Spinal Cord

Question 1

Spinal cord circulation consists of _____ anterior and ______ posterior arteries

Answer 1

2 posterior
1 anterior

Question 2

Answer 2

Question 3

The anterior spinal artery perfuses:

Answer 3

The anterior 2/3 of the spine

Question 4

The posterior spinal arteries perfuse:

Answer 4

The posterior 1/3 of the spine

Question 5

In the cervical region, spinal arteries are perfused by:

Answer 5

the vertebral arteries

Question 6

In the thoracic and lumbar regions, spinal arteries are perfused by:

Answer 6

Radicular and lumbar arteries

Question 7

What is the Artery of Adamkiewicz?

Answer 7

The greatest radicular artery

Question 8

What is a “watershed” region in the spine?

Answer 8

regions of the spinal cord that only have one blood supply and no collateral, so they’re particularly vulnerable to ischemia

Question 9

Where does the artery of adamkiewicz typically arise?

Answer 9

On the left side between T11 and T12

Question 10

An aortic cross clamp ABOVE the artery of adamkiewicz can cause:

Answer 10

Anterior spinal artery syndrome

Question 11

What is Beck’s syndrome?

Answer 11

Anterior spinal artery syndrome

Question 12

What are the classic signs and symptoms of Beck’s syndrome?

Answer 12

Question 13

The corticospinal tract is perfused by:

Answer 13

anterior blood supply

Question 14

Autonomic nerve fibers are perfused by:

Answer 14

anterior blood supply

Question 15

The spinothalamic tract is perfused by:

Answer 15

Anterior blood supply

Question 16

The dorsal column is perfused by:

Answer 16

posterior blood supply

Question 17

The corticospinal tract is responsible for:

Answer 17

primary motor activity for the somatic system from the neck to the feet

Question 18

The spinothalamic tract is responsible for:

Answer 18

carrying pain and temperature sensation toward the brain

Question 19

The dorsal column is responsible for:

Answer 19

Question 20

Answer 20

Question 21

Sensory neurons exit the spinal cord via _________

Answer 21

the dorsal nerve root

Question 22

Motor AND autonomic neurons exit the spinal cord via ______________

Answer 22

the ventral nerve root

Question 23

Where are laminae located?

Answer 23

In the gray matter of the spinal cord

Question 24

The white matter of the spinal cord contains:

Answer 24

the axons of the ascending and descending tracts

gray matter is for receiving and modulating. White matter is for travelling.

Question 25

What is the role of laminae 1-6? Where are they located?

Answer 25

Question 26

What is the role of laminae 7-10? Where are they located?

Answer 26

Question 27

How can you figure out the purpose of a tract based on its name?

Answer 27

The first half of the name indicates where the tract begins The second half indicates where the tract terminates

Question 28

Answer 28

Question 29

Answer 29

Question 30

How does damage to upper motor neurons manifest?

Answer 30

Question 31

The babinski test assess integrity of which tract?

Answer 31

corticospinal

Question 32

Is a positive babinski sign present with upper or lower motor neuron injuries?

Answer 32

Upper, not lower

Question 33

Lower motor neuron injury results in:

Answer 33

Impaired reflexes and flaccid paralysis

Question 34

SSEPs monitor which tract?

Answer 34

Dorsal column, posterior spinal artery

Question 35

MEPs monitor which tract?

Answer 35

ventral corticospinal, anterior spinal artery

Question 36

What is another name for the corticospinal tract?

Answer 36

pyramidal tract

Question 37

What is a positive babinski sign?

Answer 37

upward extension of the big toe with fanning of the other toes

Question 38

Where do upper motor neurons begin and end?

Answer 38

They begin in the cortex and end in the ventral horn of the spinal cord

Question 39

Where do lower motor neurons begin and end?

Answer 39

They begin in the ventral horn of the spinal cord and terminate at the neuromuscular junction

Question 40

What is the most common site of spinal cord injury?

Answer 40

C7

Question 41

What are the symptoms of neurogenic shock?

Answer 41

Bradycardia, hypotension, hypothermia with warm extremities

Question 42

Are spinal reflexes present with a full spinal cord injury?

Answer 42

Initially, no. They will have flaccidity. But later these reflexes will return, leading to spasticity

Question 43

Why does spinal shock involve bradycardia?

Answer 43

Knocking out the cardioaccelerators leads to unopposed vagal tone

Question 44

Can you use Succinylcholine in a patient with a spinal cord injury?

Answer 44

Technically you can for the first 24 hours, but forcing fasciculations may worsen outcomes. Best to not.

Question 45

When are patients at risk for autonomic hyperreflexia?

Answer 45

Once spinal shock ends (about 1-3 weeks out) BECAUSE spinal sympathetic reflexes return BELOW the level of injury

Question 46

Which patients develop autonomic hyperreflexia?

Answer 46

86% of patients with a lesion above t6 will develop it

Question 47

Which situations have the highest risk for triggering autonomic hyperreflexia?

Answer 47

Bladder Cath Cysto, Colonoscopy bowel movement childbirth

Question 48

How is autonomic hyperreflexia treated?

Answer 48

Removing the stimulus Deepening the anesthetic Administering a rapid-acting vasdilator

Question 49

How is bradycardia from autonomic hyperreflexia best treated?

Answer 49

With an anticholinergic

Question 50

If a woman with a spinal cord injury is laboring without pain, do they still need analgesia?

Answer 50

YES!! Stimulation can still trigger hyperreflexia. Spinal is better than epidural, which doesn't as reliably anesthetize the roots

Question 51

What is ALS?

Answer 51

progressive degeneration of motor neurons in the corticospinal tract, leaving sensation intact

Question 52

What is another name for the dorsal column?

Answer 52

Medial lemniscal tract