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Neuro Week 2 > ICL 6.0: Overview of Spinal Cord Structure & Cross Sectional Anatomy > Flashcards

ICL 6.0: Overview of Spinal Cord Structure & Cross Sectional Anatomy Flashcards

1
Q

where does the spinal cord end?

A

L1/L2

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2
Q

what is the function of the substantia gelatinosa?

A

its located at rexed laminae 2 at the apex of the horn of grey matter

fibers conveying pain, temperature and touch synapse here = spinothalamic tract

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3
Q

what is the function of the nucleus proprius?

A

its located at rexed laminae 4 at the middle of the dorsal horn of grey matter

fibers conveying senses of position and movement synapse here = DCML

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4
Q

what anatomical landmark do motor fibers exit the spinal cord?

A

anterolateral sulcus

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5
Q

what is the ratio of grey to white matter in the spinal cord as you progress down?

A

there is more grey matter in comparison to white matter as you move caudally

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6
Q

where is the Intermediolateral Cell Column? what does it do?

A

it exists the spinal cord at the T1 - L1/L2

it mediates the entire sympathetic innervation of the body = fight or flight

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7
Q

where does the fasciculus cuneatus begin? what is it?

A

it’s part of the DCML tract and carried information from the upper body

it goes from T6-medulla –> so you would only see it in the cervical and upper thoracic cord but not the sacral

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8
Q

what spinal tract is associated with the substantia gelatinosa?

A

spinothalamic tract

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9
Q

what is the correlation of cervical vertebra with spinal cord segments?

A

C1-C7 vertebra = +1 spinal cord segment

so if there’s a C3 vertebral fracture then it would cause a C4 spinal cord injury

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10
Q

what is the correlation of thoracic vertebra with spinal cord segments?

A

T1-T6 vertebra = +2 spinal cord

so if you have a T3 vertebral fracture it would be a T5 spinal cord injury

T7-T9 vertebra = +3 spinal cord

so if there’s a T8 vertebral fracture then it would be a T11 spinal cord injury

T10 vertebra = L1 -L2 spinal cord injury

T11 vertebra = L3 -L4 spinal cord

T12 vertebra = L5 spinal cord injury

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11
Q

what is the correlation of lumbar vertebra with spinal cord segments?

A

L1 = conus medularis

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12
Q

What level of the vertebral column correlates with the T5 spinal cord level?

A

T3

because T1-T6 vertebral fracture is a +2 spinal cord injury

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13
Q

what is the arterial supply of the spinal cord at thoracic spinal cord level?

A
  1. anterior spinal artery
  2. posterior spinal arteries (2)

both run the entire length of the spinal cord and are reinforced with collateral circulation at multiple levels

there’s 6-8 radicular arteries which supply the anterior and posterior spinal arteries in the thoracic area and also make them anastomose

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14
Q

what is the anterior spinal artery a branch of?

A

vertebral artery

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15
Q

what is the arterial supply of blood in the cervical region of the spinal cord?

A
  1. anterior spinal artery
  2. posterior spinal arteries (2)
  3. ascending cervical arteries
  4. deep cervical arteries
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16
Q

what is the arterial supply of blood in the lumbar region?

A
  1. anterior spinal artery
  2. posterior spinal arteries (2)
  3. artery of adamkiewicz
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17
Q

what is the artery of adamkiewicz?

A

it’s the major arterial supply of the anterior spinal artery to the spinal cord from T8 to the conus medullaris

most commonly arises on the LEFT side and it ascends on the mid-sagittal anterior surface of the spinal cord and has an identifying “hairpin turn” at its
anastomosis with the anterior spinal artery

18
Q

what parts of the spinal cord are vascularized by the anterior spinal artery?

A

the anterior 2/3 of the spinal cord which includes:

  1. anterior white columns
  2. anterior white commissure
  3. lateral white columns
  4. anterior horn of gray matter
  5. lateral horn of gray matter
  6. lamina X (anterior and posterior gray commissure)
19
Q

what parts of the spinal cord are vascularized by the posterior spinal arteries?

A

the posterior 1/3 of the spinal cord which includes:

  1. posterior white columns
  2. dorsal horn of grey matter
20
Q

what is the arterial supply of the lateral spinal cord?

A

the arterial vasocorona

21
Q

which tracts would be effected by an infarct of the anterior spinal artery?

A
  1. anterior corticospinal tract
  2. anterior spinothalamic tract
  3. ventral horn of gray matter
  4. central midline (Lamina X and anterior white commissure)
  5. lateral corticospinal tract
  6. lateral spinothalamic tract

so only the DCML and dorsal grey matter horn would be spared

22
Q

which tracts would be effected by an infarct of the posterior spinal artery?

A
  1. posterior white columns
  2. dorsal horn maybeeee
  3. DCML tract
23
Q

which tracts would be effected by an infarct of the arterial vasocorona?

A

ventral and dorsal spinocerebellar tracts

24
Q

what is the function of the corticospinal tract?

A

it’s an efferent motor tract that converts:

  1. motor impulses from cortex to the end organ (skeletal muscle)
  2. voluntary movement for limbs
25
Q

what is the pathway of the corticospinal tract?

