Chapter 22: Disorders of the Spinal Cord

Question 1

Where does corticospinal tract cross?

Answer 1

Medulla

Question 2

Sensory dermatome of C1

Answer 2

Doesn’t have any sensory fibers

Question 3

Spinal cord ends at…

Answer 3

L1 (so you can only scan thoracic and cervical cord)

Question 4

Respiratory insufficiency with what spinal level

Answer 4

C3,4,5 keeps your diaphragm alive

Question 5

Horner’s localization

Answer 5

Can be from cervical

Question 6

Abdominal reflexes

Answer 6

Lost with lesions above T6

Question 7

Blowel and bladder dysfunction

Answer 7

Lesions above sacral cord leel

Question 8

Transverse myelitis may mimic

Answer 8

Transection, but it develops over a longer period and with evidence of inflammation such as CSF pleocytosis

Question 9

Does compressing the spinal cord hurt

Answer 9

Nope, only compressing the nerve roots, etc.

Question 10

Infection causes of pain

Answer 10

Epidural abscesses following skin infections or TB or from a local osteomyelitis. Radicular and other local pain.

Question 11

Epidural abscesses…benign or bad

Answer 11

Very dangerous, need to surgically drain and Abx

Question 12

Intradural, extramedullary compressive lesions

Answer 12

Meningiomas, neurofibroma masses

Question 13

Intramedullary lesions

Answer 13

MS plaques and CNS gliomas, Primary spinal cord tumors are rare

Question 14

Brown-Sequard syndrome

Answer 14

Hemicord
Ipsilateral Motor, Touch, Vibration, Pinprick
Contralateral Pain and Temperature

Trauma; cord compression; MS

Question 15

Why do central cord lesions affect the Spinothalamic tract first?

Answer 15

Because they cross just in front of the central canal!

Question 16

Central Cord presentation

Answer 16

Cape-like loss of sensation over the shoulders and arms, with preservation of the same sensations above and below the lesion. LMN signs (weakness leading to atrophy of arm muscles)

Pain and temperature sensation is affected, touch and position sense is not. “Dissociated” sensory loss

Question 17

Central cord example

Answer 17

Syringomyelia

Question 18

Syringomyelia symptoms

Answer 18

Numbness in hands, some wasting, over many months/years

Dorsal columns are preserved

Associated with Chiari malformations

Question 19

Syringomyelia tx

Answer 19

Shunt

Question 20

Vitamin B12 Deficiency causes

Answer 20

Posterior column dysfunction

Question 21

If you damage below lumbar cord

Answer 21

Leg strength and reflexes intact while severely affecting bowel, bladder, and sexual function.

Question 22

Blood supply for the anterior 2/3 of the spinal cord

Answer 22

The solitary Longitudinal Anterior Spinal Artery (ASA)

Question 23

ASA superior origin

Answer 23

From branches of the two vertebrals joining at the top of the cord.

Question 24

ASA inferior origin

Answer 24

From artery of Adamkiewicz, originating from perforating arteries from the aorta (L2 level)

Question 25

What supplies dorsal columns

Answer 25

Plexus of many arteries

Question 26

Most common cord stroke

Answer 26

Anterior spinal artery syndrome

Question 27

Anterior Spinal Artery syndrome

Answer 27

Weakness below the lesion, intense radicualr pain or back pain, and sphincter dysfunction.
Dorsal columns intact

Question 28

Emboli to the cord

Answer 28

Rare

Question 29

Common causes of ASAS

Answer 29

Aortic surgery and atherosclerosis

Question 30

When to use high dose steroids (100 mg dexamethasone)

Answer 30

Traumatic cord compression and for compression due to tumors

Question 31

Amyotrophic Lateral Sclerosis affects what

Answer 31

Alpha motor neurons of the anterior horn of the spinal cord

Question 32

Amyotrophic means

Answer 32

Loss of muscle mass from denervation (a-myotrophic)

Question 33

Lateral in ALS refers to

Answer 33

Lateral corticospinal tracts

Question 34

ALS prognosis

Answer 34

Death within 3-5 years of diagnosis

Question 35

ALS tx

Answer 35

Riluzole

Question 36

ALS summary

Answer 36

A relentlessly progressive degenerative disease leading to loss of anterior horn cells and peripheral nerve function, with weakness and signs of denervation.
Also affects CSTs, causing spasticity and additional loss of motor control