Disorders of the Spinal Cord Flashcards
Why wouldn’t you scan the lumbar spine to visualize a spinal cord lesion?
because the spinal cord ends at about the L1 vertebral level
WHat is the primary descending motor tract?
the corticospinal tract
Describe the signs and symptoms of brown-sequard syndrome.
- ipsilateral weakness and hyperreflexia below the lesion (dysfunction of corticospinal tract)
- ipsilateral impaired position sense below the lesion (posterior column fibers)
- contralateral loss of pain and temperature sensation
A structural abnormality in the center of the spinal cord which particularly affect what tract?
the spinothalamic tract fibers crossing in the anterior white commissure at the level of the lesion, so you lose pain and temperature sensation at that level
What is the classic central cord lesion?
syringomyelia
About half of syrinxes are associated with what posterior skull and brain abnormality?
chiari malformations
What will cauda equina lesions cause?
wasting, weakness and fasciculations in the muscles innervated by the cauda equina roots, often with substantial pain
bowel, bladder and sexual dysfunction
What will lesions of the conus medullaris cause?
a mix of upper motor neuron findings like hyperreflexia, babinski signs and prominent sphincter dysfunction
radicular pain
What blood vessels supplies the anterior 2/3rds of the spinal cord?
the anterior spinal artery (ASA)
The cephalad portion of the ASA arises from branches of what arteries?
the two vertebral arteries joining at the top of the cord.
The caudal portion of the ASA is supplied by what artery?
The radial artery of adamkiewicz at the level of L2, fed by perforating artereis from the aorta
The most common form of spinal infarct is anterior spinal artery syndrome. What are the associated symptoms?
it affects the spinothalamic and corticospinal tracts, so you get weakness below the lesion, intense radicular pain or back pain and sphincter dysfunction
pain and temp sensation loss below the lesion (with preserved vibration and position sense)
What is the usual clinical level of cord dysfunction in ASA syndrome and why?
T4 because the thoracic cord is the least well perfused
What are the two common causes of ASA syndrome?
aortic surgery and atherosclerosis
Why might there be flaccid weakness and complete absence of DTRs immediately after spinal cord trauma if it’s the upper motor neurons that are affected?
you get spinal shock immediately after the trauma
eventually the typical upper motor neuron signs will develop
