Clinical Assessment of the Spine and Spinal Cord 2

Question 1

Additional Sensory Testing

Answer 1

two-point discrimination
Double simultaneous stimulation (looking for extinction)

Testing higher order (cortical) sensory processing:
Graphesthesia
Stereognosis- ability to recognize based on texture, size, temperature

Question 2

Clinical Assessment of Motor Function

Answer 2

Inspection
Observation
Palpation
Individual muscle group testing
pronator drift
fine motor movements

Question 3

The abdominal reflex (special)

Answer 3

elicited by drawing a line away from the umbilicus along the diagonals of the 4 abdominal quadrants. A normal reflex draws the umbilicus toward the direction of the line that is drawn.

Question 4

cremasteric reflex (special)

Answer 4

elicited by drawing a line along the medial thigh and watching the movement of the scrotum in the male. A normal reflex results in elevation of the ipsilateral testis.

Question 5

anal wink reflex (special)

Answer 5

elicited by gently stroking the perianal skin with a safety pin. It results in puckering of the rectal orifice owing to contraction of the corrugator-cutis-ani muscle.

Question 6

1. Complete Cord Transection

Answer 6

Tracts: All ascending sensory & descending motor/autonomic tracts.

Deficit: Sensory + motor levels below lesion; may also have root signs at site.

Note: Spinal shock followed by UMN signs.

Question 7

2. Central Lesions:

Answer 7

Tracts:Initially involve crossing ST

E.g.s: Syringomyelia (fluid-filled cavity in cord), ependymomas, cord contusion.

Deficit: PP/Temp loss at level of lesion, with
sparing of position sensation.

Note: Cape-like distribution if in C-spine.

Question 8

3. Posterior Column Syndrome:

Answer 8

Tracts: PC

E.g.s.Tabes dorsalis (form of neurosyphilis)

Deficit: Bilateral loss of position & vibration
sensation

Question 9

4. Combined Anterior Horn Cell-Pyramidal Tract Syndrome:

Answer 9

Tracts:CS and LMN cells in cord.

E.g.s:Amyotrophic lateral sclerosis (Lou Gehrig’s disease)

Deficit: Loss of bilateral strength.

Note: Fasciculations, atrophy, ↑ or ↓DTR,
normal sensation

Question 10

5. Brown-Sequard (Hemi-Section):

Answer 10

Tracts: Crossed ST + uncrossed PC + crossed CS

E.g.: Compression by herniated discs, tumor extramedullary abscess, etc.

Deficit: Below lesion, loss of
CL PP/Temp
IL Position
IL strength.

Question 11

6. Posterolateral Column Syndrome:

Answer 11

Tracts: PC + CS

E.g.: B12 deficiency (aka subacute combined degeneration)

Deficit: Bilateral loss of position & vibration, and strength.

Question 12

7. Anterior Horn Cell Syndrome:

Answer 12

Tracts: None - lower motor neuron (cell).
E.g.: Spinal muscular atrophy, polio virus

Deficit: Bilateral loss of strength.

Note: Fasciculations, ↓ tone + ↓ DTRs
with sparing of all sensory tracts and bladder functions.

Question 13

8. Anterior Spinal Artery Occlusion:

Answer 13

Tracts: ST + CS

E.g.: Anterior spinal artery occlusion.

Deficit: Bilateral loss of strength + PP/Temp,
with sparing position sense.

Question 14

9. Pyramidal Tract Syndrome:

Answer 14

Tracts: CS
E.g.: Primary lateral sclerosis.
Deficit: Bilateral UMN weakness with spastic gait, ↑ DTRs, but complete sparing of all sensory tracts and bladder function.

Question 15

10. Myelopathy with Radiculopathy:

Answer 15

Tracts: Any or all 3 tracts (esp. CS)

E.g.s:Cervical spinal stenosis, may be congenital or degenerative.

Deficit: Bilateral UMN syndrome with spastic gait, ↑ DTRs + IL or CL root signs + possible bladder dysfunction.

Question 16

CAUDA EQUINA Syndrome

Answer 16

-EARLY root pain radiating to legs
Leg weakness & ↓ DTRs (LMN)
-Patchy, asymmetric "saddle"
Late bladder dysfunction
Late bowel & sexual dysfunction

Question 17

CONUS MEDULLARIS

Answer 17

Late pain in thighs & buttocks
Pelvic floor muscle weakness
SYMMETRIC "saddle" anesthesia, numb 
-EARLY bladder dysfunction
-EARLY bowel & sexual dysfunction

Question 18

Lhermitte’s Sign

Answer 18

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 19

Cervical Stenosis

Answer 19

Congenital or acquired narrowing of central cervical spinal canal.
Can result in UMN signs in legs +/- bladder dysfunction.

Question 20

Immediate muscle weakness and hypotonia, hyporeflexia or areflexia (“Spinal Shock”)
Followed by spasticity and HYPERreflexia in days to weeks (including extensor plantar response: Babinski’s sign)
SPASTIC PARESIS

Answer 20

UMN:

Question 21

Muscle weakness, hypotonia, hyporeflexia, areflexia are all immediate and long-lasting
FLACCID PARESIS
FASCICULATIONS
ATROPHY

Answer 21

LMN

Question 22

Detrusor (smooth) muscle, activated by the preganglionic parasympathetic outflow from the

Answer 22

S2-S4 segments.

Question 23

The involuntary (smooth) sphincter, controlled by sympathetic outflow from the ________ of the spinal cord

Answer 23

T10-L2 segments

Question 24

Skeletal muscle of the pelvic floor, innervated by alpha motor neurons from the ________

Answer 24

S2-S4 segments

Question 25

Late bladder/ sex problem

Early Pain

Answer 25

Cauda Equina

Question 26

Early Bladder

Late pain

Answer 26

Conus Medullaris

Question 27

Traumatic Spinal Cord Injury (SCI)

Answer 27

Spinal Shock following spinal cord injury is a specific term that relates to the loss of all neurological activity below the level of injury, including loss of motor, sensory, reflex, and autonomic function. Physiologic disruption of cord

Question 28

Neurogenic Shock:

Answer 28

low blood pressure, slowed heart rate that results from the disruption of the autonomic pathways within the spinal cord.

Hypotension results from decreased systemic vascular resistance from loss of sympathetic tone.

Bradycardia results from unopposed vagal tone.

Question 29

Spinal Shock

Answer 29

48- 72 hours transient disruption
return bulbo-cavernouses reflex shows ending
(anal contraction)

Question 30

Primary vs Secondary injury

Answer 30

primary: cannot repair

Question 31

Sequelae of SCI

Answer 31

bladder, DVT, pressure ulcer, pneumonia, gi hemorrhage, autonomic dysreg

Question 32

Lhermitte’s Sign:

Answer 32

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 33

Radiculopathy

Answer 33

Sensory and/or motor dysfunction due to injury to a nerve root. Can be caused by herniated disk

s/s:
Lhermitets
nerve pain
reliefe: rest, nsaids