PDF - Spinal Cord Flashcards
Another name for LMNs?
Anterior horn cells
Weakness in LMN lesions?
Can present immediately but atrophy can takes weeks - months to develop
What do c5 and C6 innervate?
Deltoids and biceps
What do C7/8 Innervated?
Triceps
What innervates Tricep?
C7/8
What innervates biceps?
C5/6
What innervates deltoid?
C5/6
What do C8/T1 innervate?
Flexor digitorum
Interoseii
What innervates the Flexor digitorum?
C8/T1
What innervates the Interossei?
C8/T1
What do L2-4 innervate?
Quadriceps
Iliopsoas (hip flexor)
What innervates the Quadriceps?
L2-4
What innervates the Iliopsoas (hip flexor)?
L2-4
What does L4/5 innervate?
Tibialis anterior (foot dorsiflexor)
What innervates the tibialis anterior (foot dorsiflexor)?
L4/5
What innervates the Gastrocnemius (foot plantar flexor)?
S1/2
What does S1/2 innervate?
Gastrocnemius (foot plantar flexor)
LMN signs?
- Severe atrophy w/ milder weakness
- Fasciculations
- Decreased Tone
- Decreased stretch reflexes
- No babinski
- No clonus
UMN signs?
- Severe weakness w/ mild atrophy
- Never fasciculations
- increased tone / spasticity
- Increased reflexes
- Positive Babinski
- Possible Clonus
What is radicular pain?
Lightning, stabbing, shooting or electrical pain in dermatomal distribution of a dorsal root
Causes radicular pain?
- Inflammation: Herpes zoster
2. Extramedullary compression
Difference in intra/extramedullary compression of cord?
Extra: Radicular pain
Intra: No pain or diffuse pain
Rx Radicular pain?
- Analgesics
- Nerve blocks
- Antidepressants: duloxetine / amitriptyline
- Anticonvulsants: gabapentin / carbamazepine
Presentation spinothalamic lesion?
Pain and temperature deficit in contralateral body
What does a A suspended pattern of pain / temp deficit with sacral sparing indicate?
- Intramedullary spinothalamic lesion within spinal cord
- Disrupts decussating spinothalamic fibers
- Since sacral fibers of spinothalamic are most lateral, they may be spared
What does sensory deficit for pain and temperature up to a level with sacral involvement indicate?
Extramedullary lesion arising from outside spinal cord, and typically compressing it: IE, tumor
What is a transection?
“Transverse myelopathy”
- Complete or nearly complete lesion encompassing cross-sectional extent of spinal cord
Presentation spinal shock?
Weakness may be accompanied by decreased muscle tone and muscle stretch reflexes, with expected UMN signs gradually emerging weeks to months later
What can extensive involvement of anterior horn cells at C3, C4 and C5 may cause?
impaired phrenic nerve function causing respiratory failure
What is a brown sequard lesion?
- Lesion impacting half of spinal cord
- Contralateral deficit to pain and temperature
- Involvement of the dorsal or posterior columns produces ipsilateral deficit of vibration / position sense
What is syringomyelia?
Spinal cord lesion from a syrinx, or cavity, within center of spinal cord
- Dermatomal deficit of pain / temp sparing sacrum
“a suspended sensory level with sacral sparing”
- Vibration / proprioception spared
Presentation anterior spinal artery occlusion?
- Paraplegia with UMN signs in lower limbs
- Thoracic level sensory loss, w/o sacral sparing, to pain and temp
- Vibration / position remain normal
- Back / radicular pain = common initial symptoms
Risks spinal artery occlusion?
- AAA repair
- Aortic dissection
- Atherosclerosis
What is this:
- Paraplegia with UMN signs in lower limbs
- Thoracic level sensory loss, w/o sacral sparing, to pain and temp
- Vibration / position remain normal
- Back / radicular pain = common initial symptoms
Anterior spinal artery occlusion
Cause Posterolateral syndrome?
“Subacute combined degeneration”
- B12 deficiency (most common)
- Copper deficiency
- HIV
Presentation Subacute combined degeneration?
- Vibration / position are reduced in lower limbs
- Unsteadiness when patient stands or walks in dark - Spastic paraparesis from involvement of corticospinal tract
- Pain / temp not affected
What is this:
- Vibration / position are reduced in lower limbs
- Unsteadiness when patient stands or walks in dark - Spastic paraparesis from involvement of corticospinal tract
- Pain / temp not affected
“Subacute combined degeneration”
What is ALS?
Degenerative disease where upper / LMNs are selectively and progressively destroyed, for unknown reasons
- Lesions occur diffusely, in cortex / stem, as well as
cord
What is not present in ALS?
- Sensory impairment
- Bowel / bladder incontinence
- Radicular pain
Cause Tabes dorsalis?
Syphilis
Presentation Tabes Dorsalis
- Radicular pains in lower limbs
- Impairment of vibration / position sense in lower limbs
- Eventual loss of all sensation in lower limbs, where reflexes are lost
- Strength remains intact
What is the following:
- Radicular pains in lower limbs
- Impairment of vibration / position sense in lower limbs
- Eventual loss of all sensation in lower limbs, where reflexes are lost
- Strength remains intact
Tabes Dorsalis
