Clinical assessment of the spinal cord - Ojemann

Question 1

Myelopathy:

Answer 1

Disorder resulting in spinal cord dysfunction.

Question 2

Nerve root:

Answer 2

Nerve bundle exiting at a given vertebral level containing both motor and sensory rami

Question 3

Tracts:

Answer 3

Bundles of nerves in the CNS

Question 4

Dermatome:

Answer 4

Cutaneous area served by a given sensory root

Question 5

Myotome:

Answer 5

Muscles innervated by a given motor root

Question 6

Radiculopathy

Answer 6

Sensory or motor dysfunction due to an irritation of a nerve root

Question 7

Paresthesia

Answer 7

An abnormal sensation, can include burning, pricking,

tickling, or tingling. Sometimes characterized as “pins and needles”

Question 8

Dysthesia

Answer 8

Impairment of sensation; less than that of anesthesia

Question 9

Hyperesthesia

Answer 9

Abnormal acuteness of sensitivity to touch, pain, or other

sensory stimuli

Question 10

C4 vertebral body overlies the ____ spinal cord segment.

Answer 10

C4

Upper cervical: Vertebra # overlies same cord segment # (C2 vertebra overlies C2 spinal cord segment)

Question 11

C7 vertebral body overlies the ____ spinal cord segment.

Answer 11

C8

Lower cervical: vertebra # overlies cord segment # + 1 (C6 bone, C7 cord)

Question 12

T5 vertebral body overlies the ____ spinal cord segment.

Answer 12

T7

Upper thoracic: vertebra # overlies cord segment # + 2 (T4 bone, T6 cord)

Question 13

T11 vertebral body overlies the ____ spinal cord segment.

Answer 13

L2

Lower thoracic/lumbar: vertebra # overlies cord segment # +2- 3 (T 11bone, L1-2 cord)

Question 14

What vertebral body overlies the conus medullaris?

Answer 14

L1

Question 15

C1-7 nerve roots exit ____ the corresponding vertebral secment. C8-S5 exit ___>

Answer 15

Above, below

Question 16

Lesions, such as tumors, that evolve from OUTSIDE of the cord are called _____. They tend to cause early pain and UMN signs, and pain and temperature sensation is likely to evolve in an ascending fashion (affects sacral, then lumbar, then thoracic, cervical fibers progressively).

To what is this due?

Answer 16

Extramedullary lesions

Due to the somatotopy of the spinal cord.

Question 17

Intramedullary lesions, those that arise within the cord, will tend to cause what symptoms, and in what progressin?

Answer 17

early bladder dysfunction, with only late development of pain. Loss of pain and temperature may progress in a descending fashion- invlovling cervical and thoracic levels early, then lumbar, then sacral.

Question 18

Somatotopic organization to the tracts:

Within the Posterior Columns, ___ fibers are medial, fibers from the ____ are lateral.

Within the Corticospinal and Spinothalamic Tracts, __ fibers are medial and fibers from the ___ are lateral.

Answer 18

SACRAL; ARMS

ARMS; SACRUM

Question 19

C5 dermatome

Answer 19

back of shoulder, lateral arm

Question 20

C6 dermatome

Answer 20

thumb and index finger

Question 21

C7 dermatome

Answer 21

middle finger

Question 22

T4 dermatome anatomic landmark?

Answer 22

nipple line demarcates the bottom of the T4 dermatome

Question 23

What dermatome ends at the umbilicus?

Answer 23

T10

Question 24

What dermatome ends at the xyphoid process?

Answer 24

T6

Question 25

Where is the L4 dermatome

Answer 25

Medial leg, kneecap

Question 26

Where is the L5 dermatome

Answer 26

Dorsum of the foot, great toe

Question 27

Where is the S1 dermatome on the foot

Answer 27

Small toe, lateral foot, sole of the foot

Question 28

DCML sensation includes (4)

Answer 28

Vibration Light touch 2 touch discrimination Joint position sense

Question 29

AMS sensation includes (2)

Answer 29

Pain | Temperature

Question 30

What is babinski's sign?

Answer 30

+ extension of big toe, flexion of others - flexion of all toes Signifies UMN injury.

Question 31

What is Hoffmans sign

Answer 31

+ flexion of thumb DIP when middle fingernail flicked - no flexion This is the upper limb equivalent of babinskis sign. positive indicates UMN

Question 32

For injury of nerve root C5, which muscles, dermatomes, and reflex should be impaired. What is the disc bulge that causes this injury? With what frequency does it occur?

Answer 32

Muscles: Deltoid, Infraspinatus, Biceps Dermatomes: shoulder, upper lateral arm Reflex: bicipetal Usually involves C4-5, 10% of UE radic.

Question 33

For injury of nerve root C6, which muscles, dermatomes, and reflex should be impaired. What is the disc bulge that causes this injury? With what frequency does it occur?

