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Spinal Cord > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

Perfuses the posterior 1/3 of the spinal cord

A

Posterior spinal arteries (2)

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2
Q

Perfuses the anterior 2/3 of the spinal cord

A

Anterior spinal artery (1)

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3
Q

Perfuses the spinal arteries in the thoracolumbar region of the spinal cord

A

Radicular arteries (6-8)

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4
Q

Supplies the anterior and posterior spinal arteries in the cervical region of the spinal cord

A

Vertebral arteries

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5
Q

Blood flow paths for the posterior spinal arteries

A

Aorta > subclavian a. > vertebral a. > posterior spinal a.

Aorta > segmental a. > posterior radicular a. > posterior spinal a.

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6
Q

Blood flow paths for the anterior spinal artery

A

Aorta > subclavian a. > vertebral a. > anterior spinal a.

Aorta > segmental a. > anterior radicular a. > anterior spinal a.

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7
Q

Identify the structures

A
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8
Q

Largest, most important radicular artery

A

Artery of Adamkiewicz (Great Radicular a.)

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9
Q

Perfuses the anterior spinal cord in the thoracolumbar region

A

Artery of Adamkiewicz (Great Radicular a.)

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10
Q

Most common origin of the Artery of Adamkiewicz (Great Radicular a.)

A

Left side between T11-12

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11
Q

Watershed areas of the spinal cord

A

Region of the cord with singular blood supply.

Vulnerable to ischemia

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12
Q

Classic signs of anterior spinal artery syndrome (Beck’s syndrome)

A

Flaccid paralysis of lower extremities
Bowel and bladder dysfunction
Loss of temperature and pain sensation
Preserved touch and proprioception

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13
Q

Cause of anterior spinal artery syndrome (Beck’s syndrome)

A

Aortic cross-clap placed above the artery of Adamkiewicz

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14
Q

Cause of flaccid paralysis in anterior spinal artery syndrome (Beck’s syndrome)

A

Corticospinal tract is perfused by the anterior blood supply

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15
Q

Cause of bowel and bladder dysfunction in anterior spinal artery syndrome (Beck’s syndrome)

A

Autonomic motor fibers are perfused by the anterior blood supply

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16
Q

Cause of loss of pain and temperature sensation in anterior spinal artery syndrome (Beck’s syndrome)

A

The spinothalamic tract is perfused by the anterior blood supply

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17
Q

Why are touch and proprioception preserved in anterior spinal artery syndrome (Beck’s syndrome)?

A

The dorsal column is perfused by the posterior blood supply

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18
Q

Identify the arteries supplying the spinal cord

A
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19
Q

Structure that links the peripheral nerves to the brain

A

Spinal cord

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20
Q

Where do sensory neurons enter the spinal cord

A

Dorsal nerve root

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21
Q

Where do motor and autonomic neurons exit the spinal cord?

A

Ventral nerve root

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22
Q

Collection of cell bodies that reside outside of the CNS

A

Ganglion

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23
Q

Contains neuronal cell bodies and is the processing center for afferent signals that arrive from the periphery

A

Gray matter

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24
Q

In what regions of the spinal cord is gray matter larger?

A

Cervical (C5-C7)
Lumbar (L3-S2)

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25
Q

How many laminae does gray matter of the spinal cord have?

A

10

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26
Q

Sensory laminae

A

1-6 (dorsal gray matter)

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27
Q

Motor laminae

A

7-9 (ventral gray matter)

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28
Q

Where is lamina 10 located?

A

Around the central canal; anterior and posterior commissures

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29
Q

Contains the axons of the ascending and descending tracts

A

White matter

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30
Q

Divided into the dorsal, lateral, and ventral columns

A

White matter

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31
Q

Group of fibers inside the white matter in the CNS that relay information up or down the spinal cord or to and from the brain

A

Tracts

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32
Q

Sensory tracts

A

Dorsal column (Cuneatus and Gracilis)
Tract of Lissauer
Lateral spinothalamic tract
Ventral spinothalamic tract

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33
Q

Motor tracts

A

Lateral corticospinal tract
Ventral corticospinal tract

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34
Q

Identify the tract:
Fine touch and proprioception

A

Cuneatus and Gracilis

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35
Q

Identify the tracts:
Pain and temperature

A

Tract of Lissauer
Lateral spinothalamic tract

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36
Q

Identify the tract:
Crude touch and pressure

A

Ventral spinothalamic tract

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37
Q

Identify the tract:
Limb motor

A

Lateral corticospinal tract

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38
Q

Identify the tract:
Posture motor

A

Ventral corticospinal tract

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39
Q

Identify the tracts

A
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40
Q

Identify the anatomic structures of the spinal cord

A
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41
Q

Dorsal column- medial leminiscal system:

