Neurology p. 470-474 Flashcards
What 2 Spinal tracts are ascending and sense pressure?
Dorsal column
Spinothalamic tract
which track has a 2nd synapse on NMJ?
Lateral corticospinal tract
Which 2 tracts decussate at the 2ND-ORDER NEURON?
Dorsal column Spinothalamic tract (Anterolater)
Which 2 tracts decussate in medulla?
Dorsal column
Lateral corticospinal tract (pyramidal decussation)
Which 2 tracts sense pressure?
Spinothalamic tract
Dorsal column
Which 2 tracts cell body in dorsal root ganglion?
Spinothalamic tract
Dorsal column
Which tract decussates at anterior white commissure?
Spinothalamic tract
Where is the cell body of Lateral corticospinal tract?
cell body in 1° motor cortex
Which 2 tracts have a 3RD-ORDER NEURON end in Sensory cortex?
Spinothalamic tract
Dorsal column
Which tract sends vibration, fine touch, and proprioception to the cortex?
Dorsal column
Atrophy UMN or LMN?
LMN
Where does the Lateral corticospinal tract become LMN?
at spinal cord as 2ND-ORDER NEURON
Which tract sends
Lateral: pain, temperature
Anterior: crude touch,
Spinothalamic tract
Spastic paralysis UMN or LMN?
UMN
Which motor neuron sign is seen in both UMN and LMN?
Weakness
UMN or LMN in Werdnig-Hoffmann disease? Where is the distruction? And mode of inheritance?
LMN lesions only
destruction of anterior horns; flaccid paralysis.
Autosomal recessive
Fasciculations UMN or LMN?
LMN
A pt with weakness and fasciculations and spastic paralysis but has no sensory or oculomotor deficits suffers from what spinal coed dz?
ALS
Scanning speech, intention tremor, nystagmus are sx of what spinal cord dz?
MS
Clasp knife spasticity UMN or LMN?
UMN
Reflexes and Tone incr with UMN or LMN?
UMN
pt has impaired sensation and proprioception,
progressive sensory ataxia (inability to sense or feel
the legs causing poor coordination). What is the path?
Tabes dorsalis
Amyotrophic lateral sclerosis involves UMN or LMN? Name the cause?
both
defect in superoxide dismutase 1.
Lesion to what spinal artery destroys all but spares dorsal columns and Lissauer tract? and why is that part spared?
Complete occlusion of anterior spinal artery
because gracilis and cuneatus are supplied by Posterior spinal arteries.
⊕ Romberg sign is seen in which 2 spinal cord lesions?
Tabes dorsalis ALS Vit B12 def. Friedreich's ataxia Ménière's disease
Which artery supplies ASA below ∼ T8?
Adamkiewicz
MOA of Riluzole and what is treats?
incr modestly survival of ALS
decr presynaptic glutamate release
demyelination of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts i seen in which path?
Vit B12 def
Name 3 demyelination paths of the spinal cord?
MS
Tabes dorsalis
vit B12 def
Sx of Syringomyelia?
Where is it seen?
defect in what path?
- Bilateral loss of pain and temperature sensation (usually C8–T1)
- See in Chiari I malformation
- white commissure of spinothalamic tract (2nd-order
neurons)
What is frataxin and what path is it seen?
iron binding protein,
What test can help dx Polio?
stool sample - Virus recovered from stool or throat.
In Brown-Séquard syndrome which finding in is the only Contralateral finding?
pain and temperature loss below level of lesion (due to spinothalamic tract damage)
7 year old child presents with kyphoscoliosis, frequent falling and diabetes has a defect on chromosome 9. What is the pathphys and what will be the cause of death?
Friedreich ataxia - defected frataxin causes impairment in mitochondrial functioning. (oxidative stress)
MCC of death: hypertrophic cardiomyopathy around 7years
trinucleotide repeat disorder (GAA)
In which 6 paths do we find Horner syndrome?
Any lesion above T1
- Brown-Séquard syndrome
- PICA
- Cavernous sinus syndrome
- Bronchogenic apical lung tumor
- Pancoast tumor
- Clustera headaches
In Brown-Séquard syndrome at which levels are UMN sings and at which are there LMN signs?
UMN signs below the lesion
LMN signs at the lesion
”— at the belly butten”.
T10
”— at the teat pore.”
T4
” — is IL (Inguinal Ligament).”
L1
“Down on ALL 4’s “
L4- knees
“ — keep the penis off the floor.”
S2, 3, 4
Diaphragm and gallbladder pain referred to the
right shoulder via — nerve
phrenic
Testing for reflexes: Biceps = Triceps = Patella = Achilles =
Biceps = C5 nerve root. Triceps = C7 nerve root. Patella = L4 nerve root. Achilles = S1 nerve root
Level of cremaster reflex?
L1, L2
Level of anal wink reflex?
S3, S4
Describe Galant reflex?
Stroking along one side of the spine while newborn is in ventral suspension (face down) causes
lateral flexion of lower body toward stimulated side
Describe Rooting reflex?
Movement of head toward one side if cheek or mouth is stroked (nipple seeking)
Describe Plantar reflex?
Dorsiflexion of large toe and fanning of other toes with plantar stimulation
Babinski sign—presence of this reflex in an adult, which may signify a UMN lesion
Describe Moro reflex?
“Hang on for life” reflex—abduct/extend arms when startled, and then draw together
Gland for melatonin secretion, circadian
rhythms?
Pineal gland (neroectoderm)
CN nuclei that lie medially at brain stem:
III, IV, VI, XII. “Factors of 12, except 1 and 2.”
Area for conjugate vertical gaze center?
Superior colliculi
Area of midbrain for auditory?
Inferior colliculi
Midbrain contains which nuclei?
CN III, IV
Paralysis of conjugate vertical gaze due to lesion in superior colliculi Describes? What paths can cause that?
Parinaud syndrome ("suncken eye syndrome") stroke, hydrocephalus, pinealoma
Pons contains nuclei of which CN?
CN V, VI, VII, VIII
Medulla contains nuclei of which CN?
CN IX, X, XII
Spinal cord contains nucleus of which CN?
CN XI
CN nuclei position:
Lateral nuclei =
Medial nuclei =
Lateral nuclei = sensory (aLar plate).
—Sulcus limitans—
Medial nuclei = Motor (basal plate).