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APEX: Flashcards > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

Blood flow to spinal cord

A

Perfused by:
1 anterior spinal a. (anterior 2/3)
2 posterior spinal a. (posterior 1/3)
6-8 radicular a.

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2
Q

Posterior spinal arteries (2)

A

Perfuses posterior 1/3 of SC (green)

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

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

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3
Q

Anterior spinal artery (1)

A

Perfuses anterior 2/3 SC (blue)

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

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

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4
Q

What is the most important radicular artery?

A

artery of Adamkiewicz

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5
Q

Which spinal segment does the artery of Adamkiewicz typically enter the spinal cord?

A

T11-T12

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6
Q

What area does the artery of Adamkiewicz supply?

A

anterior cord in thoracolumbar region

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7
Q

Great radicular artery

A

Artery of Adamkiewicz

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8
Q

Anterior spinal artery syndrome

A

AKA Beck’s syndrome

aortic cross clamp above artery of Adamkiewicz –> ischemia to lower portion of anterior SC

S/S:
- flaccid paralysis of LE (corticospinal tract)
- bowel & bladder dysfunction (autonomic motor fibers)
- loss of temp & pain (spinothalamic tract)
-preserved touch & proprioception (dorsal column is perfused by posterior)

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9
Q

3 spinal pathways supplied by anterior spinal artery

A
  1. corticospinal
  2. autonomic motor fibers
  3. spinothalamic
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10
Q

List 1 spinal pathway supplied by posterior spinal artery

A

dorsal column

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11
Q

spinal cord anatomy

A
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12
Q

Grey matter

A
  • contains neuronal cell bodies
  • processing center for afferent signals
  • “H” shape
  • subdivided into 10 laminae
    1-6 in dorsal grey matter (sensory)
    7-9 in ventral grey matter (motor)
    10 central canal
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13
Q

White matter

A
  • contains axons of ascending & descending tracts
  • divided into dorsal, lateral, ventral columns
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14
Q

Sensory tracts

A
  1. Dosal column: cutaneous & gracilis
  2. Tract of Lissauer
  3. Lateral spinothalamic tract
  4. Ventral spinothalamic tract
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15
Q

Motor tracts

A
  1. Lateral corticospinal tract
  2. Ventral corticospinal tract
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16
Q

Dosal column: cutaneous & gracilis

A

fine touch & proprioception

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17
Q

Dosal Column - Medial Leminiscal System

A
  • fine touch, proprioception, vibration, pressure
  • 2 point discrimination
  • large, myelinated, rapid-conducting fibers
  • SSEPs monitor integrity
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18
Q

Meissner’s corpuscles

A

2 point discriminative touch
vibration

19
Q

Merkel’s discs

A

continuous touch

20
Q

Ruffini’s endings

A

proprioception
prolonged touch & pressure

21
Q

Pacinian corpuscles

A

vibration

22
Q

Tract of Lissauer

A

pain & temp

23
Q

Anterolateral system- spinothalamic tracts

A
  • lateral & ventral
  • pain, temp, crude touch, tickle, itch, sexual
  • no 2 point discrimination
    -smaller, myelinated & nonmyelinated, slower conducting fibers
    1. A-delta: 1st pain, mechanoreceptors
    2. C fibers: slow pain, polymodal nociceptors
24
Q

Lateral spinothalamic tract

A

pain & temp

25
Q

Ventral spinothalamic tract

A

crude touch & pressure

26
Q

Corticospinal tract (pyramidal tract)

A
  • motor
  • lateral & ventral
  • voluntary fine motor control to limbs & coordination of posture
    -MEPs monitor integrity
27
Q

Upper motor neurons

A
  • cell body: cerebral cortex
  • synapse in ventral horn of SC
  • pass messages from brain to SC
28
Q

Upper motor neuron injury

A
  • contralateral spastic paralysis
  • hyperreflexia
  • positive Babinski

ex: cerebral palsy, ALS

29
Q

Lower motor neuron

A
  • cell bodies: ventral horn of SC
  • synapse in NMJ of muscle
  • send message from SC to muscles
30
Q

lower motor neuron injury

A
  • ipsilateral flaccid paralysis
  • impaired reflexes
  • absent Babinski
31
Q

Lateral corticospinal tract

A

limb motor

32
Q

Ventral corticospinal tract

A

posture motor

33
Q

What bedside exam assesses the integrity of the corticospinal tract?