Function

A

Transmits mechanoreceptive sensations: fine touch, proprioception, vibration, and pressure

Capable of two-point discrimination

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42
Q

Dorsal column- medial lemniscal system:

Type of fibers

A

Large, myelinated, rapidly conducting (usually A-beta)

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43
Q

Dorsal column- medial leminiscal system:
Path of first order neuron

A

Enters spinal cord at DRG > ascends dorsal column ipsilaterally > medulla > synapses with 2nd order neuron in medulla (cuneate and gracile nuclei)

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44
Q

Dorsal column- medial lemniscal system:

Path of second order neuron

A

Crosses contralateral side of medulla > ascends toward the thalamus via the medial lemniscus > synapse with 3rd order neuron in the thalamic relay station (ventrobasal complex)

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45
Q

Dorsal column- medial lemniscal system:

Path of third order neuron

A

Pass through the internal capsule and advance towards the somatosensory cortex in the postcentral gyrus in the parietal lobe

46
Q

Joins second order neurons in the dorsal column- medial leminiscal system

A

Trigeminal nerve

47
Q

Identify the mechanoreceptor type:
Two-point discriminative touch
Vibration

A

Meissner’s corpuscles

48
Q

Identify the mechanoreceptor type:
Continuous touch

A

Merkel’s discs

49
Q

Identify the mechanoreceptor type:
Proprioception
Prolonged touch and pressure

A

Ruffini’s endings

50
Q

Identify the mechanoreceptor type:
Vibration

A

Pacinian corpuscles

51
Q

Anterolateral system- Spinothalamic tract:

Function

A

Pain
Temperature
Crude touch
Tickle
Itch
Sexual sensation
*no two- point discrimination

52
Q

Anterolateral system- Spinothalamic tract:

Fiber characteristics

A

Smaller, myelinated and nonmyelinated, slower conducting fibers

53
Q

Anterolateral system- Spinothalamic tract:

Fibers types

A

A-delta: “first” pain, mechanoreceptors

C-fibers: “slow” pain, polymodal nociceptors

54
Q

Anterolateral system- Spinothalamic tract:

Location of first order neuron cell body

A

Dorsal root ganglion

55
Q

Anterolateral system- Spinothalamic tract:

First order neurons ascend or descend on the ipsilateral side in the ______

A

Tract of Lissauer

56
Q

Anterolateral system- Spinothalamic tract:

Where do pain neurons synapse with second order neurons?

A

Substantia gelatinosa- Rexed’s lamina 2

Primary pain neurons also may synapse in the dorsal horn laminae 1 ,4, 5, and 6

57
Q

Anterolateral system- Spinothalamic tract:

Two second order neuron pathways

A

Lateral spinothalamic (Neopinothalamic)

Anterior spinothalamic (Paleospinothalamic)

58
Q

Anterolateral system- Spinothalamic tract:

Second order neuron tract that transmits pain and temperature

A

Lateral spinothalamic (Neopinothalamic)

59
Q

Anterolateral system- Spinothalamic tract:

Second order neuron tract that transmits crude touch and pressure

A

Anterior spinothalamic (Paleospinothalamic)

60
Q

Anterolateral system- Spinothalamic tract:

Location of second order neuron cell bodies

A

Dorsal horn of spinal cord

61
Q

Anterolateral system- Spinothalamic tract:

Where do second order neurons synapse with third order neurons

A

Reticular activating system
Thalamus

62
Q

Anterolateral system- Spinothalamic tract:

Path of most tactile signal third order neurons

A

Relayed to ventrobasal complex of the thalamus > through the internal capsule > somatosensory cortex in postcentral gyrus in the parietal lobe

63
Q

Anterolateral system- Spinothalamic tract:

Path of most pain signal third order neurons

A

Reticular activating system > thalamus

64
Q

Anterolateral system- Spinothalamic tract:

Receptor types

A

Nociceptors
Mechanoreceptors
Thermoreceptors

65
Q

Nociceptor function

A

Pain sensation

66
Q

Anterolateral system- Spinothalamic tract:

Mechanoreceptor function

A

Pressure, crude touch, tickle, itch, sexual sensation

67
Q

Thermoreceptor function

A

Temperature sensation

68
Q

Corticospinal tract:

Primary functions

A

Voluntary fine motor control to limbs
Coordination of posture

69
Q

Corticospinal tract alternate name

A

Pyramidal tract

70
Q

Corticospinal tract:
Path of motor neurons

A

Precentral gyrus of frontal lobe > through internal capsule > inferiorly through the pyramids of the medulla

71
Q

Corticospinal tract:

Where do upper motor neurons synapse with lower motor neurons

A

Ventral horn of spinal cord

72
Q

Corticospinal tract:

