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NEUROMUSCULAR > lecture 5 GD: spianl cord disease > Flashcards

lecture 5 GD: spianl cord disease Flashcards

1
Q

when do the spinal cord end

A

between L1 and L 2

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2
Q

where is the cauda equina

A

S1-S5

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3
Q

what sacral vertebrae are fused to make up the ___

A

sacrum

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4
Q

the cocygeal vertebrae are fused to make the ___ c

A

coccyx

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5
Q

sensation of ___ spinal nerves root is level with he pubic bone

A

T12

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6
Q

what spinal nerve root is level with the abdomen

A

t10

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7
Q

what spinal nerve root is level with the bottom of the sternum

A

t6

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8
Q

the intermediolateral column is from which vertebrae levels

A

c8-t3

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9
Q

the anterior horn is ___ and the posteiror horn is ____

A

motor
sensory

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10
Q

what does the spinothalamic tract do

A

pain and temperature

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11
Q

what does the dorsal column tracts do

A

proprioception/ vibration / gross touch

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12
Q

what does the cortiospinal tract do

A

motor

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13
Q

where does the dorsal column tract cross

A

internal accurate fibers in medulla

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14
Q

where does the spinothalamc tract cross

A

anterior commissure

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15
Q

where does the cortiospinal tract cross

A

pyramidal decussation

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16
Q

where is the parasympathetic in the spinal cord and where is the sympathetic

A

para - sacral cord
sym- thoracic

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17
Q

what are clues to a spinal cord lesion by the history/exam

A

-bilateral symptoms
-bladder.bowel/sexual dysfunction
- stiffness in legs
-neck or back pain w flexion/extension
-lherimitte or uhthoff phenomenon
-sensory level
-tight band sensation across trunk or torso

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18
Q

what type of impairments will u get w brownsequard syndrome

A

contralateral sensory and ipsilateral motor

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19
Q

what impairments will central cord syndrome present with

A

imparied motor function of UE and sensory impairments for LE

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20
Q

what are the 2 most common complete transverse lesion causes

A

spinal cord trauma and tumor w cord compression

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21
Q

MOI for complete transverse lesion

A

hyperflexion or hyper extension

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22
Q

what is the primary injury for SCI

A

-compression
-laceration
-shearing

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23
Q

• Vasogenic edema
• Microvessel
vasospasm
• Thrombosis
• Ion imbalance
• Loss of sodium
gradient
• Inflammation
• Glutamate
excitoxicity
• Free radicals

when does these things happen for SCI

A

minutes to hours after

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24
Q

what level of injury is the most

A

cervical injury level

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25
Q

what does quadriplegia mean

A

loss of movement and sensation in all four limbs

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26
Q

what is paraplegia

A

loss of movement and sensation in the lower half of the body

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27
Q

what is used as an spinal cord assessment

A

ASIA .. international scale done in supine

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28
Q

what does the ASIA scale tell us

A

what section is reserved and what is impacted

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29
Q

what are the key mm groups in ASiA

A

C5 Elbow flexors
C6 Wrist extensors
C7 Elbow extensors
C8 finger flexors
T1 Small finger abductors
L2 Hip flexors
L3 Knee extensors
L4 Ankle dorsiflexors
L5 Long toe extensor
S1 Ankle plantar flexors

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30
Q

what mm function grading is it if the patient has active movement , full ROM against gravity and moderate resistance in a mm specific position

A

4

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31
Q

what mm function grading is it if the patient has active movement , full ROM against gravity

A

3

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32
Q

what mm function grading is it if the patient has active movement , full ROM against gravity and sufficient resistance to be considered normal if identified factors were not present

A

5*

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33
Q

what mm function grading is it if the patient has active movement full ROM with gravity eliminated

A

2

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34
Q

what impairment letter scale would it be if no sensory or motor function is preserved in the sacral segments S4-5

A

A. complete

35
Q

what impairment letter scale would it be on the ASIA scale if they have sensory but not motor function is preserved bellow the neurological level and includes the sacral segments S4-5 and no motor function is preserved more than three levels below the motor level on either side of the body

A

B. sensory incomplete

36
Q

what impairment letter scale would it be on the ASIA scale if motor function is preserved below the neurological level and more then half of key mm functions below the neurological level of injury have a mm grade less than 3

A

C motor incomplete

37
Q

what impairment letter scale would it be on the ASIA scale if motor function is preserved below the neurological level and at lease half of key mm function is below the neurological level of injury have a mm grade >3

A

D. motor incomplete

38
Q

what impairment letter scale would it be on the ASIA scale is sensation and motor function as tested with the ISNCSCI are grades as normla in all segments and teh pateint had prior deficits

A

E. normal

39
Q

what are the steps of classification for a SCI

A
  1. determine sensory levels for right and left sides
  2. detmermine motor levels for right and left left sides
  3. determine the neurological level or injury
  4. determine weather the injury is compete or incomplete
    5.detemine ASIA impatient scale
40
Q

if there are at least half or more of the key mm below the neurological level of injury graded as 3 to better ? if yes ? if no?

A

no is ASIA c
yes is ASIA D

41
Q

what is Immediate flaccidity and loss of sensory and autonomic
function below the level of the lesion.

