Neuro: Spinal Cord Lesions Flashcards
1
Q
Upper Motor Neuron lesion
A
- Motor pathway lesion
- Neurons in the Brain stem and Cerebral cortex that project to Spinal levels
- Cortical neurons that give rise to the Lateral Corticospinal Tract (LCST)
- Hypotonia w/ Late muscle Atrophy (from disuse)
- Paralysis (Flaccid –> Spastic) w/ a Positve Babinski sign
- Reduced / Absent DTRs (myotatic reflexes)
- Increased resistance to Passive movement
- Clasp-knife syndrome
- Loss of Superficial Abdominal and Cremasteric (male) reflexes below the lesion
- Ischemic Stroke
- Traumatic injury to Brain stem or Spinal cord
2
Q
Lower Motor Neuron lesion
A
- Motor pathway lesion
- Anterior Horn cells, whose Axons exit via the Ventral Root and innervate Skeletal muscle
- Damage to α motor neurons
- Flaccid Paralysis, Hypotonia, Areflexia (DTRs), Rapid muscle Atrophy, Fasciculations, and Fibrillations of the muscle fibers
- Poliomyelitis
- Werdnig-Hoffman disease “Floppy-baby”
3
Q
Combined: Upper Motor Neuron lesion
and
Lower Motor Neuron lesion
A
- Motor pathway lesion
- Damage to BOTH Corticospinal tracts and α Motor Neuron
- Spastic paresis w/ positive Babinski
- Flaccid paralysis, Areflexia, Atrophy Fasciculations, and Fibrillations of Muscle Fibers
- Amyotrophic Lateral Sclerosis (ALS)
4
Q
Dorsal Column lesion
A
- Sensory pathway lesion
- Destruction of the Dorsal column
- Loss of Tactile Discrimination and Position
- Loss of Vibration sensation
- Shooting pain
- Paresthesias
- Romberg sign
- ex. Tabes dorsalis in Tertiary syphillis
5
Q
Brown-Sequard Syndrome
(Spinal cord hemisection)
A
- Combined Motor and Senory Lesions
- Damage to: Dorsal Columns, Lateral Corticospinal tract, Lateral Spinothalamic tract, Ventral (anterior) Horn
- Ipsilateral loss of Tactile Discrimination, Position, Vibration
- ALST - Bilat. Loss of Pain and Temperature
- AST - ipsilateral Light touch present below Lesion
- Contralateral loss of Pain and Temp. Sensation (below lesion)
- Ventral root - Ipsilateral spastic paresis (below lesion)
- Ipsilateral Horner syn. (Lesion T1 or above)
- Due to Trauma, Penetrating wounds, Tumor compression, Vertebral fracture, Multiple sclerosis
6
Q
Ventral / Anterior Spinal Artery (ASA) Occlusion
A
- Combined Motor and Sensory Lesion
- Infarction of Anterior 2/3 of Spinal cord
- Infarction of the Corticospinal tracts, Anterolateral Spinothalamic system (ALST), and Anterior Horn
- Damage may be Unilateral or Bilateral; Characteristically spares Dorsal columns and Lissauer tract (2-pt-touch)
- Preserved Tactile, Position, and Vibration sense
- Loss of Pain and Temp. Sense, Paresis, Urinary and Stool Incontinence, Horner syn. (lesion T1 or above)
- Due to Embolus or Aortic Dissection
7
Q
Subacute Combined Degeneration
A
- Combined Motor and Sensory Lesion
- Damage to: Bilateral Posterior Dorsal columns, Lateral Corticospinal tract, Spinocerebellar tracts
- Bilateral loss of Tactile Discrimination, Position, Vibration
- **Bilateral **spastic paresis, hyperactive myotatic reflexes in lower limbs
- Bilateral Upper and Lower Ataxia
- Positive Romberg sign
- Postive Babinski (bilat)
- UMN –> LMN due to Peripheral Neuropathy
- A/w Vitamin B12 deficiency, Pernicious Anemia, Friedreich ataxia (autosomal recessive, no Tx, 40-yr lifespan)
8
Q
Syringomyelia
A
- Combined Motor and Sensory lesion
- 3rd or 4th Decade of Life
- Formation of Syrinx, w/ Central gliosis and expansion of the central canal
- Central Cavitation of the Cervical cord (C8 - T1) of unknown cause; Damage to **Ventral white commissure **and Ventral horns
- Bilateral Loss of Pain and Temperature Sensation of Upper extremities - dmg. Anterior White Commissure
- BUT - Tactile sense is Preserved (Sensory Dissociation)
- Bilateral Flaccid paralysis of Intrinsic Muscles of the Hands
- W/ Time: LMN due to dmg to Ventral Horn, Horner’s Syndrome dmg to Autonomic fibers, Locomotoer Ataxia dmg to Posterior columns.
9
Q
Multiple Sclerosis
A
- Combined Motor and Sensory lesions
- Random, Asymmetrical Autoimmune-mediated Demyelination of Cervical segments of the Spinal cord and Brain
- Pathology shows Destruction of **Oligodendrocytes **and Reative gliosis
-
Charcot triad:
- Scanning speech, Nystagmus (MLF syndrome), Intention tremor
- Spastic paresis and Sensory loss
10
Q
Guillain-Barre syndrome
A
- PNS Lesions
- Demyelination and Edema of Motor fibers of Ventral roots and Peripheral nerves
- Facial diplegia, Papilledema (elevated protein lvls) Ascending Lower extremeity Weakness, LMN symptoms, Parasthesias, Life-threatening Respiratory paralysis
11
Q
Lower Back Pain
90% L4 - S1
10% C5 - C7
A
- Intervertebral Disk herniation
- Prolapse, Herniation of the Nucleus Pulposus through defective Annulus fibrosis and into Vertebral canal, Impinging on Spinal Roots
- Paresthesias, Pain, Sensory loss, Hyporeflexia, Muscle weakness
- History of heavy lifting, Positive Leg-raise test, No relief w/ sitting
12
Q
Cauda Equina Syndrome
A
- Termina cord syndromes
- Tumor impingement, Spinal stenosis, or Inflammation at L3 - Co
- Gradual and Unilateral onset, Radicular Unilateral Severe Pain, Loss of Sensation in the **Unilateral Saddle-shaped **area
- **Unilateral **Muscle atrophy and Absent patellar (L4) and Ankle (S1) jerks
- Mild incontinence and Sexual dysfunction
13
Q
Conus Medullaris Syndrome
A
- Terminal cord syndrome
- Inpingement of S3 - Co from Intramedullary tumor (Ependymoma)
- **Sudden **and Bilateral Onset
- Bilateral MILD pain
- Loss of Sensation in Bilateral Saddle-shaped area
- Mild muscle weakness preserved Reflexes
- Severe Incontinence and Sexual dysfunction
- Nonurgent treatment w/ Corticosteroid Injection or XRT
14
Q
Loss of Pain and Temperature sensation
w/ preservation of
Discriminitive Touch and Vibration
is indicitive of a lesion in the?
A
ALSTS damage
15
Q
Loss of **Discriminative Touch **and Vibration sense
w/ preservation of Pain and Temperature sense
is indicitive of a lesion in the?
A
Posterior cord
(damage to the posterior column)