A
  1. primary motor cortex in the precentral gyrus of the frontal lobe
  2. fibers descend through posterior internal capsule and through the cerebral peduncles (they’re what attach the cerebellum to the brainstem)
  3. 90% of the fibers decussate in the caudal medulla = pyramidal decussation
  4. axons descend contralaterally to synapse with lower motor neurons
  5. fibers synapse with α-motor neurons in lamina 8/9 and then exit the cord through the ventral root to spinal nerve lower motor neurons
26
Q

what is an upper motor neuron vs. lower motor neuron?

A

the nerves that send messages between the cerebral cortex and the spine are called upper motor neurons

those that relay messages from the spine to the muscles are called lower motor neurons

so an upper motor neuron lesion would be in the cerebral hemispheres, cerebellum, brainstem and spinal cord while a lower motor neuron lesion would be in the anterior horn cell, nerve roots, peripheral nerves, or neuromuscular junction

27
Q

what are the signs of an upper motor neuron lesions?

A
  1. hyperreflexic in the lower extremities
  2. positive Babinski reflex
  3. hypertonia = spasticity
  4. clonus
  5. weakness

hyperreflexia and hypertonia are the classic upper motor neuron signs thought to occur from the loss of the corticospinal motor tract suppression of the spinal reflex arc

28
Q

what are the signs of a lower motor neuron lesion?

A
  1. weakness
  2. hypotonia = flaccid
  3. atrophy
  4. fasciculations
  5. hyporeflexic

hyporeflexia and hypotonia at the level of the lesion is due to injury to the ventral horn of the gray matter –> the alpha motor neuron arises from the ventral horn and is injured at the level of the lesion

29
Q

what is the cause of spastic paralysis, exaggerated deep tendon reflexes and a positive Babinski reflex?

A

upper motor neuron lesion

30
Q

what are the two parts of the spinothalamic system?

A

the spinothalamic tract is an ascending afferent tract that conveys sensory information about pain, temperature, crude touch

  1. lateral spinothalamic tract = pain and temperature
  2. anterior spinothalamic tract = crude touch
31
Q

what is the pathway of the spinothalamic system?

A
  1. nociceptors or thermoceptors
  2. fibers enter the spinal cord and synapse in the substantia gelatinosa of the grey matter of the anterior horn which is responsible for pain and temperature
  3. fibers decussate in the spinal cord via rexed lamina 10 (they may ascend 1-2 levels in the dorsolateral tract of lissaur before synapsing)
  4. fibers ascend ipsilaterally via Lissauer’s tract to the VPL of the thalamus
  5. fibers ascend through the internal capsule to the post-central gyrus
32
Q

What is the cause for the loss of pain and temperature sensation in the lower trunk, abdomen and lower extremities?

A

problems with the spinothalamic tract

33
Q

what is the dorsal column/medial lemniscus tract?

A

ascending afferent pathway that conveys:

  1. fine touch
  2. two point touch discrimination
  3. vibration
  4. joint position/proprioception
34
Q

what is the pathway of the DCML tract?

A
  1. mechoreceptors or proprioceptors
  2. fibers enter the spinal cord and ascend ipsilateral to the gracile or cuneate fasciculus of the medulla
  3. fibers decussate in the rostral medulla in the internal arcuate fibers
  4. fibers ascend in the medial lemniscus to the VPL of the thalamus
  5. fibers ascend through the internal capsule to the post-central gyrus
35
Q

what is subacute combined degeneration?

A

a neurological complication of vitamin B12 deficiency characterized by demyelination of the DC-ML tracts (you can literally see demyelination on the stains)

this can extend to the Lateral Corticospinal tracts and Spinocerebellar tracts

DCML = fine touch, vibration, 2 point discrimination

lateral corticospinal = pain and temperature

36
Q

what is a Romberg test?

A

this is atestof the body’s sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord = DCML tract

the clinician asks the patient to first stand quietly with eyes open, and subsequently with eyes closed

the Romberg test is scored by counting the seconds the patient is able to stand with eyes closed

negative romberg = patient can stand well-balanced with their eyes opened or closed

positive romberg test = patient can stand with eyes open but falls when eyes are closed

37
Q

Injury to the DCML region of the spinal cord would cause what sensory deficit below the level of the lesion?

A
  1. vibration
  2. fine touch
  3. fine touch
  4. joint position
38
Q

Injury to the rexed lamina 10 region of the spinal cord would cause what sensory deficit below the level of the lesion?

A
  1. pain
  2. temperature
  3. crude touch

the spinothalamic tract passes through the rexed lamina 10 as soon as it enters the spinal cord!

39
Q

injury to the anterior horn of the spinal cord would cause what deficits?

A
  1. lower motor neuron signs
  2. motor deficits AT the level of the lesion

alpha motor neurons would be effected! so this is a lower motor neuron lesion

40
Q

injury to the corticospinal tract in the spinal cord would cause what deficits?

A
  1. upper motor neuron signs
  2. motor deficits BELOW the level of the lesion

so this is an upper motor neuron lesion

41
Q

injury to the posterior horn of the grey matter of the spinal cord would effect the transmission of what sensations to the CNS?

A

all of them! you’d be losing both the DCML and spinothalamic tract

so pain, vibration, temperature, fine touch, crude touch, two point discrimination and joint position would all be messed up

Neuro Week 2 (10 decks)

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