Neurology
Spinal Cord & Radiculopathy
Neurology

Spinal Cord & Radiculopathy

Cauda equina, spinal epidural abscess, B12, tabes, radiculopathies.

Select any text to highlight it or make a flashcard.

◆Subacute combined degeneration (B12)

  • •Vegan or pernicious anemia + gait instability + numb feet + ↓vibration + +Romberg
  • •Affects dorsal columns + corticospinal tracts
  • •Megaloblastic anemia with hypersegmented neutrophils
  • •Elevated methylmalonic acid + homocysteine
  • •IM B12 replacement; folate alone WORSENS neurologic symptoms

◆Tabes dorsalis (tertiary neurosyphilis)

  • •Lightning leg pains + Argyll Robertson pupils (accommodate but don't react to light) + ataxic gait
  • •Treat with IV penicillin G

◆Spinal epidural abscess

  • •Triad: fever + back pain + neuro deficit
  • •Risks: IVDU, diabetes, immunosuppression, recent procedures
  • •Most common: Staph aureus
  • •Emergent MRI + IV antibiotics + surgical decompression

◆Cauda equina syndrome

  • •Saddle anesthesia + urinary retention + ↓rectal tone + LMN leg weakness
  • •Most common cause: large disc herniation
  • •Emergent decompression within 24–48 hr

◆Radiculopathies

  • •L4: medial leg + ↓knee extension + ↓patellar reflex
  • •L5: dorsiflexion (foot drop) + big toe sensation + no reflex change
  • •S1: lateral foot + ↓plantarflexion + ↓Achilles reflex
  • •Initial conservative (NSAIDs, PT); MRI if severe/progressive

◆Mechanical back pain

  • •Acute after lifting + paraspinal tenderness + no red flags
  • •Conservative care, no imaging

◆Spinal stenosis

  • •Neurogenic claudication — pain with walking, relieved by flexion (shopping cart sign)
  • •Vascular claudication = relieved by standing
  • •MRI lumbar; conservative first, decompression if refractory

High-yield pearls

  • ◆Saddle anesthesia + retention = SURGICAL EMERGENCY
  • ◆Fever + back pain + IVDU/DM = MRI for epidural abscess
  • ◆Anti-NMDA receptor encephalitis: psych + autonomic + seizures in young woman; often ovarian teratoma
Quick check

5-question quiz on this note

Test yourself before moving on. ~1 min.

Done reading?
Track your progress by marking this complete.
Next in Neurology