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Brain and Behavior Exam 2 > Lec 30 Spinal Cord Lesions > Flashcards

Lec 30 Spinal Cord Lesions Flashcards

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The Brain flashcards
1
Q

What is monoplegia?

A

paralysis of one limb

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2
Q

what is diplegia?

A

paralysis of both upper or lower limbs

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3
Q

what is paraplegia?

A

paralysis of both lower limbs

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4
Q

what is hemiplegia?

A

paralysis of upper limb, torso, and lower leg on one side

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5
Q

what is quadriplegia?

A

paralysis of all four limbs

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6
Q

How do you determine the sensory level of a neurologic injury?

A
  • sensory level = lowest dermatomal level with normal sensation to pinprick and light touch [all dermatomes above being normal]
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7
Q

What root value for elbow flexors [biceps, brachialis]?

A

C5

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8
Q

what root value for wrist extensors [extensor carpi radialis]?

A

C6

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9
Q

what root value for elbow extensors [triceps]?

A

C7

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10
Q

what root value for finger flexors [flexor digitorum profundus]?

A

C8

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11
Q

what root value for finger abductors [abductor digiti minimi]?

A

T1

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12
Q

What root value for hip flexors [iliopsoas]

A

L2

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13
Q

What root value for knee extensors [quadriceps]?

A

L3

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14
Q

What root value for ankle dorsiflexors [tibialis anterior]?

A

L4

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15
Q

What root value for great toe extensors?

A

L5

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16
Q

What root value for anal sphincter?

A

S4-5

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17
Q

What is the motor level of neuro injury?

A

lowest innervated muscle wtih grade 3 or better strength where all muscles above are 5

18
Q

Increased muscle tone [spasticity] and reflexes – is it UMN or LMN?

A

UMN!

LMN = decreased muscle tone and absent reflexes

19
Q

What is spinal shock?

A

loss of sensation accompanied by motor paralysis with initial loss but gradual recovery of reflexes –> occurs following spinal cord injury

  • slow HR, low BP, flaccid paralysis, urinary bladder dysfunction
20
Q

What is syringomyelia?

A
  • generic term, referrs to disorder where cyst [called a syrinx] forms in spinal cord
  • syrinx expands and damages anterior white commissure of spinothalamic tract
  • -> get bilateral loss of pain/temp [usually C8-T1] = “cape-like”
  • -> as it grows: weakness of muscles in arms, atrophy, hyporeflexia
21
Q

What are signs of a central cord lesions? cause?

A
  • due to damage to anterior white commissure + spinothalamic tract
    signs: bilateral pain/temp loss, preserved mechanosensation

as it grows larger –> motor weakness in upper limbs, variable bowel/bladder involvement
usually cervical

cause: syringomyelia, tumors, anterior spinal artery ischemia

22
Q

What is syringobulbia?

A
  • syrinxes [cavities] grow in brainstem
  • can affect one or more crania nerves –> facial palsies, vocal cord paralysis, etc
  • usually due to congenital abnormality, trauma or growth
23
Q

What is brown sequard syndrome? signs?

A

hemisection of spinal cord [from vascular injury, tumor, trauma, etc]

signs:
below level of lesion: ipsilateral UMN signs [spastic], ipsilateral impaired proprioception, vibration, contralateral pain/temp impairment

1-2 levels down from level of lesion: loss of sensation ipsilaterally, ipsilateral LMN signs [flaccid]

1-2 levels down = because when spinothalamic enters the cord it travels 1-2 up before crossing over. so the part that got cut in lesion originates from 1-2 levels down

24
Q

What is horner’s syndrome? signs?

A
  • lesion of spinal cord above T1 –> interrupts path from hypothalamus to superior cervical ganglion

signs = PAM is horny
Ptosis: drooping eyelid
Anhidrosis: absence of sweat + flushing of affected side of face
Miosis: pupil constrictioin

25
Q

What is blood supply to the spinal cord?

