more common than posterior
32
Posterior spinal artery syndrome symptoms
Symptoms usually unilateral due to paired posterior spinal arteries Complete sensory loss at level of injury. Proprioception and vibration loss below level Minimal transient motor symptoms
33
Most common cause of spinal subarachnoid haemorrhage
Redistribution of intracranial subarachnoid haemorrhage
34
Causes of spinal subarachnoid haemorrhage
Redistribution of intracranial subarachnoid haemorrhage Traumatic Iatrogenic Malignancy Spontaneous (hypertension, coagulopathy) Vascular (cavernous angioma, AVM, vasculitis, aneurysm)
35
Four presentations of spinal cord cavernous malformation
1. Discrete episodes of neurological deterioration with varying degrees of recovery between episodes 2. Slow progression of neurological decline 3. Acute onset of symptoms with rapid decline 4. Acute onset of mild symptoms with subsequent gradual decline lasting weeks to months
36
Pathology of spinal cord cavernous malformation
Blood filled endothelial spaces lined by hyalinised walls that lack elastic fibres and smooth muscle
37
Pathogens in acute pyogenic meningitis
Newborn: Group B streptococcus, Gram negative bacilli, Listeria 2 - 12 months: Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis Adults: same as above and staphylococcus
38
Common pathogens in spinal cord abscess
Staphylococcus aureus, Staph epidermidis, Bacteroides, Haemophilus, Listeria monocytogenes
39
Pattern of spread causing spinal cord abscess
Haematogenous Iatrogenic Direct extension e.g. spinal dysraphism such as myelomeningocele
40
Risk factors for epidural abscess
IVDU Immunocompromised Diabetes, alcoholism, cancer, CKD.
41
Risk factors for spondylodiscitis
Sepsis IVDU Immunosuppression Diabetes Cancer Spinal instrumentation or trauma Ascending infection - from urogenital tract instrumentation
42
Typical age group of spondylodiscitis
Two peaks in children and adults (around 50) Paediatric start with disc infection (still has blood supply) Adult starts with vertebral endplate infection
43
Most common pathogens in spondylodiscitis
Staphylococcus aureus (most common) Streptococcus viridans (IVDU, immunocompromised) Gram negative organisms Granulomatous: Mycobacterium tuberculosis (Pott disease), Fungal (cryptococccus, candida), Brucella - granulomatous
44
Most common location of spondylodiscitis
Lumbar
45
Most common location of TB spondylodiscitis
Thoracolumbar region
46
Common features of seronegative spondyloarthropathies
Absence of rheumatoid factor HLA-B27 Sacroiliac joint involvement Pathologic change in entheses rather than synovium Bony proliferation leading to ankylosis
47
Typical demographics for DISH
Elderly males
48
Associations of DISH
Ossification of PLL, hyperglycaemia, 1/3 positive for HLA-B27
49
Most commonly affected region of DISH
Cervical and thoracic spine
50
Complications of DISH
Chalk-stick fracture Dysphagia
51
What is associated with "enteritis-associated arthritis"?
Inflammatory bowel disease Other GI disease including Whipple disease, coeliac disease, and rarely infections such as salmonella, shigella and yersinia.
52
Typical demographics of reactive arthritis
Males, 15-35
53
Triad of reactive arthritis (Reiter's disease)
Arthritis, conjunctivitis and urethritis (Also cervicitis in women)
54
Genetic association with reactive arthritis
HLA-B27
55
Infections associated with reactive arthritis
Yersinia, shigella, campylobacter, chlamydia, brucellosis
56
Most common chronic arthritis in childhood
Juvenile idiopathic arthritis
57
Gender predilection of juvenile idiopathic arthritis
Females
58
Subtypes of juvenile idiopathic arthritis
Oligoarticular <4 joints, usually medium to large joints. Polyarticular JIA > 5 joints, usually small to medium joints. Systemic onset JIA (Still disease)
59
Typical demographics for adult-onset stills disease
Females Bimodal peak 15-25, 35-45 year old.
