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Neuro > Apex- Spinal Cord > Flashcards

Apex- Spinal Cord Flashcards

1
Q

The artery of Adamkiwicz (select 2):

  • More commonly arises from the left side
  • provides collateral circulation to the posterior spinal cord
  • usually arises between T4-T8
  • occlusion can cause flaccid paralysis
A
  • More commonly arises from the left side
  • occlusion can cause flaccid paralysis

(arises between T8-T12 in 75% of population)

(supplies the anterior spinal artery which serves the anterior [not posterior] two-thirds of the spinal cord

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2
Q

Becks syndrome is AKA:

A

Anterior spinal artery syndrome

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3
Q

The spinal cord circulation consists of what 3 types of arteries and what do they each supply?

A
  1. 2 Posterior spinal arteries - supply posterior 1/3 of SC
  2. 1 Anterior spinal artery
    - perfuses anterior 2/3 of SC
  3. Radicular arteries (6-8) - supply the spinal arteries in the thoracolumbar region of the spinal cord
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4
Q

What supply the anterior and posterior spinal arteries in the cervical region of the spinal cord?

-what about below this?

A

Cervical = vertebral arteries

Below = radicular and lumbar arteries

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5
Q

What does the artery of Adamkiewicz perfuse?

A

The anterior spinal cord in the thoracolumbar region

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6
Q

The artery of Adamkiewicz usually originates on which side (left/right) and at which level?

A

Left side

T11-12

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7
Q

What can result in anterior spinal artery syndrome (beck syndrome)?

A

An aortic cross-clamp placed above the artery of adamkiewicz (can cause ischemia to the lower portion of the anterior spinal cord)

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8
Q

Classic s/s of anterior spinal artery syndrome (4)

A
  1. Flaccid paralysis of LE’s
  2. Bowel and bladder dysfunction
  3. Loss of temp and pain
  4. Preserved touch and proprioception
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9
Q

What is preserved in beck’s syndrome? (anterior spinal artery syndrome)

A

Touch and proprioception

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10
Q

What is the radicularis magna?

A

The Artery of Adamkiewicz

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11
Q

Generally speaking, the (anterior/posterior) cord contains (motor/sensory) neurons

A

anterior cord = motor neurons

posterior cord = sensory neurons

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12
Q

The corticospinal tract is perfused by the (anterior/posterior) blood supply.

A

anterior (corticospinal/motor)

beck syndrome = flaccid paralysis of LE’s

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13
Q

Autonomic motor fibers are perfused by the (anterior/posterior) blood supply

A

anterior

beck syndrome = bowel and bladder dysfunction

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14
Q

The spinothalamic tract is perfused by the (anterior/posterior) blood fupply

A

anterior (spinothalamic = pain and temperature)

beck syndrome = loss of pain and temp

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15
Q

The dorsal column is perfused by (anterior/posterior) blood supply

A

Posterior (dorsal column = touch and proprioception)

Beck syndrome = preserved touch and proprioception bc thats supplied by the posterior circulation and beck syndrome is anterior circulation distruption

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16
Q

What are 3 spinal pathways that are supplied by the anterior spinal artery?

A
  1. Corticospinal (motor) - A fibers (A alpha)
  2. Spinothalmic (pain&temp) (A-Delta and C)
  3. Autonomic motor fibers (bowel and bladder) (b fibers)
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17
Q

What spinal pathway is supplied by the posterior spinal artery?

A

The dorsal column (touch and proprioception)

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18
Q

Sensory neurons from the periphery enter the spinal cord via the _____.

Motor and autonomic neurons exit via the _________

A

dorsal nerve root (sensory)

Ventral nerve root (motor and autonomic)

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19
Q

What is a collection of cell bodies that reside outside the CNS?

what about inside the CNS?

A

outside = ganglion

inside = nucleus

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20
Q

What laminae are sensory, motor, and central commisure (cross-over) area

A 
1-6 = sensory (dorsal gray matter)
7-9 = motor (ventral gray matter) 
10 = central commisures (crossover area)
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21
Q

What part of the spinal cord contains the axons of the ascending and descending tracts?

A

the white matter

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22
Q

The gray matter is larger in what 2 specific regions of the spinal cord and what do they contain/supply.

A
  1. C5-C7 - contain cell bodies for neurons that supply the upper extremities
  2. L3-S2 - contain cell bodies for the neurons that supply the lower extremities
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23
Q

What contains the axons of the ascending and descending tracts?

A

White matter

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24
Q

What is the white matter divided into?