A

Babinski test

34
Q

Babinksi test

A

Assesses integrity of corticospinal tract

-normal = downward motion of toes
- upper motor neuron injury = upward ext of big toe w/ fanning of other toes
- lower motor neuron injury = no response

35
Q

Acute SCI

A
  • causes: fall, MVC, assault, sports injury
  • C7 injury most common
  • flaccid paralysis & loss of sensation below level of injury
  • loss of bowel, bladder fx
  • spinal reflexes return after acute phase –> spasticity
  • neurogenic shock
36
Q

Neurogenic shock

A
  • sympathectomy below level of injury
  • Triad:
    1. hypotension
    2. bradycardia
    3. hypothermia (impaired hypothalamus)
  • impaired cardioaccelerator fibers (T1-4)
    > unopposed cardiac vagal tone, bradycardia,
    reduced inotropy
  • decreased SNS tone –> vasodilation –>
    venous pooling –> decreased CO, BP
  • impaired cutaneous vasoconstriction –> heat loss
37
Q

How can you differentiate neurogenic shock from hypovolemic shock?

A
  • Neurogenic shock = bradycardia, hypotension, hypothermia w/ pink warm extremities
  • Hypovolemic shock = tachycardia, hypotension, cool clammy extremities
38
Q

Discuss the use of sux in a patient w/ SCI

A

-“safe” within 24 hours

  • Avoid 24 hours after injury & at least 6 months thereafter
39
Q

When is a patient w/ SCI at risk for autonomic hyperreflexia?

A

1-3 weeks after spinal shock phase

40
Q

Autonomic hyperreflexia (AH)

A
  • involuntary reaction to external stimuli in pt w/ SCI
  • increased SNS response below SCI
  • injuries above T6
  • stimulation below SCI –> vasoconstriction BELOW injury & vasodilation ABOVE injury
  • Classic presentation: HTN & bradycardia
41
Q

AH triggers

A
  • bladder, bowel, uterus stimulation
  • catheter
  • surgery esp. cysto or colonoscopy
  • BM
  • cutaneous stimulation
  • childbirth
42
Q

AH MGMT

A
  • stimulation below level of SCI can trigger event
  • GA or spinal
  • Tx HTN:
    ~ remove stimuli
    ~ deepen anesthetic
    ~ rapid-acting vasodilator (Na+ nitroprusside)
  • Tx bradycardia w/ atropine or glyco
  • Sux contraindicated w/ chronic SCI
  • close postop monitoring
43
Q

Amyotrophic Lateral Sclerosis (ALS)

A
  • progressive degenerative of motor neurons in corticospinal tract
  • replaced by astrocytic gliosis
  • S/S
    1. upper motor neurons
      ~ spasticity, hyperreflexia, loss of
      coordination
    2. lower motor neurons
      ~ muscle wknss, fasciculation, atrophy
    3. begins in hands spreads to rest of body
    4. ocular muscles not affected
    5. autonomic dysfunction
      ~ orthostatic hypotension, resting
      tachycardia
    6. sensation intact
  • Riluzole (NMDA ant) reduces mortality
  • Resp failure most common cause of death
44
Q

ALS MGMT

A
  • NO SUX –> lethal hyperkalemia
  • increased sensitivity to NDNMB
  • bulbar muscle dysfx –> aspiration risk
  • chest wknss –> reduced VC
  • consider postop mechanical ventilation

APEX: Flashcards (13 decks)

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