Answer 33

Muscles: Wrist extensors, biceps Dermatomes: thumb, index Reflex: biceps, brachioradialis Usually involves C5-6, 20% of UE radic.

Question 34

For injury of nerve root C7, which muscles, dermatomes, and reflex should be impaired. What is the disc bulge that causes this injury? With what frequency does it occur?

Answer 34

Muscles: Triceps Dermatome: 3rd digit (middle finger) Reflex: triceps Usually involves C6-7, 40-50% UE radic

Question 35

For injury of nerve root L4, which muscles, dermatomes, and reflex should be impaired. What is the disc bulge that causes this injury? With what frequency does it occur?

Answer 35

Muscles: Psoas, Quads Dermatome: Knee, medial leg Reflex: patellar Usually involves L3-4, 10% LE radic

Question 36

For injury of nerve root L5, which muscles, dermatomes, and reflex should be impaired. What is the disc bulge that causes this injury? With what frequency does it occur?

Answer 36

Muscles: Foot dorsiflexion, toe extensors, eversion and inversion Dermatome: dorsum of foot, great toe Reflex: none Usually involves L4-5, 40% of LE radic.

Question 37

For injury of nerve root S1, which muscles, dermatomes, and reflex should be impaired. What is the disc bulge that causes this injury? With what frequency does it occur?

Answer 37

Muscles: foot plantarflexion Dermatome: lateral foot, sole of foot, small toe Reflex: achilles Usually involves L5-S1, 45% of LE radic.

Question 38

Complete spinal cord transection (deficit, signs)

Answer 38

Loss of all sensory and motor below site, may have root signs at site. Spinal shock, then UMN.

Question 39

Central spinal cord lesion (deficit, eg.)

Answer 39

Pain and temp loss at level of lesion, sparing of proprioception. Syringomyelia, ependymomas, cord contusion

Question 40

Posterior column syndrome (deficit)

Answer 40

Loss of proprioception below lesion, bilaterally.

Question 41

Loss of anterior horn and lateral CS tracts. (example, deficit)

Answer 41

ALS (loss of CS tract and LMN cells in anterior horn) Loss of bilateral strength. Fasciculations, atrophy, DTR increased or decreased, normal sensation

Question 42

Describe Brown-sequard (again)

Answer 42

Hemisection of the cord results in: IL loss of movement IL loss of proprioception CL loss of pain/temp

Question 43

Posterolateral Column syndrome (example, signs)

Answer 43

B12 deficiency Bilateral motor deficit Bilateral position sense deficit (CS tracts and posterior column missing)

Question 44

Anterior horn cell syndrome (signs, examples)

Answer 44

Polio, spinal muscular atrophy. LMN symptoms (low tone, low DTR) with sparing of all bladder and sensory tracts.

Question 45

Anterior spinal artery occlusion (Tracts, signs, examples)

Answer 45

Tracts: spinothalamic and CS (all but posterior column) Signs: loss of bilateral motor, pain/temp Eg: anterior spinal artery occlusion

Question 46

Pyramidal tract syndrome (eg, signs)

Answer 46

Primary lateral sclerosis UMN symptoms bilaterally, sparing of sensory/bladder

Question 47

Myelopathy with Radiculopathy (tracts affected, signs, examples)

Answer 47

Tracts: all and any (CS, particularly) Signs: UMN bilaterally, may have bladder dysfunction Examples: cervical spinal stenosis

Question 48

What are the features of Cauda Equina syndrome?

Answer 48

1) EARLY root pain radiating to legs 2) Leg weakness, diminished DTR 3) patchy, asymmetric "saddle" anesthesia 4) Late bladder dysfunction 5) Late bowel/sexual dysfunction

Question 49

What are the features of Conus Medullaris syndrome?

Answer 49

1) Late pain in thighs/buttocks 2) Pelvic floor muscle weakness 3) SYMMETRIC "saddle" anesthesia 4) EARLY bladder dysfunction 5) EARLY sexual/bowel dysfunction

Question 50

Lhermitte's Sign:

Answer 50

Neck flexion results in "electric shock" sensation down the back and/or into arms. Attributed to posterior column disease (MS, disc, B12 def, mass).

Question 51

Summarize each of the four phases of spinal shock. (Duration, symptoms)

Answer 51

Phase 1: Lasts for 1 day. Loss of all sensory/motor function including DTR. Phase 2: Days 2-3 (2 days). Monosynaptic reflexes re-appear (bulbocavernosus reflex). Phase 3: Weeks 1-4. DTR hyperreflexia Phase 4: (Week 1 and beyond) Chronic spacticity.

Question 52

What is neurogenic shock?

Answer 52

``` Low HR (loss of sympathetic tone [unopposed vagal tone]) Low BP (loss of sympathetic tone [low TPR]) ```