MCQs on Spinal Cord

MCQ Bank Neurology

Written by Dr. James Whitfield (MBBS, FRACGP) – General Practitioner

Question 1

A 58-year-old man presents with progressive weakness and numbness in both legs over 3 months. He also reports urinary urgency and occasional incontinence. Examination reveals spastic paraparesis with brisk lower limb reflexes and a sensory level at T8. MRI shows compression of the thoracic spinal cord by a vertebral osteophyte. Which of the following is the most appropriate next step in management?

A) High-dose intravenous steroids
B) Urgent surgical decompression
C) Oral antibiotics
D) Physical therapy alone
E) Lumbar puncture

Correct Answer: B) Urgent surgical decompression

Explanation:
This clinical presentation is characteristic of spinal cord compression, a condition where an external mass or lesion compresses the spinal cord, leading to neurological deficits. Symptoms of myelopathy such as progressive spastic paraparesis, sensory level, and bladder dysfunction indicate significant spinal cord involvement. In this case, the MRI confirms compression by a vertebral osteophyte, a common cause of spinal canal narrowing.

Urgent surgical decompression is the standard of care to relieve pressure on the spinal cord, prevent further neurological deterioration, and possibly improve function. Delay in surgery can lead to irreversible damage and permanent disability.

  • High-dose steroids (Option A) may be used temporarily to reduce inflammation and edema but do not replace the need for decompression surgery.
  • Oral antibiotics (Option C) are not indicated as there is no infection.
  • Physical therapy (Option D) is supportive but insufficient without addressing the underlying compression.
  • Lumbar puncture (Option E) is contraindicated in spinal cord compression because it may precipitate or worsen neurological damage by altering cerebrospinal fluid dynamics.

Prompt diagnosis and referral for surgery is critical in patients with spinal cord compression presenting with myelopathy.

Question 2

A 35-year-old woman develops rapid onset of bilateral leg weakness and sensory loss below the level of T6, with urinary retention. MRI of the spine shows T2 hyperintensity spanning multiple segments of the thoracic cord with no evidence of compression. CSF shows mild lymphocytic pleocytosis and elevated protein. What is the most likely diagnosis?

A) Spinal cord infarction
B) Transverse myelitis
C) Multiple sclerosis
D) Guillain-Barré syndrome
E) Spinal cord tumor

Correct Answer: B) Transverse myelitis

Explanation:
Transverse myelitis is an inflammatory condition characterized by acute or subacute spinal cord dysfunction involving both sides of the cord over multiple segments. The presentation includes motor weakness, sensory changes (including a sensory level), and autonomic dysfunction such as bladder retention.

MRI findings typically show longitudinally extensive T2 hyperintense lesions spanning several vertebral segments without external compression, distinguishing it from compressive myelopathy. CSF analysis often reveals lymphocytic pleocytosis and elevated protein, consistent with inflammation.

It is important to differentiate transverse myelitis from other causes:

  • Spinal cord infarction (Option A) usually has a sudden onset and localized cord involvement, whereas transverse myelitis evolves over hours to days and affects multiple segments.
  • Multiple sclerosis (Option C) typically causes shorter segment lesions and often presents with a relapsing-remitting course rather than an acute monophasic illness.
  • Guillain-Barré syndrome (Option D) is a peripheral neuropathy affecting nerve roots and peripheral nerves, with no sensory level and no spinal cord lesions on MRI.
  • Spinal cord tumors (Option E) usually cause progressive symptoms with mass effect visible on imaging.

Early recognition and treatment with immunotherapy (such as corticosteroids) are essential to limit permanent neurological damage in transverse myelitis.

Question 3

A 42-year-old man presents with weakness and loss of proprioception in the right leg and loss of pain and temperature sensation in the left leg after a knife injury to the left side of his back. On examination, he has ipsilateral weakness and decreased proprioception below the lesion and contralateral loss of pain and temperature sensation. Which syndrome best explains these findings?

A) Anterior cord syndrome
B) Central cord syndrome
C) Brown-Séquard syndrome
D) Posterior cord syndrome
E) Cauda equina syndrome

Correct Answer: C) Brown-Séquard syndrome

Explanation:
Brown-Séquard syndrome results from a hemisection (partial lateral injury) of the spinal cord. It is characterized by a classic pattern of neurological deficits due to the anatomy of spinal cord tracts:

  • The ipsilateral corticospinal tract damage causes motor weakness or paralysis on the same side as the lesion.
  • The ipsilateral dorsal columns are affected, leading to loss of proprioception, vibration, and fine touch on the same side.
  • The contralateral spinothalamic tract fibers, which cross within one or two segments above the entry level, cause loss of pain and temperature sensation on the opposite side below the lesion.

This syndrome is typically seen after penetrating trauma (e.g., knife injury) or spinal cord hemisection caused by tumors, ischemia, or multiple sclerosis.

The other syndromes differ as follows:

  • Anterior cord syndrome (Option A): Involves damage to the anterior two-thirds of the cord, causing bilateral loss of motor function and pain/temperature sensation but sparing dorsal column modalities.
  • Central cord syndrome (Option B): Characterized by greater weakness in upper limbs than lower limbs, often due to hyperextension injury in older adults with cervical spondylosis.
  • Posterior cord syndrome (Option D): Causes loss of proprioception and vibration sense bilaterally but preserved motor and pain/temperature sensation.
  • Cauda equina syndrome (Option E): Involves lower motor neuron signs with saddle anesthesia and bladder/bowel dysfunction; it affects nerve roots rather than the spinal cord proper.

Recognition of Brown-Séquard syndrome is important as it guides the clinical localization and management, often requiring urgent imaging and intervention if due to trauma or compressive lesion.

Previous Next

1. Neurology Module

1.1 Cerebrovascular Disorders

1.2 Cranial Nerves

1.3 Spinal Cord

1.4 Peripheral Nerves

1.5 Headaches

1.6 Seizure Disorders

1.7 Movement Disorders

1.8 Neuroimaging

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