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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
How many laminae does gray matter of the spinal cord have?
10
26
Sensory laminae
1-6 (dorsal gray matter)
27
Motor laminae
7-9 (ventral gray matter)
28
Where is lamina 10 located?
Around the central canal; anterior and posterior commissures
29
Contains the axons of the ascending and descending tracts
White matter
30
Divided into the dorsal, lateral, and ventral columns
White matter
31
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
Tracts
32
Sensory tracts
Dorsal column (Cuneatus and Gracilis) Tract of Lissauer Lateral spinothalamic tract Ventral spinothalamic tract
33
Motor tracts
Lateral corticospinal tract Ventral corticospinal tract
34
Identify the tract: Fine touch and proprioception
Cuneatus and Gracilis
35
Identify the tracts: Pain and temperature
Tract of Lissauer Lateral spinothalamic tract
36
Identify the tract: Crude touch and pressure
Ventral spinothalamic tract
37
Identify the tract: Limb motor
Lateral corticospinal tract
38
Identify the tract: Posture motor
Ventral corticospinal tract
39
Identify the tracts
40
Identify the anatomic structures of the spinal cord
41
Dorsal column- medial leminiscal system: Function
Transmits mechanoreceptive sensations: fine touch, proprioception, vibration, and pressure Capable of two-point discrimination
42
Dorsal column- medial lemniscal system: Type of fibers
Large, myelinated, rapidly conducting (usually A-beta)
43
Dorsal column- medial leminiscal system: Path of first order neuron
Enters spinal cord at DRG > ascends dorsal column ipsilaterally > medulla > synapses with 2nd order neuron in medulla (cuneate and gracile nuclei)
44
Dorsal column- medial lemniscal system: Path of second order neuron
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)
45
Dorsal column- medial lemniscal system: Path of third order neuron
Pass through the internal capsule and advance towards the somatosensory cortex in the postcentral gyrus in the parietal lobe
46
Joins second order neurons in the dorsal column- medial leminiscal system
Trigeminal nerve
47
Identify the mechanoreceptor type: Two-point discriminative touch Vibration
Meissner's corpuscles
48
Identify the mechanoreceptor type: Continuous touch
Merkel's discs
49
Identify the mechanoreceptor type: Proprioception Prolonged touch and pressure
Ruffini's endings
50
Identify the mechanoreceptor type: Vibration
Pacinian corpuscles
51
Anterolateral system- Spinothalamic tract: Function
Pain Temperature Crude touch Tickle Itch Sexual sensation *no two- point discrimination
52
Anterolateral system- Spinothalamic tract: Fiber characteristics
Smaller, myelinated and nonmyelinated, slower conducting fibers
53
Anterolateral system- Spinothalamic tract: Fibers types
A-delta: "first" pain, mechanoreceptors C-fibers: "slow" pain, polymodal nociceptors
54
Anterolateral system- Spinothalamic tract: Location of first order neuron cell body
Dorsal root ganglion
55
Anterolateral system- Spinothalamic tract: First order neurons ascend or descend on the ipsilateral side in the ______
Tract of Lissauer
56
Anterolateral system- Spinothalamic tract: Where do pain neurons synapse with second order neurons?
Substantia gelatinosa- Rexed's lamina 2 Primary pain neurons also may synapse in the dorsal horn laminae 1 ,4, 5, and 6
57
Anterolateral system- Spinothalamic tract: Two second order neuron pathways
Lateral spinothalamic (Neopinothalamic) Anterior spinothalamic (Paleospinothalamic)
58
Anterolateral system- Spinothalamic tract: Second order neuron tract that transmits pain and temperature
Lateral spinothalamic (Neopinothalamic)
59
Anterolateral system- Spinothalamic tract: Second order neuron tract that transmits crude touch and pressure
Anterior spinothalamic (Paleospinothalamic)
60
Anterolateral system- Spinothalamic tract: Location of second order neuron cell bodies
Dorsal horn of spinal cord
61
Anterolateral system- Spinothalamic tract: Where do second order neurons synapse with third order neurons
Reticular activating system Thalamus
62
Anterolateral system- Spinothalamic tract: Path of most tactile signal third order neurons
Relayed to ventrobasal complex of the thalamus > through the internal capsule > somatosensory cortex in postcentral gyrus in the parietal lobe
63
Anterolateral system- Spinothalamic tract: Path of most pain signal third order neurons
Reticular activating system > thalamus
64
Anterolateral system- Spinothalamic tract: Receptor types
Nociceptors Mechanoreceptors Thermoreceptors
65
Nociceptor function
Pain sensation
66
Anterolateral system- Spinothalamic tract: Mechanoreceptor function
Pressure, crude touch, tickle, itch, sexual sensation
67
Thermoreceptor function
Temperature sensation
68
Corticospinal tract: Primary functions
Voluntary fine motor control to limbs Coordination of posture
69
Corticospinal tract alternate name
Pyramidal tract
70
Corticospinal tract: Path of motor neurons
Precentral gyrus of frontal lobe > through internal capsule > inferiorly through the pyramids of the medulla
71
Corticospinal tract: Where do upper motor neurons synapse with lower motor neurons
Ventral horn of spinal cord
72
Corticospinal tract: Origin of upper motor neurons cell bodies
Cerebral cortex
73
Corticospinal tract: Upper motor neuron injury consequence
Contralateral spastic paralysis Hyperreflexia
74
Corticospinal tract: Examples of upper motor neuron injury
Cerebral palsy Amyotrophic lateral sclerosis
75
Corticospinal tract: Test of tract integrity
Babinski test
76
Corticospinal tract: Where do lower motor neurons originate and end
Ventral horn> neuromuscular junction
77
Corticospinal tract: Lower motor neurons function
Relay messages from the spinal cord to the muscles
78
Corticospinal tract: Lower motor neuron injury consequence
Ipsilateral flaccid paralysis Impaired reflexes
79
When is babinski sign present/ absent?
