Sos- Motor Spinal Cord Flashcards
how many cervical vertebrae and how many cervical nerves
7 vertebrae
8 nerves
how many thoracic vertebrae and nerves
12
how many lumbar vertebrae and nerves
5
how many sacral vertebrae and nerves
5
how many coccyx vertebrae and nerves
1
spinal disease at or below L2 does not produce _______, only ________
doesn’t produce myelopathy (bilateral)
does produce radiculopathy (unilateral)
color of spinal cord and subarachnoid space
black
white
top R
middle R
cauda equina
conus medullaris
why do cervical and lumbar have wider diameter vertebrae than thoracic
cervical deals with upper extremities
lumbar deals with lower extremities
end of spinal cord
L1-L2 (conus medullaris)
____ mater anchors spinal cord caudally as filum terminale
pia mater
where to do lumbar puncture (spinal tap)
L3-L5
spinal cord vs brain white and gray matter orientation
brain: gray on periphery; white in middle
spinal cord: white on periphery; gray in middle
what roots form spinal n
ventral and dorsal roots
_____ enlargement—arms and legs
“wide bunny”
C8 (cervical enlargement—arms and legs)
“skinny butterfly”
T2 (thoracic)
_____ horn present from T1-L2 (sympathetics)
lateral horn
____ enlargement (legs)
lumbar enlargement
two L lines
C1
C2 body (can see dens)
atlas (ring); secured to base of skull; moves with the head
C1
axis (has the dens that sticks straight up) head rotates around this; dens in anterior location
C2
pick out C7
spinous process sticks out (is palpable)
L5?
at the bend just before the sacrum
do you worry about puncturing nerve during spinal tap b/t L3-L5?
no, they will roll around like noodles in boiling water
space for epidural anesthesia
L3-L5
which disc is bulging and which one is herniated
middle arrow: bulging
bottom arrow: herniated (can see white)
C8 and above pedicle/ nerve root match or mismatch
mismatch
both discs affect same nerve root in ____ spine, different than the others
cervical
at C6/C7 intervertebral disc, if there is medial or lateral bulging of disc, what nerve is affected
C7
intervertbral disc bulging at C7/T1, what nerve is affected
C8
paracentral lesion at L4/L5 intervertebral disc, what nerve affected
L5
Far lateral lesion at L4/L5 affects what nerve
L4
talking about movements and reflexes of body that are impaired after a spinal cord trauma
spinal shock
focusing on CNS autonomic control when spinal cord damaged in trauma
neurogenic shock
both have hypotension and bradycardia
spinal and neurogenic shock
peripheral neurons become temporarily unresponsive to brain stimuli
spinal shock
disruption of autonomic pathways; loss of sympathetic tone and vasodilation
neurogenic shock
lesions above ____ eliminate all sympathetic flow
T1
Lesions between T1 and T6
block sympathetic flow to the ______ and lower extremities
adrenals
Lesions below ______block sympathetic flow to the lower extremities
T6
what are the main arteries that supply spinal cord
2 posterior spinal arteries
1 anterior spinal artery
next to T5/T6 (very large artery for the spinal cord that supplies a good portion of the cord——-if this is damaged, will have anterior part of cord stroking or dying
Adamkiewicz artery
Anterior cord syndrome often from damage to _________
Adamkiewicz a.
