DELTA notes Flashcards
Where is the lateral horn of the spinal cord located?
only in the thoracic and upper lumbar segment of the spinal cord
Sensory path involved in pressure signals from T5 dermatome?
dorsal column medial lemniscus pathway
secondary neurones in nucleus cuneatus
2nd order neurones for fine touch, pressure and vibration from below T6 dermatome?
nucelus gracilis
DCML pathway
Function of dorsal/posterior spinocerebellar pathway?
carries unconscious proprioceptive information (from muscle spineless mainly) from lower limbs -
Signals from lower limbs synapse in dorsal nucleus of Clarke and 2nd order neurones ascend to ipsilateral cerebellum…?
dorsal/posterior spinocerebellar pathway
Which pathway carries unconscious proprioceptive information from upper limbs to the ipsilateral cerebellum?
cuneocerebellar
Which spinocerebellar pathway decussates twice?
ventral/anterior spinocerebellar
unconscious proprioceptive information from golgi tendon organs of lower limb is carried in which spinocerebellar tract?
ventral/anterior spinocerebellar
Motor fibres which decussate at medullary pyramids continue down in which tract and supply where?
lateral corticospinal tract
supply distal extremities
the motor fibres which don’t decussate at the medullary pyramids continue down the spinal cord in which tract and supply where?
anterior corticospinal tract
proximal and axial muscles
what fibres the corticobulbar tracts contain?
upper motor neurone of CNs
which motor nuclei are the exception for the corticobulbar tracts?
they innervate motor nuclei bilaterally however, the hypoglossal and lower facial nuclei are innervated contra laterally only.
Patient presents with paralysis of the lower left half of their face. their forehead muscles are unaffected - where is the lesion and what is the name for this condition?
right upper motor lesion in corticobulbar tract (cortex) - central facial palsy
(upper facial division innervated bilaterally; lower innervated contra laterally)
Patient presents with paralysis of left half of their face including their forehead - where is the lesion and name this condition.
lower motor neurone lesion - left brainstem or lower = Bell’s palsy
anti-gravity muscles receive input from this tract
vestibulospinal
which tract facilitates reflexes and increases tone?
pontine reticulospinal tract
Which tract inhibits reflexes and decreases tone?
medullary reticulospinal tract
which tract originates from the red nucleus in the midbrain and which muscles does it innervate?
rubrospinal tract
excites flexor muscles and inhibits extensor muscles of upper body
Where does the tecto-spinal tract originate and what does it co-ordinate?
from superior colliculus in midbrain
movements of head and neck to visual stimuli
Which nerve is tested by the biceps reflex?
musculocutaneous
which spinal ligament appears yellow and why?
ligamentum flavum - rich in elastin
list the layers that a needle passes through during a lumbar puncture.
skin > fascia > supraspinous ligament > interspinous ligament > ligamentum flavum > epidural space > dura
Patient has back pain which is worse in morning and better with movement. It is worse after sitting for a long time and they have new pain down the back of their legs to just above the knee.
diagnosis and explanation
mechanical back pain
hypertrophied facet joints causing referred pain from nerve supplying joint - mimics sciatica but doesn’t radiate below the knee
What are the red flags for low back pain?
extreme of age: <20 or >60 pain not improved by rest pain wakes patient up at night urinary retention/incontinence & faecal incontinence saddle anaesthesia Hx of malignancy unexplained weight loss fever, immunosuppression or PWID
Describe a disc herniation.
nucleus pulposus herniates through a tear in the annulus ring and compresses adjacent nerve roots
A paramedian (aka posterolateral) herniated disc at level L4/5 will compress which nerve root?
the traversing nerve = L5
A far lateral (extraforaminal) herniated disc at L4/5 will compress which nerve root?
the nerve root exiting at level of prolapse = L4
What is radiculopathy?
dysfunction of a nerve root causing dermatomal sensory deficit with weakness of the muscle groups supplied bu that nerve
Patient presents with pain along posterior thigh which radiates to the heel, weak plantar flexion, sensory loss in lateral foot and reduced ankle jerk.
Which spinal level is involved?
L5/S1 prolapsed intervertebral disc - S1 root involved
Patient with pain along posterior thigh that radiates to dorsal of foot and great toe, weak dorsiflexion and numbness of foot and great toe.
Which spinal level is involved?
L4/5 prolapsed intervertebral disc - root involved = L5
Patient has pain in anterior thigh, visible wasting of quads, weakness of quadriceps and dorsiflexion, reduced sensation over anterior thigh, knee and medial aspect of lower leg, knee jerk also reduced.
Which spinal level is involved?
L3/4 prolapsed intervertebral disc - root involved = L4
Patient has severe exacerbation of lower back pain –> intermittent bladder spasms and small volume incontinence/ retention.