60
Typical ages for transverse myelitis
Bimodal distribution with peaks at 10-19 years and 30-39 years
61
Inclusion criteria for transverse myelitis
Myelopathic symptoms, no extrinsic compressive lesion, CSF pleocytosis
62
Exclusion criteria for transverse myelitis
Radiation to spine in last 10 years, distribution consistent with anterior spinal artery thrombosis, abnormal flow voids to suggest dAVF
63
Diseases to be excluded for diagnosis of idiopathic transverse myelitis
Connective tissue disease, CNS infection, MS
64
Causes of facet joint arthropathy
Osteoarthritis (most common), RA, ankylosing spondylitis and septic arthritis.
65
Causes of bone marrow infiltration/ replacement
Bone marrow hyperplasia, myeloproliferative disease, lymphoproliferative disease, myelofibrosis Diffuse bone metastases Iron deposition pathology such as haemochromatosis. Sarcoidosis Renal osteodystrophy Gout
66
Causes of subacute combined degeneration
Vitamin B12 deficiency Insufficient intrinsic factor (Pernicious anaemia, atrophic gastritis, gastrectomy) Ileal malabsorption (Crohns, resection of ileum, infective ileitis) Genetic Nutritional (alcohol, vegans) Drugs (nitrous oxide, PPI, metformin)
67
Typical age group for CPPD
>50, males=females
68
Second most common spinal cord tumour
Diffuse astrocytoma Also most common paediatric intramedullary tumour
69
Typical demographics, location and association of spinal diffuse astrocytoma
Males, 30s Thoracic cord, eccentrically, intramural NF1
70
Most common spinal intramedullary neoplasm in adults
Ependymoma Also second most common paediatric intramedullary tumour
71
Typical demographics, location, WHO grade and association with spinal ependymoma
Males, 40s Cervical cord, centrally in cord, intradural WHO grade 2 (majority) NF2
72
Typical age group, location and WHO grade for myxopapillary ependymoma
35 Intradural, extramedullary WHO grade 2
73
Most common intradural extramedullary spinal cord lesion
Schwannoma Second most common is meningioma
74
Typical demographics, location, risk factors, WHO grade and associations for spinal meningioma
Female (much stronger than intracranial), 60-80s Thoracic (then cervical) Ionising radiation in childhood, prior trauma WHO grade 1 (mostly, some 2 - 3) NF2
75
Most common spinal extradural malignancy
Metastasis - Leptomeningeal carcinomatosis (adenocarcinoma of lung or breast, melanoma, small cell lung cancer) - Drop metastases (high grade astrocytoma, GBM, ependymoma, medulloblastoma, germinoma, choroid plexus papilloma) Also from leukaemia and lymphoma
76
With spinal osteoid osteomas, is the concavity of the associated scoliosis to or away from the tumour
Concavity is on the same side as the tumour
77
Typical demographics and location of spinal osteoid osteomas
Males, 20s Neural arch of lumbar spine (then cervical)
78
Typical demographics and location of spinal osteoblastomas
Males, 20-30s Posterior column of cervical spine (then lumbar)
79
Third most common intramedullary spinal neoplasm
Haemangioblastoma
80
Typical age group, location and association of haemangioblastoma
40s Thoracic cord (then cervical) Von-Hippel-Lindau
81
Typical age group, location and association for malignant peripheral nerve sheath tumour
20-50s Intradural extramedullary NF1
82
Definition of spina bifida
Abnormal fusion of the posterior elements (bony defect) leading to secondary CNS abnormalities.
83
Most common neural tube defect
Spina bifida (AKA spinal dysraphism).
84
Definition of terminal myelocystocoele
Marked dilatation of the central canal of the spinal cord (also known as hydromyelia) which herniates posteriorly through a dorsal spinal defect. Type of closed spinal dysraphism with a subcutaneous mass (large cystic lesion typically in the lumbosacral region).
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