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Neuro III > Classification and syndromes > Flashcards

Classification and syndromes Flashcards

1
Q

non-traumatic injuries

A

infections (polio), vascular lesions or inflammatory disorders, diseases or degeneration (MS, DDD), congenital anomalies, psychological causes (hysterical paralysis), neoplasms, CVA in spinal cord

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2
Q

Transverse Myelitis

A

common inflammatory disorder
F to M 4:1
progresses over period of 48 hr- weeks
50% have paralysis, all have neurogenic bladder, 80-95% have sensory problems
prognosis: 1/3 recover, 1/3 have paraplegia, 1/3 have some neuro deficits

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3
Q

Traumatic SCI stats

A

12,000 new US per year
average age 33 but mainly 16-30 yo
caucasian>AA>hispanic
Less SCI are complete today vs incomplete
Many d/c home and life expectancy is shortened

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4
Q

Spinal cord segments

A

31 pairs
C1-7 above corresponding vertebra
C8 down exit below corresponding vertebra
8C, 12T, 5L, 5S, 1Coccygeal

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5
Q

spinal cord cross section

A

dorsal nerve root= sensory, anterior= motor
gray matter= cell bodies
white= axons, tracts

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6
Q

conus medullaris

A

termination of SC at L1-2 vertebra

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7
Q

filum terminale

A

attaches SC to coccyx

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8
Q

cauda equina

A

get more LMN injury or peripheral N injury

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9
Q

Vertebra bone

A

Know location of vertebral canal, spinous process, transverse process, lamina, pedicle, facet joint

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10
Q

Ligaments

A

Know ALA lig and transverse ligament of atlas

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11
Q

blood supply

A

1 anterior spinal artery and 2 posterior spinal arteries

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12
Q

corticospinal tract

A

descending; voluntary mvt ms, 90% crosses in medulla; 10% doesn’t cross

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13
Q

vestibulospinal tract

A

descends ipsilaterally; posture and head stability

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14
Q

reticulospinal tract

A

descending; RAS in brainstem; ventral ipsilateral extension mvt; lateral ipsi and contralateral ms tone

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15
Q

rubrospinal tract

A

descending; facilitates flexion UE

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16
Q

tectospinal tract

A

descending; reflex posture, mvt head, coordinates head/eye mvt

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17
Q

spinothalamic tract

A

ascending; lateral pain/temp, ascends 2-4 levels then crosses

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18
Q

spinocerebellar tract

A

ascending; unconscious proprioception, some contra and ipsilateral

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19
Q

dorsal columns tract

A

ascending; cross at medulla, kinesthesia, vibration, 2 pt discrimination, stereognosis

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20
Q

SCI mechanism of injury

A

usually indirect trauma–> violent mvt of head or trunk
magnitude/direction determines pattern and severity of injury
extent and location of bony and ligamentous damage determines spine’s stability
Single or limited # vertebra

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21
Q

SCIWORA

A

SCI without radiographic abnormality; force with pre-existing abnormality

22
Q

Cervical cord innervations

A 
C3-5= diaphragm, chief ms of inspiration via phrenic nerve
C4-7= SH and arm ms
C6-8= FA ext and flexors
C8-T1= hand ms
23
Q

Cervical injuries

A

most vulnerable; usually damage to lower levels of cervical

24
Q

Thoracic cord

A

spinal roots form intercostal nerves along inferior rib margin; main ms of expiration; innervate heart and abdominal organs

25
Q

Thoracic injuries

A

most stable, more likely to be complete, T12-L1 junction most common site

26
Q

Lumbosacral cord innervations

A

L1-2= sympathetic pelvic and abdominal organs
L2-3= hip flexion
L3-4= knee ext
L4-5= ankle DF and hip ext
L5-S1= knee flex
S1-2= ankle PF
Sacral also innervate parasympathetic pelvic and abdominal organs

27
Q

Lumbar injuries

A

usually inomplete

cauda equina less sensitive to trauma than spinal cord

28
Q

Associated injuries

A

fx, pneumothorax, hemothorax, head injury, brachial plexus, peripheral nerve injury

29
Q

Pathological changes

A

damage spreads out, rostrally and caudally
primary damage= neuronal damage
secondary damge= ischemia, inflammation, disruption of ion concentration, apoptosis

30
Q

spinal shock

A

transient; absent or depressed caudal to lesion: motor/sensory, reflexes, autonomic function

31
Q

return to function

A

return if brain and spinal cord remain connected; if no return, will still have reflexes at each individual level

32
Q

mechanism of return

A

remyelination of surviving neurons

resolution of secondary problems: edema, hemorrhage, vasoconstriction

33
Q

predictors of motor return

A

incomplete vs complete, preserved motor or pin prick sensation, early vs late return, age

34
Q

neurological level

A

most caudal spinal cord section with intact sensory and motor function bilaterally; if motor/sensory different, can still document but should document both separately too

35
Q

motor level

A

most caudal or lowest level with normal function bilaterally (>3/5) and level above must be 5/5

36
Q

sensory level

A

most caudal section spinal cord with normal sensory bilaterally

37
Q

complete vs incomplete SCI

A

complete means no motor or sensory at S4 or S5

38
Q

zone of partial preservation

A

sensory and/or motor below neuro level, but nothing at S4 or S5; must be complete injury or ASIA A

39
Q

ASIA Impairment scale A

A

complete; no motor or sensory function is preserved in sacral segments S4 or S5

40
Q

ASIA Impairment scale B

A

incomplete; sensory but not motor function is preserved below neuro level and includes sacral segments S4 or S5

41
Q

ASIA Impairment scale C

A

incomplete; motor function is preserved below neuro level and more than half key muscles below neuro level have muscle grade <3/5

42
Q

ASIA Impairment scale D

A

incomplete; motor function is preserved below neuro level and at least half key muscles below neuro level have muscle grade of 3 or more

43
Q

ASIA Impairment scale E

A

normal: motor and sensory function are normal; had SCI and improved to this point

44
Q

UE Key muscles for ASIA

A 
C5 elbow flexion
C6 wrist ext
C7 elbow ext
C8 finger flex
T1 finger ABD
tested in supine
45
Q

LE Key muscles for ASIA

A 
L2 hip flex
L3 knee ext
L4 ankle DF
L5 long toe ext
S1 ankle PF
tested in supine
46
Q

Brown Sequard Syndrome

A

ipsilateral loss of position sense/vibration and motor along with spasticity below LOL
contralateral loss of pain/temp below LOL
Flaccid paralysis at LOL
good prognosis

47
Q

Anterior Cord Syndrome

A

motor: anterior horn cells B sides
LMN at LOL, UMN below
Sensory: bilateral pain/temp loss at LOL and below
preservation of dorsal column (prop/vibration)
Poor prognosis

48
Q

Central cord syndrome

A

motor loss UE>LE
Sensory loss variable, may be sacral sparing S4-S5
ok Prognosis

49
Q

Conus medullaris syndrome

A

vertebral level T12-L2
contains motor neuron for B&B
sacral sparing

50
Q

sacral sparing

A

refers to incomplete lesion- have perianal sensation and external sphincter control

51
Q

Cauda Equina syndrome

A

LMN incomplete injury
behaves like a PN injury- flaccid paralysis B&B function
full recovery not typical

Neuro III (5 decks)

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