Module Exam 5: Spinal Cord Flashcards
Parts of the vertebra
Posterior segment, Intervertebral disc & Anterior segment “PIA”
Vertebral column
Cervical 7, Thoracic 12, Lumbar 5, Sacral 1 & Coccygeal 1
Lies within the vertebral canal
Spinal cord
Three surrounding fibrous membranes that protects the Spinal cord
Meninges
Spinal cord is held in position by __________ on each side and _________ inferiorly.
Denticulate ligaments. Filum terminale.
In spinal cord, segmented and paired posterior/sensory and anterior/motor roots corresponding to each segment of the cord leave the vertebral canal through the
Intervertebral foramina
Shorter than the vertebral column and terminates in the adult at the level of
Spinal cord. Lower border of first lumbar vertebra.
Spinal cord components
Gray & white matter and central canal
Columns in the White Matter
Posterior F, Anterior F & Lateral F. (PAL)
Each column in the white matter is subdivided into these tracts:
Ascending T, Intersegmental T & Descending T “AID”
Parts of the Gray Matter
Posterior H, Anterior H & Lateral H “PAL”
The cell bodies in the gray substance are grouped into clusters of _______.
Nuclei of laminae
Laminae of Rexed: Located in the posterior horn
Laminae I-VI
Laminae of Rexed: Located in the lateral horn
Lamina VII
Laminae of Rexed: Located in the anterior horn
Laminae VIII & IX
Laminae of Rexed: gray substance surrounding the central canal
Lamina X
Vascular supply from vertebral
Anterior spinal artery
Vascular supply paired, from vertebral
Posterior spinal arteries
Vascular supply of anterior and posterior SC
Radicular arteries
Vascular supply of aorta
Artery of Adamkiewiscz
Ascending tract for position sense, 2pt discriminative,vibration sense & stereognosis.
Dorsal/Posterior Column
Part of the ascending tracts
Dorsal/Posterior column & Spinothalamic tracts
Tract for pain & temperature
LSTT
Tract for touch and pressure
ASTT
Enumerate of Descending tracts
Medial reticulospinal, Anterior corticospinal, Lateral corticospinal, Lateral reticulospinal, Vestibulospinal, Tectospinal & Rubrospinal “MALL VTR”
Tracts included in the Anterior Funiculus
Vestibulospinal, Anterior Corticospinal, Reticulospinal & Tectospinal “VART”
Tracts included in the Lateral Funiculus
Lateral corticospinal & Rubrospinal “LR”
Provides voluntary control of skeletal muscles. Owes its name to the _________ of the primary cortex.
Pyramidal system. Pyramidal cells.
Pyramidal system consists of
Lateral corticospinal, Anterior corticospinal & Corticobulbar “LAC”
Pyramidal system originates at the
Primary motor cortex
Axons of pyramidal cells descend in the
Internal capsule
Axons extend into the brainstem & spinal cord to synapse on
Lower motor neurons
LCST is at the _______, axons decussate the midline to enter the _____ of the SC.
Lower medulla. Opposite side.
Descending pathways also referred to as
Upper motor neurons
Final common pathways for the control of skeletal muscle activity; referred to as __________.
Motor cells in the anterior gray horn & Motor nuclei of the cranial nerves. Lower motor neurons.
Sign of what motor neuron lesion manifest spastic paralysis
UMNL
Sign of what motor neuron lesion manifests atrophy
LMNL
Sign of what motor neuron lesion manifest flaccid paralysis
LMNL
Sign of what motor neuron lesion manifests clonus
UMNL
Sign of what motor neuron lesion manifests fasciculation
LMNL
Sign of what motor neuron lesion manifests pathologic reflexes
UMNL
Sign of what motor neuron lesion manifests decreased muscle tone
LMNL
Sign of what motor neuron lesion manifests increased muscle tone
UMNL
Lesion of the CST above the level of decussation, manifest _______. Stroke involving right motor are of the cerebrum- ______.
Contralateral. Left side paralysis.
Lesion of the CST below the level of decussation, manifest _______. Ex: Spinal cord lesion on right side-_______.
Ipsilaterally. Right side paralysis.
Clinical symptoms of Spinal cord disorders
Deep tendon reflexes, Autonomics, Motor findings & Sensory level “DAMS”
Bilateral cervical spinal cord damage _______ may result in paralysis of all four extremities known as _________.
C4-C6. Quadriplegia.
Unilateral SC lesions in ________ may result in paralysis of the ipsilateral lower extremity known as ________.
Thoracic levels. Monoplegia.
If the thoracic SC damage is bilateral, _________ may be paralyzed known as ________.
Both lower extremities. Paraplegia.
Follows acute damage to the Spinal cord; temporary interruption of the function of SC following injury. All cord functions below the level of the lesion become depressed or lost. Persists for less than ____ or may persist for as long as _______.
