14. Dr. Stephens CIS lectures spinal cord and brainstem lectures (pre-reading and lectures)

Question 1

What are the deficit patterns that are seen with dorsal root injuries?

Answer 1

Diminished sensation or reflex from associated sensory or motor dermatome

Question 2

What are the deficit patterns that are seen with an injury to the fasciculus gracilis?

Answer 2

Ipsilateral loss of proprioception and no 2 point discrimination of the lower limb

Question 3

What are the deficit patterns that are seen with an injury to the fasciculus cutaneous?

Answer 3

Ipsilateral loss of the proprioception and no 2 point discrimination to the upper limb

Question 4

If the lateral corticospinal tract is damaged, what happens?

Answer 4

ipsilateral spastic paralysis

Question 5

If the lateral reticulospinal tract is damaged, what happens?

Answer 5

Contralateral loss of pain and temperature 2 sensory dermatomes below the lesion

Question 6

If the lateral reticulospinal tract is damaged, what happens?

Answer 6

There is loss of autonomic functions including bowel and bladder incontinence

Question 7

If there is damage to the anterior white commissure, what happens?

Answer 7

Bilateral pain and temperature anesthesia

Question 8

If there is damage to the anterior horns, what happens?

Answer 8

Ipsilateral LMN paralysis

Question 9

If there is decreased proprioception to to L3-S4 dermatomes of the right leg, where is the associated lesion?

Answer 9

Fasciculus gracilis

Question 10

If there is hyperreflexia, hypertonia, paralyzed muscles to the left lower extremity including clonus, what is involved in the deficit?

Answer 10

These muscles are in spastic paralysis and the lateral corticospinal tract is involved

Question 11

If there is loss of pain and temperuare of the L3-S4 dermatomes, what is the tract that is involved?

Answer 11

Lateral spinothalamic tract

Question 12

If there is a loss of pain and temperature to C5-C6 region, what is the deficit? What is this called?

Answer 12

Anterior white commissure deficit and it is called syringomyelia

Question 13

If the following clinically presents, what would your diagnosis be?

Upper extremity: bilateral areflexemia, atonia, paretic and atrophied muscles

Lower extremity: bilateral hyperreflexemia, hypertonia paralyzed muscle strength with clonus and bilateral positive babinski reflexes

Answer 13

ALS: LMN and UMN paralysis

Question 14

Describe how spinal shock would present clinically using the following picture as a guide to the injury

Answer 14

Bilateral loss of pain and temperature below L1 and loss of proprioception and 2 point discrimination below L1

Upper extremity would be WNL

Lower extremity: areflexemia, atonia, paralysis

Question 15

If there is a loss of proprioception and 2 point discrimination from L2-S5 in the right lower extremity with hyperreflexemia, hypertonia, and paralysis

In addition to decreased pain and temperature in the left lower extremity from L4-S5, what could be happening?

Answer 15

Brown Sequard syndrome

Question 17

What causes brown sequard syndrome?

Answer 17

Lesions in the SC, hemisections. The loss of proprioception and 2 point discrimination occurs on the same side of the lesion and the loss of pain and temperature occurs on the opposite side of the lesion

Question 18

In this clinical presenation of Brown Sequard syndrome, where would the lesion be? (red is loss of pain and temperature and green is a loss of proprioception and 2 point discrimination)

Answer 18

The lesion would be in the right spinal cord

Question 19

A patient presents with left sided spastic hemiplegia including

LUE: hyperreflexemia, hypertonia, paralysis and a positive Hoffmans sign

LLE: hyper reflexemia, hypertonia, paralysis and clonus

positive Babinksis sign

Which tract is involved with these sx?

Answer 19

Corticospinal tract

Question 20

If a patient presents with L sided proprioceptive hemianesthesia, where would you suspect the damage is?

Answer 20

Medial Lemniscus: an issue with PCMLS

Question 21

If a patient presents with deficits of the spinal lemniscus, what would you expect to see in that patient?

Answer 21

Loss of pain and temp to an entire side of the body (hemianalgesia)

Question 22

If there is a lesion at 1, what would you expect to see?

Answer 22

CONTRALATERAL spastic hemiplasia because there is a lesion of the corticospinal tract

Question 23

If there was a lesion at 2, what would you expect to see?

Answer 23

Contralateral loss of proprio/2 point discrimination due to a lesion of the medial lemniscus

Question 24

If there was a lesion at 3, what would occur?

Answer 24

Contralateral hemianalgesia, due to a lesion of the spinal lemniscus

Question 25

If there was a lesion at 4, what would occur?

Answer 25

Ipsilateral hemianalgesia in the face due to a lesion in the descending tract of V

Question 26

If there was a lesion at 5, what would you expect to see clinically?

Answer 26

Ipsilateral Vestibular signs (nystagmus, vertigo, nausea, etc.) due to a lesion of the Vestibular nuclei

Question 27

If there was a lesion at 6, what would you expect to see clinically?

Answer 27

Ipsilateral cerebellar signs due to a lesion in the inferior cerebellar peduncle

Positive Romberg, ataxia, dysmetria, etc

Question 28

Review the picture on page 10 of the DSA for Stephens

Answer 28

Review for 5 minutes (Staci this is what you do so I am just putting this here for you, youre welcome)

Question 29

If a patient presents with a lesion in 3 and 4, what would you expect to see clinically?

Answer 29

Ipsilateral loss of pain and temperature to the face

Contralateral loss of pain and temperature to the body due to the involvement of the descending tract of CN V, and spinal lemniscus alternating hemianalgesia

With dysphagia and dysphonia secondary to CN X involvement

Also known as lateral medullary syndrome or Wallenburgs syndrome

Question 30

If there is a lesion at 4, what would you expect to see?

Answer 30

Lesion is at the right fasciculus gracilis which would result in ipsilateral loss of proprioception to the lower extremity

Question 31

What are the 7 clinically important structures that are located within the spinal cord?

Answer 31

sensory

1. dorsal roots
2. posterior columns
3. lateral spinothalamic tract
4. anterior white commissure

motor

5. lateral corticospinal tract
6. anterior horn
7. lateral reticulospinal tract

Question 32

What are the 8 clinically important structures in the brainstem?

Answer 32

sensory

1. spinal lemniscus
2. medial lemniscus
3. trigeminal lemniscus
4. lateral lemniscus
5. descending tract of CN V

motor

6. corticospinal tract
7. corticobulbar tract

special

8. medial longitudinal fasciciulus

Question 34

Spastic hemiplegia indicates involvement of which of the following?

a. Corticospinal tract
b. Lateral reticulospinal tract
c. Spinal lemniscus
d. Genu of internal capsule
e. Ventral roots

Answer 34

a. corticospinal tract

Question 35

Supranuclear facial palsy indicates involvement of which of the following?

a. Facial nerve
b. Corticobulbar tract
c. Corticospinal tract
d. Posterior limb of internal capsule
e. Rubrospinal tract

Answer 35

B

1.

2.

3.

Corticobulbar fibers originate in the head region of precentral gyrus,
Course through the genu of the internal capsule and cerebral peduncles as uncrossed CBT

• Unilateral lesions of uncrossed CBT result in contralateral supranuclear facial palsy

Decussate in lower pons (between V and VI) and descend in the lower brainstem as crossed CBT

• Unilateral lesions below the decussation may result in some ipsilateral cranial nerve palsies.