Localization of Spinal Cord Lesions Flashcards
LMN involvement means
LMN involvement means SPINAL CORD INVOLVEMENT or root or nerve
C4 dermatome
clavicle **
C5 dermatome
shoulder
C6 dermatome
thumb
C7 dermatome
middle finger
C8 dermatome
little finger
T4 dermatome
nipple line **
T10 dermatome
umbilicus **
L1 dermatome
inguinal crease **
L5 dermatome
lateral calf **
S4-S5 dermatome
perianal area **
biceps brachii myotome
C5 (C6)
triceps myotome
C7 (C6-C8)
intrinsic hand muscles myotome
C8, T1
quadriceps femoris myotome
L3 (L2-L4)
gastrocnemius myotome
S1
spinothalamic tract crosses in ________
spinothalamic tract crosses in SPINAL CORD
dorsal columns cross in _________
spinothalamic tract crosses in medulla
a lesion on one side of the spinal cord will cause loss of ____________________ on the side of the lesion, and loss of ______________ on side opposite the lesion
a lesion on one side of the spinal cord will cause loss of POSITION and VIBRATORY SENSE on the side of the lesion, and loss of PAIN and TEMPERATURE on side opposite the lesion
Brown-Sequard Syndrome
Hemisection of spinal cord.
Deficits in dorsal column, spinothalamic, and corticospinal tracts.
Ipsilateral loss of position and vibration sense.
Contralateral loss of pain and temperature sense (slightly below level of lesion due to movement of spinothalamic fivers up thru lissauer’s tract before decussation).
Ipsilateral paralysis.
a lesion in the central part of the spinal cord can affect ___________, leaving ______ and ______ tracts unaffected.
a lesion in the central part of the spinal cord can affect PAIN and TEMPERATURE, leaving DORSAL COLUMN and CORTICOSPINAL tracts unaffected.
suspended sensory loss for pain and temperature means
spinal cord disease
only ventral white commisure is affected
lesion of ventral white commisure
Only fibers that cross at level of lesion will be affected. (lose pain/temp at level of lesion)
Pain and temperature will be normal above and below the lesion.
syringomyelia
- affects ventral white commisure
- suspended sensory loss for pain and temperature
- starts small, gets bigger: next affected is burning fingers w/o realizing, LMN weakness
ALS
Amyotrophic Lateral Sclerosis
- motor disease only
- combined UMN and LMN disease [LMN signs predominate, fasciculations]
- affects corticospinal tract, LMNs
- does NOT affect sensory
- rare
- elderly
- progressive
- 2-3 yr survival
- death from infection
ALS - LMN lesions vs UMN lesions
LMN lesions: fasciculations
UMN lesions: clonus, babinski sign
variants of ALS
Spinal muscular atrophy - LMN
Primary lateral sclerosis - UMN
Bulbar ALS - LMN cranial nerves
tabes dorsalis
Predominant DORSAL COLUMN deficits
- loss of position/vibration sense
- difficulty maintaining erect posture
- Romberg sign
- patchy loss of pain/temp
- affects dorsal roots/ganglia
-form of tertiary neurosyphilis
Romberg sign
Patient can stand with eyes open, but cannot stand with eyes closed
Seen with Tabes Dorsalis
what is needed for balance?
2 of the following:
- visual
- vestibular
- posterior column
subacute combined degeneration posterolateral sclerosis
Dorsal columns and corticospinal tract deficits
- Romberg sign
- UMN signs
- vitamin B12 deficiency
- pernicious anemia
poliomyelitis
Anterior horn cells affected.
LMN syndrome.
-viral infection with predilection for anterior horn cells
-acute febrile illness
post-polio syndrome
- new weakness years after acute polio (stress to system)
- often in same distribution as original weakness
anterior spinal syndrome
Spinothalamic and Corticospinal affected.
Dorsal column preserved.
(due to loss of anterior spinal artery, providing blood to anterior 2/3 of spinal cord)
Loss of pain/temperature, motor function
extrinsic cord compression
osteophytes, herniations, tumors, abcesses
- commonly presents with pain (from root compression)
- early involvement of sacral segments (from compression of lateral aspects of spinothalamic tracts and lateral corticospinal tracts)
- localized LMN lesion from compression of ventral root