Spinal shock. 24hrs. 1-4weeks.
Spinal shock can determined by testing for the activity of the
Anal sphincter reflex
Flaccid, areflexic paralysis, complete loss of sensation, loss of autonomic function & loss of reflex activity- paralysis of the ____ & _____.
Spinal shock. Bladder & Rectum.
Destructive Spinal Cord Syndromes
Brown Sequard’s- Hemisection, Central cord, Anterior cord & Complete cord transection “BCCA”
Progressive cavitation around the central canal; loss of pain & temperature sensations in hands & forearm. Common in ______.
Syringomyelia. Cervical.
Attacks the anterior horn cells leading to ____.
Poliomyelitis. LMNL.
Caused by neurosyphylis; dorsal root involvement with secondary degeneration of dorsal columns (loss of vibration and position sense)
Tabes dorsalis
Pure motor disease involving the degeneration of anterior horn cells (LMNL) & CST (UMNL); no sensory loss
Amyotrophic lateral sclerosis
Caused by Vit. B12 deficiency; degeneration of posterior and lateral columns (loss of position sense and vibration in legs associated with UMNL)
Subacute combined degeneration
A 25 y/o male unable to move his R leg. He could not feel pain on the L side up to the level of the umbilicus. He could not feel vibration of the tuning fork on his R foot.
Brown Sequard’s Syndrome
Spinal cord hemisection. Contralateral loss of pain and temperature. Ipsilateral loss of propioception. Ipsilateral manifestations of upper and lower motor neuron lesions.
Brown-Sequard’s syndrome
BSS: LCST tract damage. ______ upper motor neuron weakness.
Ipsilateral
BSS: posterior column. Ipsilateral ______ & ______ loss.
Vibration. Proprioception.
BSS: anterolateral system. Contralateral ______ and ______ loss.
Pain & Temperature
Dermatome: C2
Back of head
Dermatome: S5
Perineum
Dermatome: C5
tip of shoulder
Dermatome: S1
Small toe
Dermatome: C6
Thumb
Dermatome: L4-L5
Big toe
Dermatome: C8
Small finger
Dermatome: L1
Inguinal
Dermatome: T4-T5
Nipple
Dermatome: T10
Umbilicus
Right lower extremity and loss of pain and thermal sensations on the left side beginning at the level of the umbilicus. Damage to what tract would correlate with weakness of the lower extremity?
Right LCST
Weakness of the right lower extremity and loss of pain and thermal sensations on the left side beginning at the level of the umbilicus. What represents the most likely damage to the SC resulting from fracture to the vertebral column?
T8 on the R
Loss of pain and thermal sensations on the contralateral side about 1-2 segments below the level of the lesion.
Anterolateral system
T8 on the R: loss of pain/temp at T10 dermatome
L sid
Damage at the T6 level would result in loss beginning at the __ level on the ________ side; T10 level damage= loss at beginning __ level.
T8. Contralateral. T12.
Caused by neurosyphilis; dorsal root involvement with secondary degeneration of dorsal columns (loss of vibration and position sense)
Tabes dorsalis
Clinical signs of injury to the Lemniscal Pathway
Loss of 2pt discrimination, Inability to recognize limb position, Astereognosis, (+) Romberg sign & Loss of vibration sense “LIAR L”
Patient started to sway upon closing eyes. Loss of muscle joint sense of both legs and was unable to detect any feeling of vibration when a vibrating tuning fork was placed on either legs. No sensory loss.
Tabes dorsalis
Vibration and proprioception loss below the level of the lesion
Posterior column damage
A patient who can stand with feet together and the eyes open, but who sways and falls when the eyes are closed. Indicates an absence of position sense in the lower limbs.
Romberg sign
Progressive cavitation around the central canal; loss of pain & temp sensations in hands & forearm (common in cervical) Dissociated sensory loss.
Syringomyelia
Central cord lesions. Small lesions: damage to the ______ crossing the ventral commissure causes bilateral regions of sensory loss of ______ & ______. Cervical: classic cape distribution.
Spinothalamic fibers. Pain & Temp.
Central cord lesion. Large lesions: _______ producing lower motor neuron deficits.
Anterior horn cell
Central cord lesion. Large lesions: _______ producing upper motor neuron deficits.
CST damage
Central cord lesion. Large lesions: _______ producing vibration and proprioception deficits. Posterior column damage.
Posterior column damage
With analgesia and thermoanesthesia on the medial side of the L hand that persisted for 6mos. 3wks PTA, she had severely burned the little finger of her left hand on a hot stove and was unaware that the burned had occurred. On PE, she was found to have reduced pain and temp sense involving C8 and T1 dermatomes of the L hand. However, her sense of tactile discrimination was normal.
Syringomyelia
