Theme: Spinal disorders
A. Osteomyelitis
B. Potts disease of the spine
C. Scheuermanns disease
D. Transverse myelitis
E. Tabes dorsalis
F. Subacute degeneration of the cord
G. Brown-Sequard syndrome
H. Syringomyelia
I. Epidural haematoma
Which is the most likely diagnosis for the scenario given. Each option may be used once, more than
once or not at all.
1. A 68 year old man presents to the plastics team with severe burns to his hands. He is not
distressed by the burns. He has bilateral charcot joints. On examination; there is loss of pain
and temperature sensation of the upper limbs.
You answered Osteomyelitis
The correct answer is Syringomyelia
This patient has syringomyelia which selectively affects the spinotholamic tracts.
Syringomyelia is a disorder in which a cystic cavity forms within the spinal cord. The
commonest variant is the Arnold- Chiari malformation in which the cavity connects with a
congenital malformation affecting the cerebellum. Acquired forms of the condition may
occur as a result of previous meningitis, surgery or tumours. Many neurological
manifestations have been reported, although the classical variety spares the dorsal columns
and medial lemniscus and affecting only the spinothalamic tract with loss of pain and
temperature sensation. The bilateral distribution of this patients symptoms would therefore
favor syringomyelia over SCID or Brown Sequard syndrome. Osteomyelitis would tend to
present with back pain and fever in addition to any neurological signs. Epidural haematoma
large enough to produce neurological impairment will usually have motor symptoms in
addition to any selective sensory loss, and the history is usually shorter.
2. A 24 year old man presents with localised spinal pain over 2 months which is worsened on
movement. He is known to be an IVDU. He has no history suggestive of tuberculosis. The
pain is now excruciating at rest and not improving with analgesia. He has a temperature of
39 oC.
Osteomyelitis
In an IVDU with back pain and pyrexia have a high suspicion for osteomylelitis. The most
, likely organism is staph aureus and the cervical spine is the most common region affected.
TB tends to affect the thoracic spine and in other causes of osteomyelitis the lumbar spine is
affected.
3. A 22 year man is shot in the back, in the lumbar region. He has increased tone and hyper-
reflexia of his right leg. He cannot feel his left leg.
You answered Osteomyelitis
The correct answer is Brown-Sequard syndrome
Theme from January 2012 exam
Brown -Sequard syndrome is caused by hemisection of the spinal cord. It may result from
stab injuries or lateral vertebral fractures. It results in ipsilateral paralysis (pyramidal tract) ,
and also loss of proprioception and fine discrimination (dorsal columns). Pain and
temperature sensation are lost on the contra-lateral side. This is because the fibres of the
spinothalamic tract have decussated below the level of the cord transection.
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Spinal disorders
Dorsal column lesion Loss vibration and proprioception
Tabes dorsalis, SACD
Spinothalamic tract Loss of pain, sensation and temperature
lesion
Central cord lesion Flaccid paralysis of the upper limbs
Osteomyelitis Normally progressive
Staph aureus in IVDU, normally cervical region affected
Fungal infections in immunocompromised
Thoracic region affected in TB
Infarction spinal cord Dorsal column signs (loss of proprioception and fine
, discrimination)
Cord compression UMN signs
Malignancy
Haematoma
Fracture
Brown-sequard Hemisection of the spinal cord
syndrome Ipsilateral paralysis
Ipsilateral loss of proprioception and fine discrimination
Contralateral loss of pain and temperature
, Image sourced from Wikipedia
A. Osteomyelitis
B. Potts disease of the spine
C. Scheuermanns disease
D. Transverse myelitis
E. Tabes dorsalis
F. Subacute degeneration of the cord
G. Brown-Sequard syndrome
H. Syringomyelia
I. Epidural haematoma
Which is the most likely diagnosis for the scenario given. Each option may be used once, more than
once or not at all.
1. A 68 year old man presents to the plastics team with severe burns to his hands. He is not
distressed by the burns. He has bilateral charcot joints. On examination; there is loss of pain
and temperature sensation of the upper limbs.
You answered Osteomyelitis
The correct answer is Syringomyelia
This patient has syringomyelia which selectively affects the spinotholamic tracts.
Syringomyelia is a disorder in which a cystic cavity forms within the spinal cord. The
commonest variant is the Arnold- Chiari malformation in which the cavity connects with a
congenital malformation affecting the cerebellum. Acquired forms of the condition may
occur as a result of previous meningitis, surgery or tumours. Many neurological
manifestations have been reported, although the classical variety spares the dorsal columns
and medial lemniscus and affecting only the spinothalamic tract with loss of pain and
temperature sensation. The bilateral distribution of this patients symptoms would therefore
favor syringomyelia over SCID or Brown Sequard syndrome. Osteomyelitis would tend to
present with back pain and fever in addition to any neurological signs. Epidural haematoma
large enough to produce neurological impairment will usually have motor symptoms in
addition to any selective sensory loss, and the history is usually shorter.
2. A 24 year old man presents with localised spinal pain over 2 months which is worsened on
movement. He is known to be an IVDU. He has no history suggestive of tuberculosis. The
pain is now excruciating at rest and not improving with analgesia. He has a temperature of
39 oC.
Osteomyelitis
In an IVDU with back pain and pyrexia have a high suspicion for osteomylelitis. The most
, likely organism is staph aureus and the cervical spine is the most common region affected.
TB tends to affect the thoracic spine and in other causes of osteomyelitis the lumbar spine is
affected.
3. A 22 year man is shot in the back, in the lumbar region. He has increased tone and hyper-
reflexia of his right leg. He cannot feel his left leg.
You answered Osteomyelitis
The correct answer is Brown-Sequard syndrome
Theme from January 2012 exam
Brown -Sequard syndrome is caused by hemisection of the spinal cord. It may result from
stab injuries or lateral vertebral fractures. It results in ipsilateral paralysis (pyramidal tract) ,
and also loss of proprioception and fine discrimination (dorsal columns). Pain and
temperature sensation are lost on the contra-lateral side. This is because the fibres of the
spinothalamic tract have decussated below the level of the cord transection.
Please rate this question:
Discuss and give feedback
Next question
Spinal disorders
Dorsal column lesion Loss vibration and proprioception
Tabes dorsalis, SACD
Spinothalamic tract Loss of pain, sensation and temperature
lesion
Central cord lesion Flaccid paralysis of the upper limbs
Osteomyelitis Normally progressive
Staph aureus in IVDU, normally cervical region affected
Fungal infections in immunocompromised
Thoracic region affected in TB
Infarction spinal cord Dorsal column signs (loss of proprioception and fine
, discrimination)
Cord compression UMN signs
Malignancy
Haematoma
Fracture
Brown-sequard Hemisection of the spinal cord
syndrome Ipsilateral paralysis
Ipsilateral loss of proprioception and fine discrimination
Contralateral loss of pain and temperature
, Image sourced from Wikipedia