main 3 parts of the cord (don’t pay attention to these colors)
anterior, lateral, posterior funiculus
origin is from primary motor cortex, premotor frontal
lateral and anterior corticospinal motor tracts
corticospinal tract that decussates
lateral corticospinal
decussates at inferior medulla
lateral corticospinal tract
primary function is contralateral voluntary movement
lateral corticospinal tract
where does lateral corticospinal cord terminate
along entire cord at ventral horn
where does anterior corticospinal tract terminate
cervical and thoracic ventral horns
control of bilateral axial and girdle muscles
anterior corticospinal tract
what part of brain looks like mickey mouse in a horizontal cut
midbrain
Large cell bodies in motor cortex
Betz cells
what part of midbrain
pons
what part of midbrain
medulla
____ motor neurons before decussation
UMNs
_____ motor neurons after decussation
LMNs
blue
purple
red line
blue: basal ganglia
purple: thalamus
red line: internal capsule
anterior limb of internal capsule primary functions
higher cortical functions
face and head at the bend (genu) of _____
internal capsule
upper and lower extremities and trunk in what limb of internal capsule
posterior
what motor tract
lateral corticospinal tract
what tract
dorsal column medial lemniscus (DCML)
what tract
anterolateral system
tract of spinal cord that is the exception of the normal (normal is medial—upper extremities while lateral——lower extremities)
DCML (which is actually similar to how the brain is set up)
dermatome for jaw and back of head
C2
dermatome for neck
C3/C4
dermatome for thumb
C6
dermatome for middle finger
C7
dermatome for little finger (pinkie)
C8
dermatome for nipple
T4
dermatome for navel
T10
dermatome for patella
L4
dermatome for great toe
L5
dermatome for genitalia
S2/S3
dermatome for anus
C0
help localize spinal cord and spinal root injuries
dermatomes
cervical flexion myotome
C1,C2
cervical side flexion myotome
C3
scapula elevation myotome
C4
shoulder abduction myotome
C5
elbow flexion and wrist extension myotome
C6
elbow extension and wrist flexion myotome
C7
thumb extension myotome
C8
finger abduction myotome
T1
hip flexion myotome
L1, L2
knee extension myotome
L3
ankle dorsiflexion myotome
L4
big toe extension myotome
L5
ankle plantarflexion myotome
S1
knee flexion myotome
S2
components of reflex arc
quick response by spinal cord
syndrome that frequently involves elderly with underlying spondylosis or younger people with sever extension injury
upper extremity deficits greater than lower extremity
central cord syndrome
bilateral loss of pain and temperature
syringomyelia (causes cape like distribution)
central cord syndrome
upper extremity deficit greater than lower extremity deficit in this syndrome b/c lower extremity corticospinal tracts are located lateral in the cord
central cord syndrome
Anterior spinal artery infarction
artery of Adamkiewicz infarction
anterior cord syndrome
vertebral burst fracture
thoracic surgery
muscle weakness
bilateral loss of pain and temp. (b/c anterolateral system is located anterior of spinal cord)
anterior cord syndrome
presents with immediate paralysis, b/c corticospinal tracts are located in anterior aspect of spinal cord
anterior cord syndrome
extramedullary tumor
penetrating trauma such as a stab wound
Brown Sequard syndrome
ipsilateral motor weakness and contralateral sensory deficit due to hemisection of spinal cord
Brown-Sequard syndrome
Tertiary syphillis, B12 deficiency
loss of vibration and proprioception
good prognosis
posterior cord syndrome
Also – potentially, tranverse myelitis
Probably due to infectious process
total absence of sensation and motor function caudal to level of injury
complete spinal cord injury
min-hours
trauma
acute
days to weeks
hematoma, brain tumor, abscess
subacute
age-related
months to years
overgrowth of bone compressing spinal cord
chronic
cervical spondylosis
advanced RA
______ effectively transects cord
compression injury
_____lesion
autoimmune lesion
wavy and bumpy
bilateral lesions
transverse myelitis
random focal lesions
usually unilateral
MS
developmental
syringomyelia
anterior cord syndrome
motor disease that affects UMNs and LMNs
Amyotropic lateral sclerosis (ALS)
+ Babinski sign
UMN and LMNs damaged
ALS
bilateral (demyelinating)
ALS
unilateral (demyelinating)
MS, stroke
LMNs affected
Most severe: young children (type I and II)
spinal muscular atrophy (SMA)
ALS or SMA
ALS (bilateral)
mickey mouse (midbrain) with bilateral white dots
ALS
