Disorders of the Spine Flashcards

1
Q

inner fibres and outer fibres of the white matter of the spinal cord in each section are responsible for functioning where ( motor and sensory )

A

inner : Cervical functioning
middle : thoracic then lumber
outer : sacral

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2
Q

What are the 2 subsystems of the sensory pathway

A

1- Dorsal column system

2- spinothalamic tract

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3
Q

Where are the 3 neurons systems in the dorsal column system and spinothalamic tracts ( Explain pathways in detail )

A

Neurons transfer info from peripheral organ ( skin ) to cortex

1st neuron - located in dorsal root ganglion , travels up SC

2nd-
Dorsal system : 1st neurone reaches second neurone in medulla and 2nd neurone projects axon to cross over contralaterally then go towards thalamus
Spinothalamic : axon of 1st neuron enter posterior horn of grey matter where second neurone is , will crossover immediately in SC then travel to thalamus

3rd- located in thalamus contralateraly to dorsal root ganglion and axon goes to Cortex

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4
Q

What is the dorsal column system responsible for

A

Fine touch and proprioception of body

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5
Q

What is spinothalamic tract responsible for

A

pain and temperature sensation

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6
Q

What the divergence between the dorsal column system and spinothalamic tract

A

Dorsal column : 2nd neuron is in the medulla and cross over happens there

Spinothalamic : 2nd neuron is in the posterior horn of grey matter and cross over will happen there in the SC

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7
Q

What if a something is inactivating half of the SC ( hemisection of cord ) , on presentation what will be missing on the side of the lesion and what will be missing on the opposite Side

A

Side of lesion : missing fine touch and proprioception because dorsal column system doesn’t cross over till medulla

Opposite side : missing pain and temperature because spinothalamic tract in that lesion is responsible for other side

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8
Q

What are the 2 motor pathway systems

A

1- Pyramidal : starting from cortex and crosses over at the pyramidal decussation before the spinal cord

2- extrapyramidal : start from midbrain and crosses over at the midbrain

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9
Q

What is the function of the rubrospinal tract ? what happens if it is missing ?

A

To suppress the second motor neuron it meets in the spinal cord.
If missing then suppressing role won’t be there and spinal tone will be increased

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10
Q

Why does UMN lesion give you increased muscular tone

A

If there is a lesion to the rubrospinal tract that stops it’s suppressing role and thus muscle tone goes up

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11
Q

What is the difference between motor function in UMN lesion or LMN lesion

A

UMN : reduced power / missing power

LMN : reduced power/ missing power

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12
Q

What is another name for UMN

A

Central MN and first MN

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13
Q

What is another name for LMN

A

Peripheral MN , second MN

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14
Q

What is the difference between abnormalities in deep tendon reflexes in UMN lesion or LMN lesion

A

UMN : exaggerated , brisk , increased reflexogenic zone , polyclonal answers
LMN : weak / missing

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15
Q

What is the difference between pathological reflexes in UMN lesion or LMN lesion

A

UMN : Hoffman and Babinski present

LMN : missing

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16
Q

What is the difference between muscular tone in UMN lesion or LMN lesion

A

UMN : increased/spastic

LMN : decreased/missing

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17
Q

What creates the muscular tone and what suppresses it

A

Created by : 2 motor neurone / LMN

Suppressed by : rubrospinal tract / UMN / 1st neurone

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18
Q

What is typical for Parkinson’s increased muscle tone

A

Rigidity

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19
Q

What is Spastic increased muscle tone

A

” Clasp knife “

Resistance at first and then with continued pressure , suddenly resistance will drop and there will be sudden flop of limb

20
Q

What is increased reflexogenic zone

A

In UMN lesion when there is reflex not exactly at the tendon

21
Q

What is Polyclonal reflex

A

in UMN lesion when you get multiple reflexes after taping the tendon

22
Q

What is Hoffman’s pathological sign

A

Present in UMN lesion , for upper limb.

holding and Flicking middle finger will result in grasping movement of rest of fingers

23
Q

What is Babinski’s reflex

A

Present in UMN lesion, for lower limb.

stimulation of plantar side of foot causes Big toe to move upwards and back and rest of toes go down

24
Q

What could go wrong with the spine ( types of problems, non specific )

A
1- congenital 
2- developmental 
3- inflammatory / infection 
4- degenerative 
5- traumatic 
6- neoplastic 
7- metabolic / endocrine
25
Q

Where is the cervical enlargement

A

C5-8

26
Q

Where are the lumber enlargement

A

L1-5

27
Q

Why are the cervical and lumber enlargements important

A

Cervical : where 2nd neurone for arms is located

Lumber : where 2nd neurone for legs is located

28
Q

What second neurone is at the thoracic segments

A

Thoracic intercostal muscle neurons

29
Q

For leg movement where does the 1st neurone need to travel to to meet the 2nd neurone that projects to legs

