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BMB Test 1 > B7.015 Selective Vulnerability from the Spinal Cord > Flashcards

B7.015 Selective Vulnerability from the Spinal Cord Flashcards

1
Q

UMN damage symptoms

A

increased muscle tone
no atrophy
hyperreflexia
pathological reflexes present

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2
Q

LMN damage symptoms

A

decreased muscle tone
atrophy
hyporeflexia
pathological reflexes absent

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3
Q

reflex grading scale

A

0: no reflex
1: reflex only with reinforcement
2: reflex without reinforcement
3: reflex spreads to other muscles
4: clonus
+ if high amplitude
- if low amplitude

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4
Q

normal plantar response

A

toes down (flexion)

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5
Q

abnormal plantar response

A

Babinski sign
toes up and fanned
exaggerated withdrawal response

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6
Q

use of Babinski sign in UMN damage

A 
moderate sensitivity (60-70% have it with an UMN injury)
high specificity
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7
Q

what type of midline structural lesion would cause bilateral arm and leg weakness

A

high cervical spinal cord lesion

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8
Q

why should you consider midline lesions first

A

typically more dangerous and require more urgent therapy

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9
Q

dorsal horn

A

sensory

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10
Q

ventral horn

A

motor

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11
Q

what is present in the central gray matter

A

sensory dorsal cells

motor ventral cells

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12
Q

what is present in the peripheral white matter

A

intersegmental communications

“long tracts”

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13
Q

why do cervical and lumbar sections of the spinal cord have large ventral horns?

A

innervate limbs which require more motor control than the abdominal area (thoracic cord)

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14
Q

why is there a 3rd small out pouching between the dorsal and ventral horns in the thoracic cord

A

region where the sympathetic neurons exit the cord

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15
Q

orientation of lateral corticospinal tract in the cord

A

on lateral side of the cord, between dorsal and ventral horns
leg nerves lateral
arm nerves medial

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16
Q

2 neurons of the corticospinal tract

A

UMN

LMN

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17
Q

3 neurons of the DCML system

A
  1. dorsal root ganglion
  2. nucleus gracilis or cuneatus (corticomedullary junction)
  3. thalamus
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18
Q

orientation of the DCML system in the cord

A

on dorsal side in between the 2 dorsal horns

wedge shaped area

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19
Q

acute B1 deficiency

A

Wernicke Korsakoff

targets: mamillary bodies, medial dorsal nucleus of the thalamus, peri aqueductal structures

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20
Q

chronic B1 deficiency

A

dry beriberi

targets: peripheral nerves

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21
Q

B3 deficiency

A

pellagra

targets: cerebrum (dementia)

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22
Q

B6 deficiency

A

pyridoxine deficiency
may be caused by isoniazid
targets: peripheral nerves

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23
Q

B12 of Cu deficiency

A

subacute combined degeneration

targets: posterior columns, corticospinal tract

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24
Q

vitamin E deficiency

A

vitamin E deficiency
due to fat malabsorption
targets: neuropathy, retinopathy, spinocerebellar tracts

25
Q

indications of Cu or B12 deficiency

A 
macrocytic anemia
bariatric surgery (impairs absorption)
zinc supplementations (competes with Cu for absorption)
26
Q

treatment of Cu deficiency

A

stop zinc supplements
copper replacement
-IV infusion
-oral

27
Q

why do we see consistent patterns of structural selective vulnerability

A

shared anatomy

  • proximity
  • blood supply
28
Q

why do we see consistent patterns of toxic metabolic selective vulnerability

A

shared physiology

  • toxin sensitivity
  • metabolic insult insensitivity
29
Q

3 neurons of ALS system

A
  1. dorsal root ganglion
  2. dorsal horn
  3. thalamus
30
Q

orientation of ALS system in the spinal cord

A

anterior section slightly lateral to the anterior horns

31
Q

deficits with hemi-section loss of the thoracic spinal cord

A

contralateral pain and temp loss
ipsilateral proprioceptive loss
ipsilateral weakness

32
Q

C5 weakness

A

deltoid
infraspinatus
biceps

33
Q

C5 reflex

A

biceps

pectoralis

34
Q

C6 weakness

A

wrist extensors

biceps

35
Q

C6 reflex

A

biceps

brachioradialis

36
Q

C7 weakness

37
Q

C7 reflex

38
Q

L4 weakness

A

iliopsoas

quads

39
Q

L4 reflex

A

patellar tendon (knee jerk)

40
Q

L5 weakness

A

foot dorsiflexion
big toe extension
foot eversion, inversion

41
Q

L5 reflex

42
Q

S1 weakness

A

foot plantar flexion

43
Q

S1 reflex

A

Achilles tendon (ankle jerk)

44
Q

cervical mantle

A

area where C5-T1 dermatomes get pulled out into arms and the neck to check jumps from C4 to T2

45
Q

levels of pain and temp loss in relation to a lesion

A

several levels below (travel up a few levels before decussation)

46
Q

areas affected by posterior spinal artery infarction

A

bilateral proprioceptive loss

47
Q

areas affected by anterior spinal artery infarction

A

bilateral pain and temperature loss and weakness

48
Q

deficits seen in cervical central cord syndrome

A

pain and temp loss in upper extremities only (suspended loss)
NO proprioceptive loss
LMN loss in upper extremities
UMN loss in lower extremities

49
Q

deficits seen in external compressive lesion of cervical spinal cord

A

usually corticospinal tract damage

  • selectively vulnerable for an unknown reason
  • bilateral spasticity and mild weakness without sensory change
50
Q

causes of subacute combined degeneration

A

B12 def
Cu def
Friedrich’s ataxia (also have spinocerebellar involvement)

51
Q

deficits seen in subacute combined degeneration

A

corticospinal and DCML only
bilateral, symmetric proprioceptive loss and weakness
(pain and temp is fine)

52
Q

deficits seen in primary lateral sclerosis

A

corticospinal tract only
UMN weakness alone
-bilateral symmetric weakness

53
Q

deficits seen in amyotrophic lateral sclerosis

A

corticospinal and anterior horn cell involvement

UMN and LMN weakness

54
Q

conditions that cause anterior horn cell deficits

A

spinal muscular atrophy

poliomyelitis

55
Q

deficits seen with anterior horn cell damage

A

LMN weakness alone

bilateral, symmetric

56
Q

conditions that cause posterior column deficits

A 
Tabes dorsalis (tertiary syphilis)
B6 intoxication
paraneoplastic (sensory neuropathy)
57
Q

deficits seen with posterior column damage

A

bilateral, symmetric proprioceptive loss

58
Q

conditions that can cause multifocal deficits

A

transverse myelitis

multiple sclerosis

BMB Test 1 (29 decks)

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