Cord Lesions/ Lumbar puncture Flashcards
3 most clinically important tracts of spinal cord
- dorsal columns
- lateral corticospinal tracts
- spinothalamic tracts (w/in anterolateral pathway)
function of dorsal columns
- carry info on fine touch, vibration, and proprioception to the brain
function of the lateral corticospinal tracts
- carry efferent impulses from the motor cortices to the peripheral musculature, to control fine, voluntary movements
function of the spinothalamic tracts
- carry information on pain and temperature from the periphery to the brain
describe transverse lesions
- complete transection of the cord resulting in loss of pain/temp perception, vibration/touch/proprioception perception, and UMN lesion sx
describe UMN lesion sx
5
- paralysis
- spasticity
- hyper-reflexemia
- clonus
- pos babinski
describe anterior lesions
- bilateral UMN lesion signs
- Loss of pain/temp sensation below the level of the lesion
- Dorsal columns spared (no loss of fine touch)
describe posterior lesions
- bilateral loss of fine touch, vibration, and proprioception below level of spinal lesion
- motor function and pain/temp sensation are spared
hemi-cord lesions AKA
brown-sequard syndrome
describe hemi cord lesions
- loss of fine touch, proprioception, and vibration sensation and UMN lesion sx on the side of the lesion
- loss of pain/temp sensation on the opposite side of the lesion
describe small central cord lesions
- only disrupts the spinothalamic fibers at the level of the lesion
- causes a “cape of pain/temp loss” over the arms
describe large central cord lesions
- disrupts all but the outermost area of the spinal cord
- sacral region is spared
mnemonic for identifying causes of lesions
INVITED MD
INVITED MD
I
what it stands for + 2 specifics
INFECTIOUS
* epidural abscess
* tertiary syphilis
INVITED MD
N
2 specifics
NEOPLASM
* intrinsic/extrinsic spinal cord tumor
INVITED MD
V
3 specifics
VASCULAR
* spinal stroke
* AVM
* cavernoma
INVITED MD
I
3 specifics
INFLAMMATORY
* transverse myelitis
* MS
* neuromyelitis optica
INVITED MD
T
2 specifics
TRAUMA
* stab wound
* spinal fracture
INVITED MD
E
no specifics
ENDOCRINE
INVITED MD
D
2 specifics
DEGENERATIVE
* intervertebral disc prolapse
* spondylosis
INVITED MD
M
1 specific
METABOLIC
* vit B12 deficiency
INVITED MD
D
no specifics
DRUGS
Lumbar puncture
common indication
Serious bacterial , viral or fungal infections like meningitis, encephalitis and syphilis.
Bleeding around the brain (subarachnoid hemorrhage)
Suspicion of other neurologic conditions, especially demyelinating ones, like Guillain-Barre and Multiple Sclerosis.
Therapeutic relief of Idiopathic Intracranial Hypertension
Certain cancers of the brain and Spinal cord
Lumbar puncture
Contraindications
CNS lesion causing midline shift, mass effect, effacement of basal cisterns (herniation risk)
Skin infection in area of spinal needle placement
Lumbar Spinal Trauma
Risk of hemorrhaging
Coagulation disorders/bleeding disorders
Platelet count under 20000
Heparin dose within 24 hours
INR greater than 1.5
LP
Tubes 1-4
- cell count
- glucose proetin
- special tests
- gram stain. culture, repeat cell count
manometer
measured in H2O cm
LP
where do you puncture?
between L4, L5
or
L3, L4
LP
Patient positioning
lying more common
LP
Types of needles
LP
complications
Post-lumbar puncture headache (25%)
Back discomfort or pain
Bleeding
Brainstem herniation
