19. Neurological Exam/SC Syndromes

Question 1

Signs for UMN lesion

Answer 1

No atrophy
Inc tone and spasticity
Inc DTRs
+Babinski

Question 2

Sign LMN lesion

Answer 2

Atrophy/flaccid paralysis
Dec. or absent DTR
-Babinski

Question 3

Nerve level for deltoid

Answer 3

C5

Question 4

Nerve level for biceps

Answer 4

C6

Question 5

Nerve level for triceps

Answer 5

C7

Question 6

Nerve level for intrinsic hand muscles

Answer 6

C8

Question 7

Nerve level for Hip flexors

Answer 7

L2/L3

Question 8

Nerve level for Quads

Answer 8

L4

Question 9

Nerve level for plantarflexors

Answer 9

L5

Question 10

Nerve level for everything on back of leg

Answer 10

S1

Question 11

What is the name of the artery that supplies T9-L2 region?

Answer 11

Artery of Adamkiewicz

Question 12

Which forces cause spinal cord trauma to the cervical region? Thoracolumbar region?

Answer 12

Compression and hyperextension

Compression and hyperflexion

Question 13

Symptoms of acute spinal shock during first few weeks (3 symptoms)

Answer 13

1. Flaccid paralysis
2. Red. DTR
3. Smooth muscle hypofunction

Question 14

Symptoms of spinal shock when it becomes chronic (after several weeks)

Answer 14

Inc reflexes and tone
Involuntary spasms
Hyperactive bladder and bowel with involuntary emptying

Question 15

What is effected with central spinal cord syndrome? Which are spared?

Answer 15

Anterior horn cells –> LMN –> weak, atrophic limbs

Dorsal columns and LCST are spared

Question 16

What is the most common type of spinal cord tumor?

Answer 16

Metastatic (extradural)

Question 17

Where do metastatic cancers to the SC come from?

Answer 17

Breast, lungs, and prostate

Question 18

What are the three infections of the spinal cord?

Answer 18

Epidural abscess by S. aureus
Poliomyelitis by polio virus
Neurosyphilis by T. pallidum

Question 19

Epidural abscess organism, mechanism, common mechanism of spread, symptoms, treatment

Answer 19

S. aureus
Skin infection –> osteomyelitis –> abscess
Hematogenous is how it spreads
Fever and spinal cord compression are the symptoms
Treatment: Lg abscesses = surgery, abx
Sm abscess = abx, percutaneous drainage

Question 20

Poliomyelitis involves which cells, symptoms, pathology,

Answer 20

Lower alpha motor neurons are involved
Pathology: diffuse chromatolysis with acidophilic nuclear inclusions –> PMNs invade –> neuonophagia
Symptoms:
Anterior horn cells - limb weakness, atrophy, hyporeflexia
Thx region - kyphoscoliosis, resp difficulty
Cranial nerve nuceli - dysarthria, dysphagia

Question 21

Neurosyphilis what is involved, signs, symptoms

Answer 21

Demylinating disease of dorsal columns - Romberg sign and gait ataxia
Hyporeflexia
Bladder hypotonicity

Question 22

What nutritional disease causes damage to SC? What happens? Tx?

Answer 22

Vit B12 deficiency causes demylination of LCST and posterior columns
UMN weakness
Loss of vibration, proprioception, and touch sensations
Tx: B12 supplements

Question 23

Friedreich’s Ataxia is what type of disease? Symptoms

Answer 23

Demyelination

Posterior columns, Cerebellum (ataxia), DRG (hyporeflexia), LCST (weakness, Babinski)

Question 24

Als involves which system, presentation

Answer 24

Pure motor system involvement

Prominent weakness of one limb, spasticity of another limb, tongue atrophy, problems with speech

Question 25

What is cervical spondylosis? Clinical triad of spondylosis. Pathogenesis

Answer 25

Myelopathy due to degenerative arthritis
Triad: Neck pain, LMN (arm pain, upper extremity signs), UMN (Spastic weakness and ataxia in legs)
Canal diameter reduced due to disc herniation, spondolytic ridging, congenital narrowing –> cord compression

Question 26

Syringomyelia

Answer 26

Due to cavitation of central portion of the cord
Vestigial canal forms, used to be central spinal canal
From obstruction of central canal, dilates –> syringomyelia
Tracts effected: STT, Anterior horn cells