A

Dorsal, lateral, and ventral columns

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25
Q

Match the sensory tracts:

  • Dorsal Column
  • Tract of Lissaur
  • Lateral spinothalmic tract
  • ventral spinaothalmic tract
  • pain and temp (2)
  • fine touch and proprioception
  • crude touch and pressure

*bonus if you can list the associated fibers

A
  • Dorsal Column
    >fine touch and proprioception
    (A-alpha = proprioception)

-Tract of Lissaur
>pain and temp
(A-delta and C fibers)

-Lateral spinothalmic tract
>Pain and temp
(A-delta and C fibers)

-ventral spinothalamic tract
>Crude touch and pressure
(A-beta = touch and pressure)

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26
Q

What are the 2 motor tracts and what do they transmit?

A

Lateral corticospinal tract (limb motor)

Ventral corticospinal tract (posture motor)

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27
Q

The ascending and descending tracts of the spinal cord contain what part of the neuron?

A

The axon (makes up the white matter)

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28
Q

T/F - the dorsal column transmits nociceptive input to the thalamus

A

False!

-The anterolateral system

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29
Q

The dorsal column is a (1-2-3) neuron sensory pathway that transmits what 4 things

A

3-neuron sensory pathway

transmits:

  1. Fine touch
  2. Proprioception (A-Alpha)
  3. Vibration (A-beta)
  4. Pressure (A-beta)
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30
Q

Which spinal system is capable of two-point discrimination?

A

Dorsal Column Medial Lemniscal System

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31
Q

T/F- the dorsal column medial lemniscal system transmits sensory information faster than the anterolateral system

A

True

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32
Q

Describe transmission through the Dorsal Column-Medial lemniscal system

A

1st order neuron (A-alpha or A-beta) enters DRG and ascends the ipislateral side

*synapses with 2nd in the medulla > crosses to contralateral side & ascends

> thalmus *synapses with 3rd order neuron & ascends to the somatosensory cortex in the parietal lobe

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33
Q

Match:

Merkel’s discs
Pacinian corpuscles
Ruffini’s endings
Meissner’s corpuscles

  • Vibration
  • Proprioception
  • Continous touch
  • Prolonged touch and pressure
  • 2 point discrimination touch and vibration
A

Merkel’s discs
>Continuous touch

Pacinian corpuscles
>Vibration

Ruffini’s endings
>Prolonged touch and pressure (its never going to END)
>proprioception

Meissner’s corpuscles
>2 point discrimination touch and vibration

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34
Q

Which pathway transmit afferent nociceptive input to the brain?

A. Medial lemniscal system
B. Anterolateral system
C. Corticospinal tract
D. Tract of Lissauer

A

B. Anterolateral system

(DMLS)- transmits fine touch, proprioception, vibration and pressure

(Lissauer) - relays sensory info

(corticospinal) - transmits motor impulses

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35
Q

Anterolateral system AKA

A

spinothalamic tract

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36
Q

Anterolateral system transmits what 6 sensations

A
  1. Pain
  2. Temp
  3. Crude touch
  4. Tickle
  5. Sexual sensations
  6. Itch

*the kinky tract = anterolateral

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37
Q

Describe transmission through the anterolateral system (ventrolateral)

A

1st order neuron (A-delta or C) enters DRG and may ascend/descend 1-3 levels on ipislateral side in the tract of lissaur before synapsing with 2nd

*synapses with 2nd in the substantial gelatinosa (rex lamina 2) > crosses to contralateral side of spinal cord & ascends via the lateral or antero/ventral spinothalmic tracts

> *synapses with 3rd order neuron in RAS and thalmus & ascends to the somatosensory cortex in the parietal lobe

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38
Q

Neopinothalmic tract =

A

Lateral spinothalmic tract (transmits pain and temp)

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39
Q

Paleopsinothalmic tract =

A

Anterior (ventral) spinothalmic tract (transmits crude touch and pressure)

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40
Q

Injury to the corticospinal tract above the level of decussation in the medulla will result in (select 2)

  • flaccid paralysis
  • contralateral paralysis
  • ipsilateral paralysis
  • spastic paralysis
A
  • spastic paralysis
  • contralateral paralysis

(injury above decussation = spastic paralysis on the contralateral side)

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41
Q

Pyramidal tract =

A

Corticospinal tract

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42
Q

All motor pathways outside of the corticospinal tract are collectively known as what

A

the extrapyramidal tract

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43
Q

Upper motor neurons begin in the _______ and synapse with the lower motor neurons where?