How can you tell from examining them that this is not cauda equina?
if ankle reflexes are present = highly unlikely they have cauda equina
How do you surgically manage cauda equina due to herniated disc?
discectomy
How do you surgically manage cauda equina due to fracture?
decompression ± fixation
How do you surgically manage cauda equina due to a haematoma?
evacuation
Patient presents by progressively worse unilateral buttock and lower leg burning pain which is worse on prolonged standing and relieved by walking uphill. The episodes sometimes include leg weakness on ipsilateral side.
lumbar spinal stenosis at L4/5 with neurogenic intermittent claudication
What would you see on a radiograph of cervical spondylosis?
narrowing of disc space - C5/6 or C6/7
osteophyte formation
Surgery for posterior compression on spinal cord due to osteophyte or ligamentum flavum hypertrophy?
decompressive cervical laminectomy
surgery for predominant anterior compression of spinal cord due to disc?
anterior cervical discectomy
surgery for unilateral nerve root compression in cervical spine?
posterior cervical foraminotomy
Elderly patient with “clumsy hands” - difficulty holding cutlery - recent 2 falls and partner complaining their legs jumping at night.
degenerative cervical myelopathy
What do you expect to find on examination of a patient with degenerative cervical myelopathy?
hyperreflexia, spasticity, weakness
positive babinski sign
loss of dexterity using fingers
cord infarction by the area supplied by the anterior spinal artery - paralysis, loss of pain and temp below level of injury but preserved vibration and proprioception
anterior cord syndrome
all motor and sensory modalities affected below lesion = ?
cord transection
describe Brown-Sequard syndrome
ipsilateral UMN paralysis & loss of proprioception below lesion
contralateral loss of pain & temperature below lesion
Acute extension injury to already stenotic neck or syringomyelia or tumour –> ?
central cord syndrome
why is a lesion in the central cord more likely to damage the upper limb fibres and hence cause upper limb weakness > lower limb weakness?
fibres supplying upper limbs in lateral corticospinal tracts are more medial to the fibres supplying lower limbs
Patient presents with nystagmus, ataxic gait and is confused. He is hypothermic and has a low BP. He looks unkept and smells like alcohol.
Diagnosis?
Wernicke’s encephalopathy due to thiamine (B1) deficiency
Signs of a thalamic infarction?
hemiparesis, hemichorea, spontaneous pain, even severe impairment of consciousness
hemiballism is a sign of lesion in which part of the diencephalon?
sub thalamic nucleus
What is genetic anticipation?
seen in Huntington’s disease when the CAG repeat increases from generation to generation - describes increasing severity and earlier onset of inherited disease as it is transmitted from generation to generation
Patient presents with memory loss, left superior quadrantopia and receptive dysphasia - where is the lesion?
right temporal lobe - Wernikie’s area
Patient presents with cognitive slowing, right sided weakness, urinary incontinence and expressive dysphasia - where is the lesion?
left frontal lobe - Broca’s area, primary motor cortex, and micturition inhibition centre affected
Patient is right handed and their left parietal lobe is found to have a tumour in it - what symptoms are they bound to experience?
Right sided weakness and sensory loss, right inferior quadrantopia, Gerstmann syndrome (dyscalculia, dysgraphia, finger agnosia, and right-left disorientation)
What is a sign that a patient has a tumour in their parietal lobe on their non-dominant side?
neglect (not aware of one side of body), dressing apraxia, constructional apraxia
MRI shows a heterogenous enhancing SOL with areas of necrosis and ‘butterfly’ appearance.
glioblastoma multiforme
Foster- Kennedy syndrome
a meningioma in the olfactory groove which is clinically defined as optic atrophy in the ipsilateral eye and papilloedema in the contralateral eye.
Young person presents with bilateral tinnitus, vertigo and O/E has bilateral SNHL. MRI shows bilateral SOLs in the cerebellopontine angle.
bilateral acoustic neuromas = NF2
What spinal level is the carotid bifurcation at?
C4
The internal carotid artery terminates into a bifurcation - which 2 arteries arise here?
middle cerebral artery and anterior cerebral artery
Artery that supplies the medial part of the cerebral hemispheres back to the parietal lobe, most of corpus callosum, anterior limb of internal capsule + part of caudate nucleus…?
anterior cerebral artery
Artery that supplies majority of lateral hemisphere, basal ganglia and internal capsule?
middle cerebral artery
What is the main branch of the vertebral arteries and where does it supply?
posterior inferior cerebellar arteries - supply posteroinferior cerebellar hemispheres
Which artery supplies the occipital cortex and gives off branches to supply the thalamus?
posterior cerebral artery
Cerebral deep veins mainly drain into the sagittal sinus - T/F?
fale - deep veins drain into the straight sinus
Where do superficial cerebral veins drain blood into?
superior sagittal sinus
What is the first sign of an uncal herniation?
pupillary dilatation - compression of ipsilateral CN III
if continues –> contralateral hemiparesis due to compression of pyramidal tracts
What happens in a subfalcine herniation?
cingulate gyrus herniates below the fall cerebri - compresses anterior cerebral artery –> weakness in lower extremities
Patient presents with inability to gaze laterally without diplopia and reduced corneal reflex. MRI shows herniation where?
central herniation of brainstem