A
  • posterior spinal arteries

- anterior spinal arteries [artery of adamkiewicz is largest]

26
Q

What is anterior cord syndrome? cause? signs?

A

infarction of anterior 2/3 of spinal cord due to vascular injury of anterior spinal artery

signs: bilateral loss of motor control, bilateral loss of pain/temp sensation with preserved light touch and joint position

occurs in upper thoracic cord = watershed area

27
Q

What is posterolateral column disease?

A
  • demyelination of drosal
28
Q

What happens to spinal column with vit B12 or vit E deficiency?

A

subacute combined degeneration = demyelination of dorsal columns, lateral corticospinal tracts, spinocerebellar tracts

  • ataxic gait, paresthesia, impaired position and vibration, + romberg
29
Q

What should you think if you see loss of reflexes due to peripheral neuropathy and + babinski

A

posteriolateral column disease = B12 or # deficiency

30
Q

What is cauda equina syndrome?

A

occurs with central disk herniation
- gradual asymmetric onset at L4, L5, S1 nerve roots

signs:

  • asymmetric flaccid paralysis
  • asymmetric saddle anesthesia, sharp radicular pain
  • LMN bladder/bowel develop late
31
Q

What is conus medullaris syndrome?

A 
occurs with central disk herniation
- sudden, bilateral onset at L1, L2
signs
- symmetric weakness
- symmetric saddle anesthesia
- dull pain
- LMN bladder/bowel develop early
32
Q

What happens in poliomyelitis? signs?

A
  • caused by poliovirus –> goes to bloodstream to CNS
  • destroyrs cells in anterior horn of spinal cord

symptoms: weakness, hypotonia, flaccid paralysis, fasciulations, muscle atrophy + malaise, headache, fever, nausea
findings: high WBC and slight high protein in CSF, virus in stool or throat

33
Q

What is spondylolisthesis? treat?

A

anterior/posterior displacement of vertebrae relative to its neighbors

treat: NSAIDs, steroids, PT, spinal fusion surgery

34
Q

What is lumbar spinal stenosis?

A
  • spinal canal narrows and compresses cords/nerves
  • due to aging or spinal disk herniation

signs: low back pain, abnormal sensation in legs/thighs/feet/buttoks, loss of bladder control

35
Q

What happens in spinal disc herniation?

A
  • nucleus pulposus bulges out beyond annulus fibrosus postero-laterally
  • may cause severe pain due to release of inflammatory chemical mediators
36
Q

What is tabes dorsalis? cause? signs?

A

due to tertiary neurosyphilis
- demyelination/degeneration of dorsal columns and roots

  • impaired sensation and proprioception, progressive sensory ataxia
  • areflexia, + romberg
  • argyll robertson pupils = small bilateral pupils that further constrict to accomodation and convergence not to light
37
Q

What causes autonomic dysreflexia? what is it?

A

spinal cord injuries above T6
- stimulus activated nociceptors below level of injury –> afferent impulses –> sympathetic neurons activated –> generalized sympathetic response –> PNS output prevails

–> bradycardia,

38
Q

What are signs of spinal tumor?

A

usually thoracic, due to metastatic cancer

sensory: pain, numbness
motor: UMN spasticity, bowel/bladder

39
Q

what are signs of epidural abscess?

A

due to infection, causes spinal cord/nerve root compression

back pain, radiculopathy [sharp, shooting pain]

40
Q

what are signs of disc prolapse?

A

spinal cord/nerve root compression

signs: radiculopathy, numbness, weakness, bowel/bladder disruption

41
Q

What are signs of UMN vs LMN bladder?

A

UMN = hyperactivity of bladder and urinary sphincter, difficulty emptying

LMN –> weak urethral sphincter, prone to leakage of urine

42
Q

What are signs of UMN vs LMN bowel?

A

UMN: defacation cannot be initiated by voluntary relaxation of external anal sphincter

LMN: anal sphincter atonic, prone to leakage

Brain and Behavior Exam 2 (21 decks)

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