Present in upper motor neuron injury Absent in normal function and lower motor neuron injury
80
Corticospinal tract: Tract responsible for limb innervation
Lateral corticospinal tract
81
Corticospinal tract: Tract responsible for axial muscle innervation
Ventral corticospinal tract
82
Corticospinal tract: Where do most fibers of the ventral corticospinal tract cross to the contralateral side of the spinal cord?
When they reach the cervical or thoracic area
83
Corticospinal tract: Where do most fibers of the lateral corticospinal tract cross decussate?
In the medulla
84
SSEPs monitor the integrity of ______
Dorsal column (medial lemniscus)
85
The posterior arteries perfuse what region of the spinal cord?
Dorsal column (medial lemniscus)
86
MEPs monitor the integrity of the ______
Corticospinal tract
87
The anterior spinal artery perfuses the ____
Corticospinal tract
88
Triad of neurogenic shock
Hypotension Bradycardia Hypothermia
89
Length of time neurogenic shock can last
1-3 weeks
90
How does neurogenic shock present differently than hypovolemic shock?
Neurogenic- bradycardia and hypothermia with warm pink extremities present Hypovolemic- tachycardia and cool, clammy extremities present
91
Treatment of hypotension in neurogenic shock
Norepinephrine Volume expansion- monitor closely d/t risk of pulmonary edema when sympathetic tone is restored
92
Succinylcholine in spinal cord injury
Fasciculations may worsen outcomes Avoid after 24 hours d/t extrajunctional upregulation
93
Major causes of morbidity and mortality in patients with cervical and upper thoracic lesions
Ineffective alveolar ventilation Inability to clear pulmonary secretions
94
Patholophysiology of autonomic hyperreflexia
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
Vertebral level at which autonomic hyperreflexia will almost certainly occur
Above T6
96
Autonomic hyperreflexia is not likely below what vertebral level?
T10
97
Relationship between injury level and autonomic hyperreflexia
The higher the level, the more intense the response
98
Common evens that cause autonomic hyperreflexia
Stimulaiton o fthe hollow organs Bladder catheterization Surgery (especially cystoscopy or colonoscopy) Bowel movement Cutaneous stimulation Childbirth
99
Presentation of autonomic hyperreflexia
Hypertension Bradycardia
100
Signs of malignant hypertension d/t autonomic hyperreflexia
Stroke Seizure LVF Dysrhythmias Pulmonary edema Myocardial infarction
101
Best anesthetic approach for patients with a non-acute SCI
General anesthesia Spinal anesthesia
102
Best treatment of hypertension for the patient with autonomic hyperreflexia
Removal of stimulus Deepen anesthetic Rapid-acting vasodilator (sodium nitroprusside)
103
Bradycardia tx or the patient with autonomic hyperreflexia
Atropine Glycopyrrolate
104
Progressive degeneration of motor neurons in the corticospinal tract
ALS
105
ALS progression
Begins in hands, weakness spreads to the rest of the body affecting the tongue, pharynx, larynx, and chest Ocular muscles not affected
106
Only drug that reduces mortality in ALS
Riluzole (NDMA receptor antagonist)
107
Most common cause of death in ALS
Respiratory failure
108
Anesthetic considerations for ALS
Succinylcholine can cause lethal hyperkalemia Increased sensitivity to nondepolarizers VC and maximal MV are reduced Consider postoperative mechanical ventilation
109
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Spinal Cord (1 decks)

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