Origin of upper motor neurons cell bodies

A

Cerebral cortex

73
Q

Corticospinal tract:
Upper motor neuron injury consequence

A

Contralateral spastic paralysis
Hyperreflexia

74
Q

Corticospinal tract:
Examples of upper motor neuron injury

A

Cerebral palsy
Amyotrophic lateral sclerosis

75
Q

Corticospinal tract:
Test of tract integrity

A

Babinski test

76
Q

Corticospinal tract:
Where do lower motor neurons originate and end

A

Ventral horn> neuromuscular junction

77
Q

Corticospinal tract:
Lower motor neurons function

A

Relay messages from the spinal cord to the muscles

78
Q

Corticospinal tract:
Lower motor neuron injury consequence

A

Ipsilateral flaccid paralysis
Impaired reflexes

79
Q

When is babinski sign present/ absent?

A

Present in upper motor neuron injury
Absent in normal function and lower motor neuron injury

80
Q

Corticospinal tract:
Tract responsible for limb innervation

A

Lateral corticospinal tract

81
Q

Corticospinal tract:
Tract responsible for axial muscle innervation

A

Ventral corticospinal tract

82
Q

Corticospinal tract:
Where do most fibers of the ventral corticospinal tract cross to the contralateral side of the spinal cord?

A

When they reach the cervical or thoracic area

83
Q

Corticospinal tract:
Where do most fibers of the lateral corticospinal tract cross decussate?

A

In the medulla

84
Q

SSEPs monitor the integrity of ______

A

Dorsal column (medial lemniscus)

85
Q

The posterior arteries perfuse what region of the spinal cord?

A

Dorsal column (medial lemniscus)

86
Q

MEPs monitor the integrity of the ______

A

Corticospinal tract

87
Q

The anterior spinal artery perfuses the ____

A

Corticospinal tract

88
Q

Triad of neurogenic shock

A

Hypotension
Bradycardia
Hypothermia

89
Q

Length of time neurogenic shock can last

A

1-3 weeks

90
Q

How does neurogenic shock present differently than hypovolemic shock?

A

Neurogenic- bradycardia and hypothermia with warm pink extremities present

Hypovolemic- tachycardia and cool, clammy extremities present

91
Q

Treatment of hypotension in neurogenic shock

A

Norepinephrine
Volume expansion- monitor closely d/t risk of pulmonary edema when sympathetic tone is restored

92
Q

Succinylcholine in spinal cord injury

A

Fasciculations may worsen outcomes

Avoid after 24 hours d/t extrajunctional upregulation

93
Q

Major causes of morbidity and mortality in patients with cervical and upper thoracic lesions

A

Ineffective alveolar ventilation

Inability to clear pulmonary secretions

94
Q

Patholophysiology of autonomic hyperreflexia

A

Spinal shock phase ends > SNS reflexes return to level below the injury > inhibitory signals above the level of injury cannot reach below the level of injury = overactive sympathetic response below injury

95
Q

Vertebral level at which autonomic hyperreflexia will almost certainly occur

A

Above T6

96
Q

Autonomic hyperreflexia is not likely below what vertebral level?

A

T10

97
Q

Relationship between injury level and autonomic hyperreflexia

A

The higher the level, the more intense the response

98
Q

Common evens that cause autonomic hyperreflexia

A

Stimulaiton o fthe hollow organs
Bladder catheterization
Surgery (especially cystoscopy or colonoscopy)
Bowel movement
Cutaneous stimulation
Childbirth

99
Q

Presentation of autonomic hyperreflexia

A

Hypertension
Bradycardia

100
Q

Signs of malignant hypertension d/t autonomic hyperreflexia

A

Stroke
Seizure
LVF
Dysrhythmias
Pulmonary edema
Myocardial infarction

101
Q

Best anesthetic approach for patients with a non-acute SCI

A

General anesthesia
Spinal anesthesia

102
Q

Best treatment of hypertension for the patient with autonomic hyperreflexia

A

Removal of stimulus
Deepen anesthetic
Rapid-acting vasodilator (sodium nitroprusside)

103
Q

Bradycardia tx or the patient with autonomic hyperreflexia

A

Atropine
Glycopyrrolate

104
Q

Progressive degeneration of motor neurons in the corticospinal tract

A

ALS

105
Q

ALS progression

A

Begins in hands, weakness spreads to the rest of the body affecting the tongue, pharynx, larynx, and chest

Ocular muscles not affected

106
Q

Only drug that reduces mortality in ALS

A

Riluzole (NDMA receptor antagonist)

107
Q

Most common cause of death in ALS

A

Respiratory failure

108
Q

Anesthetic considerations for ALS

A

Succinylcholine can cause lethal hyperkalemia

Increased sensitivity to nondepolarizers

VC and maximal MV are reduced

Consider postoperative mechanical ventilation

109
Q
A
110
Q
A

Spinal Cord (1 decks)

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