Whereas lower motor neurons begin in the ______ and end where?

A

begin in the cerebral cortex

  • synapse with lower motor neurons in the ventral horn of the spinal cord
  • lower motor neurons begin in the ventral horn & end at the NMJ
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44
Q

UPPER motor neuron injury ABOVE/below the level of decussation results in what?

2 examples of upper motor neuron disease

A

UPPER ABOVE: Spastic, contralateral paralysis

UPPER BELOW: spastic ipsilateral paralysis

-CP & ALS

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45
Q

What does lower motor neuron injury result in and how does it present?

A

ipsilateral flaccid paralysis with impaired reflexes

46
Q

______ neurons exit the precentral gyrus of the frontal lobe, pass through the internal capsule and then travel inferiorly through the pyramids of the medulla

A

motor neurons

47
Q

The fibers that innervate the LIMBS cross over to the contralateral side in the ________ and then desecend the spinal cord via which tract

A

medulla

  • LATERAL corticospinal tract
  • think they cross so they go lateral – LATERAL LIMBS
48
Q

The fibers that innervate the AXIAL MUSCLES … how do they descend?

*Where do they cross?

A

They remain on the IPSILATERAL side as they descend via the VENTRAL corticalspinal tract

VIA
Ventral
Ipsilateral
Axial muscles

*they crossover to the contralateral side of the spinal cord wehn the yreach the cervical or upper thoracic area

49
Q

What does upper motor neuron injury result in?

A

Contralateral spastic paralysis and hyperreflexia

50
Q

Upper motor neurons pass messages from where to where?

A

brain to spinal cord

51
Q

cell bodies of upper motor neurons orginate wehre?

A

in the cerebral cortex

52
Q

Why spastic paralysis and hyper-reflexia with upper motor neuron injury?

A

Bc normally there is a subset of neurons in the corticospinal tract that inhibit the lower motor neurons from firing to frequently;

this mechanism is blocked with upper motor neuron injury > spastic paralysis and hyperreflexia (CONTRALATERAL)

53
Q

What test assesses the integrity of the corticospinal tract?

-what indicates and constitutes a negative/positive test?

A

The babinski test

  • negative test = intact CST: firm stimulus to the underside of the foot produces a DOWNWARD mortion of all toes (down, negative test = good)
  • positive test = damage to the CST; a firm stimulus to the understide of hte foot produces an upward extention of the big toe with fanning of other toes (Up = positive test = bad)
  • it’s good if your toes curl in the bedroom
54
Q

T/F- Babinski sign is absent with lower motor neuron injurty

A

true

55
Q

How does lower motor neuron injury present?

A

Ipsilateral flaccid paralysis and impaired reflexes

56
Q

where do cell bodies of lower motor neurons orginate?

A

ventral horn

57
Q

Lower motor neurons pass messages from where to where?

A

Spinal cord to the muscles

58
Q

How are evoked potentials produced?

A

By applying a current to a neural pathway

59
Q

(SSEP/MEP) monitor the integrity of the (dorsal column medial lemniscus/corticospinal tract)

A 
SSEP = dorsal
MEP = corticospinal
60
Q

What perfuse(s) the dorsal column medial lemniscus tract? The cortical spinal tract?

A

Dorsal =The posterior spinal arteries

Corticospinal = anterior spinal artery

61
Q

Where does the upper motor neuron begin and end

A

cerebral cortex > ventral horn of spinal cord

62
Q

Where does the lower motor neuron begin and end?

A

ventral horn > NMJ

63
Q

Which findings are MOST likely to occur during hte acute phase of spinal cord transection at C7?

A. Autonomic hyperreflexia and hypothermia

B. Bradycardia and hypothermia

C. Tachycardia and hypotension

D. Hypothermia and tachycardia

A

B. Bradycardia and hypothermia

  • patient with an acute C7 transection will experience neurogenic shock.
64
Q

Patients with an acute ____ transection will experience neurogenic shock

A

C7

65
Q

Neurogenic vs hypovolemic shock s/s

A

Neurogenic = bradycardia, hypotension, hypothermia + pink/warm extremities

Hypovolemic = tachycardia, hypotension + cool, clammy extremities

66
Q

What are the most common causes (4) and most common site of SCI?

