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Neuro 3 - MS1 > Lecture 05 Clinical Aspects of the Sensory and Motor Pathways > Flashcards

Lecture 05 Clinical Aspects of the Sensory and Motor Pathways Flashcards

1
Q

What does destruction of the dorsal root result in? What happens with the sacral region specifically?

A

Diminished motor reflexes including muscle tonicity

Sacral region: atonic bladder and painless retention of urine

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2
Q

What does complete unilateral lesions of the posterior columns result in?

A

an ipsilateral loss of proprioception, 2-pt tactile discrimination and vibratory sensations below the lvl of lesion

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3
Q

What does a unilateral lesion of the fasiculus gracilis result in?

A

ipsilateral loss of proprioception, 2-pt tactile discrimination and vibratory sensations from the lower half of the body and lower extremity

Partial lesion: sensory dermatomal deficit corresponding to affected region

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4
Q

What does a unilateral lesion of the fasciculus cuneatus result in?

A

ipsilateral loss of proprioception, 2-pt tactile discrimination and vibratory sensations from the upper half of the body and upper extremity

partial lesion: sensory dermatomal deficit corresponding to affected region

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5
Q

What is found in the lateral funiculus?

A

Lateral corticospinal tract

Lateral reticulospinal tract

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6
Q

What does the destruction of the LCSt and associated motor tracts in lateral funiculus result in?

A 
spastic paralysis
hyperreflexia
hypertonia
Babinski sign
clonus
disuse atrophy
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7
Q

What does transection of the spinal cord above S2 intterupt?

A

the LRST to the sacra autonomic nucleus

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8
Q

What does LRST interruption result in?

A

pt unable to voluntarily void bladder = urinary retention

After spinal Shock, bladder reflex may return w/o voluntary control, automatic reflex voiding or reflex bladder

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9
Q

What is found in the anterior funiculus?

A

Lateral spinothalamic tract
Anterior white commissure
LMN

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10
Q

What does unilateral lesions of the lateral spinothalamic tract result in?

A

contralateral loss of pain and temp sensation 2 sensory dermatomal segments BELOW the lvl of lesion

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11
Q

What does destruction of the anterior white commissure result in?

A

bilateral loss of pain and temp sensations to the upper extremities (yoke-like)

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12
Q

What does Destruction of LMN or axons of one or more of the cranial or spinal motor nuclei result in?

A

LMN paralysis: flaccid paralysis, areflexia, attonia, atrophy, and fasiculations

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13
Q

What are pts that are insensitive to pain missing. (congenital)

A

C type fibers

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14
Q

What does Herpes Zoster compromise?

A

non-nociceptive A alpha/beta fibers

C fibers take over and open gate to pain

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15
Q

What does unilateral lesions of the spinoreticular fibers result in?

A

no significatn sensory deficits

Bilateral may eliminate crude pain sensations

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16
Q

What is done neurosurgically to treat intractable pain?

A

LSTT transected

Anterolateral quadrant of the cord is cut two segments above and on the opposite side of the area of pain

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17
Q

What serves as a landmark between LSTT and corticospinal fibers during anterolateral cordotomy?

A

denticulate ligaments

18
Q

What does unilateral lesions of the spinal lemniscus result in?

A

contralateral hemianalgeisa and thermal hemianesthesia

19
Q

Syringomyelia results in the destruction of what?

A

anterior white commissure
lateral corticospinal tracts
anterior horns
posterior columns

20
Q

What does unilateral lesions of the medial lemniscus result in?

A

a loss of proprioception, 2-pt tactile discrimination and vibratory sensations on the opposite side of the body and limbs

21
Q

What are lightning pains or rheumatic pains from the lower limbs in pts with tabes dorsalis is probably due to what?

A

irritation of the type A pain fibers in the dorsal roots

22
Q

What are the symptoms of LMN paralysis

A 
Flaccid paralysis 
Areflexia
Atonia
Atrophy 
Fasiculations
23
Q

What is flaccid paralysis?

A

muscle completely limp and there is no resistance to passive movement

24
Q

What is areflexia?

A

loss of efferent component of reflex arc to a muscle results in an absence of the associated muscle reflex

25
Q

What is Atonia?

A

Destruction of gamma motor neurons or their axons results in the absence of muscle tone

26
Q

What is atrophy?

A

tissue waste

- denervated muscle atrophies due to loss of stimulation from the motor neurons

27
Q

What are fasiculations?

A

twitchings of denervated muscle probably due to hypersensitivity of the motor end plate

28
Q

What does poliomyelitis involve?

A

the motor neurons of the anterior horns and the cranial nerve motor nuclei

29
Q

What are the symptoms of UMN paralysis ?

A

Varying degree of spastic paresis of axial and proximal limb m
Some degree of spastic paralysis of distal limb m especial upper
Hypertonia
Hyperreflexia
Babinski sign
Clonus
Disuse atrophy

30
Q

What is spasticity ?

A

abnormal, passive resistance to movement in one direction

31
Q

What is rigidity ?

A

abnormal passive resistance to movement in one direction

32
Q

What are the three phases of physical events following UMN lesion?

A
  1. Spinal shock with areflexia, atonia, and flaccid paralysis
  2. wks-months: return of basic spinal reflexes, some spastic paresis of axial and prox limb mm and spastic paralysis of distal limb
  3. yrs: spasms of extensors, flexors or remain flaccid
33
Q

Clonus, clasp-knife spasticity, babinski reflex

UMN or LMN lesion?

A

UMN

34
Q

Hyperactive deep tendon reflexes

UMN or LMN lesion?

A

UMN

35
Q

Hypoactive or absent deep tendon reflexes

UMN or LMN lesion?

A

LMN

36
Q

Hypotonia

UMN or LMN lesion?

A

LMN

37
Q

The most common form of amyotrophic lateral sclerosis (ALS) involves the combination of what structures?

A

LMN: anterior horn cells, hypoglossal nucleus, nucleus ambiguus, facial motor nucleus

UMN: chronic, progressive degeneration of the corticospinal tracts

38
Q

What does ALS lead to?

A

LMN paresis and atrophy of the intrinsic mm of the hand followed later by arms and shoulder musculature

39
Q

What does the involvement of the corticospinal tract with ALS lead to?

A

spastic paralysis, hyperreflexia and babinski sign

NO SENSORY DEFICITS

40
Q

What are the 7 clinically important regions of the spinal cord?

A 
Dorsal roots
Posterior columns 
Lateral corticospinal tract (UMN) 
Lateral spinothalamic tract (pain/2pt)
Anterior white commissure 
Anterior horn (alpha motor neurons, LMN)
Lateral reticulospinal tract

Neuro 3 - MS1 (9 decks)

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