A

L1-L5

30
Q

For arm movement where does the 1st neurone need to travel to to meet the 2nd neurone that projects to arms

A

C5-C8

31
Q

Signs of Complete high C1-C4 cervical injury ( what’s happening with patient )

A

aka. Complete severing of spinal cord

1- Quadriplegia : no movement in arms or legs ( 2nd neuron isn’t being stimulated )
2- Spastic : rubrospinal is being suppressed
3- Sensory loss : correspond with level of injury, C4 dermatome is at clavicle. from clavicle down everything will be numb ( anesthesia )
4- Bowel and bladder function : central type impairment
5- Breathing problems : intercostal muscles impaired and diaphragm is partially working

32
Q

Causes of high C1-C4 cervical injury

A

1- Trauma / fracture / compression
2- herniated disk
3- tumour
4- Infection

33
Q

What is central type impairment of bowel and bladder function and what could it lead to

A

Bladder: retention of urine ( catheterization )
Bowel : severe constipation
= recurrent UTI ‘s , can kill them

34
Q

How is the diaphragm innervated

A

Neurones located in brainstem and partially neurones in the first cervical segments

35
Q

Signs of Complete Low C5 to T1 injury ( what’s happening with patient )

A

Where the 2nd neurone for the arms so they will be injured too

1- Flaccid paralysis of arms: since 2nd neurone in C5-8 will also be injured then will muscle won’t be spastic will be flaccid ( NO INCREASED TONE IN ARMS )
2- Spastic paralysis in lower limbs ( INCREASED TONE )
3- Breathing problems : intercostal muscles not working but Diaphragm is working ( shouldn’t need help )
4- Bowel and bladder function : centrally impaired
5- Sensory loss: correspond with level of injury. lateral Dermatomes of arm are spared but not medial or rest of body.
6- Horner’s syndrome : Contracted pupil , drooping eyelid , no sweating of face

36
Q

Signs of Complete thoracic T2 to T12 injury ( what’s happening with patient )

A

Below Cervical enlargement so arms are sparred ( lower spastic paraplegia )

1- Intact arm movement due to Preserved 1st and 2nd neurone for arm
2- Spastic paralysis of lower limbs : injury above lumber enlargement
3- Breathing problems: intercostal muscles not working but Diaphragm is working
4- Sensory loss : correspond with level of injury. Anesthesia from chest down, arms sparred
5- Bowel and bladder function : centrally impaired

37
Q

Signs of Complete Lumbar L1 to L3 injury ( what’s happening with patient )

A

At lumber enlargement so 2nd neurones for lower limbs are damaged too

1- Arms are fully intact
2- Normal breathing : intercostal and diaphragm working
2- Flaccid paraplegia of lower limbs : 2nd neurones are impaired too
3- Bowel and bladder function : centrally impaired
4- Sensory loss: Correspond with level of injury. anesthesia from waist ( inguinal folds) down

38
Q

Signs of Complete Conus S2 injury ( what’s happening with patient )

A

Impaired conus medlars / cauda equina

1- Intact movement of all limbs
2- Bowel and Bladder function : peripheral impairment( incontinence) , leaving urine and faeces
3- Anal reflex impairment
4- Sensory loss : saddle type anesthesia : back buttocks and upper inner thigh
5- Peripheral type paralysis : flaccid, weakness of legs

39
Q

What is peripheral impairment of bowel and bladder

A

Incontinence : urine and faeces leaking

40
Q

Signs of Cauda Equine syndrome ( S2 )

A
1- Loss of anal tone 
2- loss of perineal sensation 
3- faecal and urinary incontinence 
4- maybe sciatic type symptoms 
5- leg weakness: flaccid type paralysis
41
Q

Acute cauda equine compression is a ….

A

neuroseurigal emergenecy

42
Q

What is a acute condition common neurosurgical emergency

A

Acute Cauda Equine compression ( incomplete cauda equine )

43
Q

What is Brown Sequard Syndrome ( Left side, T11 ) and what are the symptoms

A

Lesion only affecting left side of cord ( at T11 )

1- Only one leg is affected , usually left side same side s injury. Weakness with spasticity : central spastic paralysis
2- Priorproception and deep sensation anesthesia on left side and pain and temperature anesthesia on right side of waist down

44
Q

Where is the conus medularis

A

L1

45
Q

Where is the cauda equina

A

L2

46
Q

If there is a C7 vertebral fracture where is the lesion

A

T1

47
Q

If there is a C4 vertebral fracture where is the lesion

A

C5