A
  1. MVI
  2. fall
  3. assult
  4. sports injury

*C7 (neurogenic shock- bradycardia, hypotension)

67
Q

Complete SCI damages the (upper/lower) motor neurons:

acute phase sx vs later phase sx

A

upper motor neurons

acute phase = flaccid paralysis

later= spasticity

68
Q

What are the major causes of morbidity and mortality in patients with cervical and upper thoracic lesions (2)

A

ineffective alveolar ventilation & inability to clear pulmonary secretions

69
Q

T/F- avoid sux in patients with SCI

A

True - after 24 hours after injury due to upregulation of extrajunctional receptors

70
Q

T/F- the higher the SCI, the less degree of hemodynamic instability

A

False - greater instability

71
Q

Explain the decreased BP with neurogenic shock

A

decreased SNS tone
> vasodilation
> venous pooling
> decreased CO & BP

72
Q

Explain the bradycardia with neurogenic shock

A

impaired cardioaccelerator fibers (T1-T4)
>unopposed cardiac vagal tone
>bradycardia and reduced inotropy

73
Q

Explain hypothermia with neurogenic shock

A

decreased SNS tone
>vasodilation
>cutaneous heat loss
>hypothermia

74
Q

SCI - which NMB agent should you use - nondepolarizer or depolarizer

A

NON-depolarizer

-there will be upregulation and depolarizers will cause massive K release

75
Q

A patient with a 2-year-old C7 spinal cord transection presents for a cysto under GA. Insertion of the cystoscope causes the HR to decrease from 75 to 30….which statements are most likley to be true (select 2)

A. Ephedrine is a better option than atropine
B. Nitroprusside is a better option than hydralazine
C. The patient is at risk for ICH
D. The Bezold-Jarisch reflex caused the heart rate to decrease

A

B. Nitroprusside is a better option than hydralazine

C. The patient is at risk for ICH

-the patient experiencing autonomic hyperreflexia (AH) will vasodilate ABOVE the level of injury and vasoconstrict BELOW the level of injury (risk of severe HTN)

-consequences of HTN
>bradycardia via the BRR
>tx with anticholinergic

> treat HTN promptly- can cause stroke, LV failure and pulm edema

> nitroprusside will take effect much sooner than hydralazine (onset 10-20 mins)

76
Q

After spinal shock phase ends (________[timeframe]), there is a return of sympathetic reflexes (above/below) the level of injury, placing patients at risk for what?

A

1-3 weeks

below level of injury

autonomic hyperreflexia

77
Q

Typical presentation of autonomic hyperreflexia (2)

A

Hypertension

Bradycardia

78
Q

Up to 85% of patients with injury above level ______ will develop autonomic hyperreflexia

A

T6 - wow that’s a lot

-esp if majority of SCI is C7

79
Q

What conditions increase the risk of autonomic hyperrelfexia? (4)

A

Bladder catheritzation surgery (cysto/colonoscopy), bowel movement,
cutaneous stimulation,
child birth

80
Q

After SCI, t he sympathetic nerves (above/below) the level of injury do not vasodilate in response to the baro-receptor response

s/s?

A

Below

-HTN > HA and BV

-Malignant HTN
>stroke
>seizure
>LV failure
>dysrhythmias
>pulm edema
>MI
81
Q

Reflex vasodilation ABOVE the level of spinal cord injury will result in what symptom?

A

nasal stuffiness

82
Q

T/F: patients do not have sensation BELOW the level of SCI

A

True - however, stimulation to the affected areas can elcit autonomic hyperreflexia

83
Q

Best type of anessthetic fo SCI and preventing risk of autonomic dysreflexia

A

GA or spinal (>epidural)

84
Q

3 steps in treating HTN in the patient at risk for AH

A
  1. Remove stimulus
  2. Deepen anesthetic
  3. Administer a rapid-acting vasodilator such as sodium nitroprusside
85
Q

T/F: adding lidocaine jelly to the cystoscope or foley catheter prevents AH

A

False

86
Q

T/F: Sux is contraindicated i npatients with chronic SCI

A

true

87
Q

What is autonomic dysreflexia?

A

an involuntary reaction to external stimuli in patients with existing SCI.

-Increased SNS response below the level of SCI.

88
Q

Consequences of amyotrophic lateral sclerosis include all of the following EXCEPT:

A. Hyperkalemia with sux

B. Cardiomyopathy

C. Risk of pulmonary aspiration

D. Increased sensitivity to nondepolarizing NMBs

A

B. Cardiomyopathy

  • ALS does not affect cardiac muscle
  • bulbar muscle weakness increases risk of aspiration
  • extrajunctional receptors at the NMJ can cause life-threatening hyperkalemia
89
Q

ALS causes progressive degeneration of (upper/lower) motor neurons in the corticospinal tract

A

both

upper motor neuron involvement presents as: spasticity, hyperreflexia, and loss of coordination

lower motor neuron involvement presents as: muscle weakenss, fasiculations and atrophy.