A

spinal shock

42
Q

spinal shock is replaced by increased ___, ___ below the level of lesion

A

reflexes , spasticity

43
Q

___ ____ with lesions above T5 level

A

autonomic dysreflexia

44
Q

what are disabilities associated with level of injury C1-C5 tetraplegia

A

-dressing
-bathing
-communication

45
Q

how can a T1 and below paraplegia dress, bath and communicate

A

independent with use of assistive device for dress and bath and independent with commnicatoin

46
Q

what is. Exaggerated sympathetic response to noxious stimuli below lesion

A

Autonomic Dysreflexia

47
Q

what are symptoms of Autonomic Dysreflexia

A

– Hypertension ( to 300 mmHg systolic)
– Sweating (above injury)
– Flushing (above injury)
– Bradycardia (vagus still working)

48
Q

Autonomic Dysreflexia is associated with level above ___

A

T5

49
Q

Autonomic Dysreflexia has an increased risk after recovery from what

A

spinal shock

50
Q
  • Full bladder
  • Full or impacted bowel
  • Scrotal compression
  • Kidney stones
  • Gastritis
  • Onset of menses
  • Deep venous thrombosis
  • Pulmonary embolus
  • Pressure ulcers
  • Changes in temperature
  • Pain or irritation below the level of the lesion

these are all triggers for what

A

autonomic dysreflexia

51
Q

what are cardiovascular complications with SCI

A

• Arrhythmias, fluctuating blood pressure, orthostatic hypotension
- thrombophlebitis and PE
-edema

52
Q

what are respiraotry complications in SCI

A

-• Impaired cough and reduced ability to mobilize secretions
– Increased risk of pneumonia • Increased risk of
obstructive sleep apnea
• Reduced exercise tolerance

53
Q

what rehab do u do fo SCI

A

-ROM
-stretching
-orthotic devices

54
Q

what are the leading causes of death for SCI

A

-sepsis
-pneumonia
-respiraotry failure

55
Q

what is cervical spondylosis

A

degenerative disease of the spine with myelopathy and radiculopathy

56
Q

where’s cervical spondylosis most common at

A

C5-C6

57
Q

what are cervical spondylosis myelopathy symptoms

A

• Pain
• Burning
• Weakness
• Numbness
• Tingling
• Bowel and bladder dysfunction
• Lhermitte’s phenomenon

58
Q

what is the progression of cervical spondyotic myelopathy

A
  • gait impairment often early
    -lower limb sensory symptoms if dorsal column compressed
  • lateral arm weakness and loss of finger dexterity
  • concurrent cervical radicular dysfunction
59
Q

what kind of SC tumor is within the SC

A

intramedullary

60
Q

what SC tumor is lying on the surface of the cord , arising from roots or meninges

A

extrameduallry intradural

61
Q

what SC tumor is in the epidural space but able to compress upon the spinal cord

A

extra dural

62
Q

what are the primary tumor sites from SC metastases

A

lung
breast
prostate
kidney
thyroid
gut

63
Q

what are symptoms that present when tumors metastasize to the SC

A

Back pain, tenderness, paraparesis, incontinence

64
Q

how do u treat tumors that metastasize to SC

A

high dose of steroids and radiation

65
Q

what may occur with osteomyelitis or skin infection

A

epidural abscess

66
Q

what are red flag symptoms with epidural abscess

A

fever, back pain and diabetes

67
Q

what is the treatment with epidural abscess

A

Laminectomy & drainage, then antibiotics

68
Q
  • B12 deficiency
  • Copper deficiency
  • Cervical spondylosis
  • Paraneoplastic myelitis
  • HTLV1 myelopathy

these 5 things can cause what syndrome

A

posterolaterla column syndrome

69
Q

what Spinal cord syndrome resulting from deficiency of vitamin B12 or copper

A

Subacute Combined Degeneration

70
Q

Subacute Combined Degeneration involves what tracts

A

posterior columns and corticospinal tracts.

71
Q

what is B 12 found in

A

eggs, meat , milk and fortified foods

72
Q

• Neurosyphilis (Tabes dorsalis)
• Early cervical spondylotic myelopathy
• Radiation induced myelopathy

these all come with what syndrome

A

postioer column syndrome

73
Q

tabes dorsalis (syphilis) is a ___ transmitted infection

A

sexually

74
Q

tabes dorsalis (syphilis) causes ___ ___ demyelination in chronic untreated infections

A

dorsal column

75
Q

what does tabes dorsalis impair

A

vibration and proprioception

76
Q

what are symptoms of hemicord syndrome ipsilaterally and contralterally

A

ipsilateral UMN weaklesnn below the level of lesion
- ipsilateral LMN weaknes at the level of injury (anterior horn)
-ispi loss of vibration and proprioception (posteior column uncrossed)
- ispi nerves root pain
-ispi imparted sweating (descending autonomic fibers)
-contra loss of pan and temp 1-2 levels below the lesion (spinothalamic tract crossed(

77
Q
  • Syringomyelia
  • Intramedullary Tumors
  • Neuromyelitis Optica
  • Cervical Hyperextension

these can all be from what syndrome

A

central cord syndrome

78
Q

what is Central cavitation (syrinx) of the spinal cord

A

Syringomyelia

79
Q

where is Syringomyelia most commonly in

A

cervical region

80
Q

Syringomyelia has segmental weakness and atrophy of ___ and ___ with loss of tendon reflexes

A

hands and arms

81
Q

what will be lost and whqt will be preserved with anterior cord syndrome

A

loss of motor function and preserved position , vibration , and touch sense

82
Q

what is preserved in Conus Medullaris and Cauda Equina Syndromes

A

UE strength/ sensation

83
Q

what is impaired , where is there sensory loss and where is there weakness for Conus Medullaris and Cauda Equina Syndromes

A

impaired bowel and bladder funciotn , proximal leg weakness anf sensory loss in proximal legs/saddle anesthesia

84
Q

what are casues of Conus Medullaris and Cauda Equina Syndromes

A

• Disc herniation
• Vascular
• Infections
• Radiation
• Neoplastic disorders
• Inflammatory disorders

NEUROMUSCULAR (15 decks)

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