B7-015 Myelopathies Flashcards
because of bilateral symmetric symptoms and signs, [….] mimic diffuse toxic metabolic processes
midline structural processes
(usually more dangerous and require more urgent treatment)
the dorsal (posterior) horn contains […] neurons
sensory
the ventral (anterior) horn contains […] neurons
motor (includes LMN)
the first order sensory neuron lives in the
dorsal root ganglia
LMN lives in the
anterior horn
white matter tracts in the spinal cord [3]
posterior funiculus
lateral funiculus
anterior funiculus
the long tracts reside in the […] matter
white
what areas of the cord have larger anterior horns?
cervical and lumber
(contain more motor neurons to innnervate limbs)
what area of the cord has a lot of white matter?
cervical
spinal cord ends at
L1
UMN live in the
corticospinal tract
lives in the posterior faniculus
DC/ML
the first order neuron of the DC/ML
dorsal root ganglion
the second order neuron of the DC/ML
nucleus gracilis/cuneatus
the third order neuron of the DC/ML
thalamus
ways to test the DCML
proprioception (move joint)
tuning fork
ways to test spinothalamic
pain with pinprick
using a cool metal tool for temperature
what nutrient deficiency can affect the posterior columns and corticospinal tract?
B12 or copper
[…] competes with copper for absorption
zinc
first order neuron of the spinothalamic system
dorsal root ganglion
second order neuron of the spinothalamic system
dorsal horn
third order neuron of the spinothalamic system
thalamus
label the three systems
hemisection of the spinal cord will cause ipsilateral […] and contralateral […]
ipsilateral: proprioceptive loss and weakness (DC/ML and corticospinal)
contralateral: pain and temperature loss (spinothalamic)
what information can tell you which spinal cord lesion the deficit is at? [3]
level of weakness
level of reflex change
level of numbness
deltoid, infraspinatus, and biceps weakness
C5
weakened biceps and pectoralis weakness
C5
wrist extensor and biceps weakness
C6
biceps and brachioradialis reflex weakness
C6
triceps weakness and reflex weakness
C7
iliopsoas and quadriceps weakness
L4
patellar reflex weakness
L4
foot dorsiflexion
big toe extension
foot eversion weakness
L5
weakness of foot plantar flexion
S1
weak Achilles reflex
S1
jaw jerk reflex
[where is the lesion?]
lesion is above brainstem
nipple line
T4
umbilicus
T10
abrupt transition from C4 to T2
cervical mantle
where do loss of pain and temperature typically occur?
several levels below the lesion
supply the posterior columns of the spinal cord
posterior spinal arteries
rare to get infarct here
supply the anterior 2/3 of the spinal cord
anterior spinal artery
infarct will affect this area usually
bilateral weakness
bilateral pain/temperature loss
spared proprioception
infarction of spinal cord at anterior spinal artery
bilateral upper extremity pain/temp loss
LMN findings in arms
UMN findings in legs
spared proprioception
cervical central cord syndrome
“cape-like” loss of sensation
central cord syndrome
external compression of the spinal cord tends to only effect the
corticospinal tract
spared pain/temperature
spared proprioception
UMN signs in arms and legs
external compression of the cervical spinal cord
the reason for selective vulnerability in toxic metabolic processes is
unknown
upper and lower extremity weakness
upper and lower extremity proprioception loss
pain/temperature spared
[3]
B12 deficiency
copper deficiency
Friedrich’s ataxia
subacute combined degeneration
UMN and LMN weakness
ALS
diseases affecting anterior horn cell causing LMN weakness [2]
spinal muscular atrophy (werndig-hoffman)
poliomyelitis (WNV)
diseases affecting posterior columns only causing proprioceptive loss [3]
tabes dorsalis (tertiary syphilis)
B6 (pyroxidine) intoxication
paraneoplastic
[…] is almost always preserved with spinal cord infarction
dorsal column
chronic progressive sensory ataxia
+ Romberg sign
absent DTRs
tabes dorsalis
can be secondary to aortic aneurysm repair
anterior spinal artery occlusion
congenital degeneration of the anterior horn
spinal muscular atrophy (Werdnig-Hoffmann)
floppy baby
marked hypotonia (flaccid paralysis)
tongue fasciulations
symmetric weakness
spinal muscular atrophy (Werdnig-Hoffmann)
poliomyelitis affects the […]
anterior horn
acute LMN signs
asymmetric weakness
symptoms of viral meningitis
poliomyelitis
CSF shows:
elevated WBCs
slight elevation of protein
no change in glucose
poliomyelitis
caused by autosomal recessive mutation in SMN1
spinal muscular atrophy (Werdnig-Hoffmann)
LMN signs associated with ALS [4]
flaccid limb weakness
fasciculations
atrophy
bulbar palsy (dysarthia, dysphagia, tongue atrophy)
UMN signs associated with ALS
spastic limb weakness
hyperreflexia
clonus
psuedobulbar palsy (dysarthia, dysphagia, emotional lability)
what nervous system functions are spared in ALS [2]
sensory
bowel/bladder deficits
demyelination of:
spinocerebellar tracts
lateral corticospinal tracts
dorsal columns
subacute combined degeneration
SCD
subacute combined degeneration is caused by […] deficiency
B12
ataxic gait
impaired vibration/sensation
+ Romberg
UMN signs
subacute combined degeneration
presents with UMN signs above the lesion and LMN signs at level of lesion
loss of pain/temperature below lesion
dorsal columns spared
anterior spinal artery occlusion
ependymomas can cause
central cord syndrome