90
Q

What motor neuron disease affects skeletal and cardiac muscle where patients commonly have associated cardiomypoathies and CHF

A

Friedreich’s ataxia

91
Q

T/F - patients with ALS have intact sensory function

A

True - disease just affects motor neurons in the corticospinal tract - not sensory

92
Q

Most common cause of death in ALS

A

resp failure

93
Q

T/F - Sux is contraindicated in ALS patients

A

true - risk of lethal hyperkalemia

94
Q

pts with ALS have an (increased/decrease/no change) in sensitivity to NONDEPOLARIZING neuromusuclar blockers

A

increased sensitivity

think they are already weak- wont need as much

95
Q

Why are ALS patients at risk for aspiration?

A

due to bulbar muscle dysfunction

96
Q

changes in resp status in ALS patients(volume/capacity changes and why)

A

decreased VC and minute ventilation due to chest weakens

97
Q

Eitiology of ALS

A

unknown

98
Q

What is autonomic dysfunction evidenced by in those with ALS?

A

orthostatic hypotension and resting tachycardia

99
Q

What is the only drug that reduces mortality in patients with ALS and what kind of drug is it?

A

Riluzole - NMDA antagonist

100
Q

What is the optimal anesthetic plan for someone with ALS

A

no evidence supports a clear benefit to any particular anesthetic technique over another.

101
Q

What NMBs should be avoided in the patient with ALS?

A

All of them

>SUX = hyperkalemia
>NDMR = very sensitive to
  • if NMDR are given, consider the need for postop ventilation
102
Q

Administration of roc during a complex spinal surgery will impede the monitoring of:

A. Dorsal column
B. Corticospinal tract
C. Tract of Lissauer
D. Anterolateral system

A

B. Corticospinal tract

103
Q

The tract of Lissauer is a component of which spinal pathway?

A. Corticospinal tract
B. Spinothalamic tract
C. Rubrospinal trct
D. Dorsal column

A

B. Spinothalamic tract

104
Q

Which type of mechanoreceptor allows pts who are blind to read braille?

A. Pacinian corpuscles
B. Ruffini’s endings
C. Merkle’s Discs
D. Meissner’s Corpuscles

A

D. Meissner’s Corpuscles

(2 point discrimination)

*being blind isnt as messy (meissi) as you think, their two-point descrimination allows them to read braille better than any of us can

105
Q

A pt recovering from an open AAA has paraplegia with preserved sensory function. Blood flow to which spinal artery was MOST likely impaired by the aortic cross-clamp:

A. Anterior sulcal artery
B. Posterior spinal artery
C. Lumbar artery
D. Great radicular artery

A

D. Great radicular artery

106
Q

An aortic cross clamped placed above the artery of Adamkiewicz (great radiuclar artery) can cause ischemia to the (upper/lower) portion of the (antterior/posterior) spinal cord

A

lower portion of the anterior spinal cord

  • Becks syndrome
  • flaccid paralysis of LE’s
  • bowel and bladder dysfx
  • loss of pain and temp
  • preserved touch and proprioception
107
Q

A quadriplegic patient presents for a small bowel resection. Five mins after foley insertion the patient becoems severely hypertensive and bradycardic. What is the MOST likely cuase of this complication?

A. Neurogenic shock
B. Anaphylaxis
C. MH
D. Mass Reflex

A

D. Mass Reflex

AKA: autonomic hyperreflexia

108
Q

Which pathwya is involved in the transmission of pain?

A. Spinothalamic tracts
B. Corticospinal tracts
C. Dorsal columns
D. Autonomic motor fibers

(what is another name for the answer)

A

A. Spinothalamic tracts

*Anterolateral system

109
Q

Which spinal cord pathwya is perfused by the posterior spinal arteries?

A. Medial lemniscal system
B. Autonomic motor fibers
C. Spinothalamic tract
D. Corticospinal tract

A

A. Medial lemniscal system

(dorsal column)

Spinothalmic, corticospinal, and autonomic motor fibers recieve their blood supply from the anterior spinal artery.

110
Q

Spinothalmic, corticospinal, and autonomic motor fibers recieve their blood supply from what

A

the anterior spinal artery

111
Q

A quad presents for dorsal rhizotomy. What induction agent should be avoided?

A

Sux

Neuro (5 decks)

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