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Spinal Cord Flashcards

1
Q

What is myelopathy?

A

• Myelopathy: Disorder resulting in spinal cord dysfunction.

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2
Q

What is a nerve root?

A

o Nerve Root: Combined sensory and motor rami of the spinal cord (e.g. L5)

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3
Q

What is a tract?

A

o Tracts: Axons that travel in the spinal cord to relay information. (e.g. corticospinal tract).

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4
Q

What is a hyperesthesia?

A

Hyperesthesia: Abnormal acuteness of sensitivity to touch, pain, or other sensory stimuli

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5
Q

What is a dysesthesia?

A

o Dysesthesia: Impairment of sensation short of anesthesia

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6
Q

What is a parasthesia?

A

o Paresthesia: An abnormal sensation, can include burning, pricking, tickling, or tingling. Sometimes characterized as “pins and needles”

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7
Q

What is an intervertebral foramen?

A

o Intervertebral foramen: Opening formed by 2 adjacent vertebral bodies through which the nerve roots travel.

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8
Q

What is a radiculopathy?

A

o Radiculopathy: Sensory and/or motor dysfunction due to injury to a nerve root.

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9
Q

What is a myotome?

A

o Myotome: Muscles innervated by an individual motor root.

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10
Q

What is a dermatome?

A

o Dermatome: Cutaneous area served by an individual sensory root.

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11
Q

How many pairs of nerve roots are there coming from what spinal levels?

A

31 pairs of nerve roots (8 Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral, 1 Coccygeal).

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12
Q

There are 7 cervical vertebrae, but how many cervical nerves?

A

8 cervical nerves, to 7 cervical vertebrae.

  • for all cervical levels, the X cervical spinal nerve exits ABOVE the vertebral body.
  • for thoracic nerves and below, the X spinal nerve exits BELOW the vertebral body
  • the only trick then to remember is C7 has the 7th spinal nerve above it and the 8th spinal nerve below it (C8)
  • C8 = spinal nerve C8, never the vertebral body C8
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13
Q

What’s the general rule of thumb to use when keeping track of vertebral body level injuries correlating to spinal cord level injuries?

A

• Upper cervical
○ Vertebra # overlies same cord segment #
• Lower cervical
○ Vertebra # overlies cord segment +1 (C6 is over C7)
• Upper thoracic
○ Vertebra # overlies cord segment +2 (T4 is over T6)
• Lower thoracic/lumbar
○ Vertebra # overlies cord segment +2-3 (range)
§ T11 overlies L1-2 cord
§ The vertebral bodies are bigger at that point than the spinal cord segments
• Lower edge of the L1 vertebral body overlies the cord tip (conus medullaris)
○ Thus the lumbar puncture)

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14
Q

What spinal cord levels make up the conus medullaris?

A
  • S3-S5
    • Tip of the cord
    • Supplies bladder, rectum, genitalia
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15
Q

What does the conus medullaris innervate?

A
  • S3-S5
    • Tip of the cord
    • Supplies bladder, rectum, genitalia
    • Remember these exit the cord way lower, but the spinal cord levels are higher up, within the 4th and 5th lumbar vertebral area
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16
Q

What spinal cord levels make up the cauda equina?

A

• LS roots within the lumbosacral cistern

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17
Q

Because of the organization of the spinal cord tracts, what will an extramedullary tumor present as?

A
  • Early UMN problems
    • Early pain
    • Pain and temp loss in an ascending fashion
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18
Q

Because of the organization of the spinal cord tracts, what will an INTRAmedullary tumor present as?

A
  • Early bladder dysfunction
    • Late development of pain
    • Even later development of UMN syndrome
    • Temperature and pain loss is a descending pattern (cervical first, then down)
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19
Q

The spinothalamic tract is organized how?

A

• With bundles moving from medial to lateral
○ Whole thing is anterolateral tract, pain and temperature from the contralateral side
• Cervical (medial), then thoracic, lumbar and sacral moving lateral
• Thus intrameddullary lesion has pain and temp loss in a descending pattern

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20
Q

What spinal cord structure is organized (from medial to lateral) in an ascending manner?

A
  • The Dorsal column/lemniscal system
    • Fasciculus gracilis (fine touch, vibration, proprioception) is medial and the fasciculus cuneatus is more lateral
    • Thus an intramedullary lesion in the dorsal spinal cord will produce fine touch loss in an ascending pattern
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21
Q

The lateral corticospinal tract is organized how?

A
  • These are upper motor neurons on the lateral side of the grey matter
    • Organized with cervical levels most medial and progressing lateral to sacral UMNs
    • Thus an intrameddullary lesion would cause UMN syndrome in a descending manner
    • Extramedullary lesion would cause UMN syndrome in an ascending manner
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22
Q

Following the normal dermatome map is great, but you must remember one detail…?

A

• Variations are common, and a persons variation is +/- one full dermatome

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23
Q

What are the major dermatomal landmarks?

A
  • Top of head = C2
    • Side of face = C3
    • Neck = C3/4
    • Nipples - mark T4 and T5 border
    • Umbilicus - mark T10 and 11 border
    • Back of shoulder and lateral arm = C5
    • Thumb and 2nd digit = C6
    • Third digit (middle finger) = C7
    • Last two fingers = C8
    • Medial arm (medial bicep region) = T1/2
    • Knee region (medial) - L3/4
    • Shins - L4/5
    • Great toe and dorsal foot - L5
    • Lateral foot, small toe, bottom foot - S1
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24
Q

The observational part of the neuro exam is looking for what?

A
  • Atrophy,
    • Hypertrophy
    • Fasciculations
    • Tremor
    • Involuntary movements
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25
Q

In passive movement, you may find spasticity in a certain muscle group. What does this look like?

A
  • Velocity dependent increase in muscle tone

* You are moving the limb and it all of a sudden starts resisting (sometimes jerkily)

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26
Q

What are the upper extremity muscle testing maneuvers?

A
  • Shoulder abduction
    • Elbow flexion and extension
    • Wrist flexion and extension
    • Finger abduction
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27
Q

What are the LOWER extremity muscle testing maneuvers?

A
  • Hip flexion
    • Knee flexion and extension
    • Leg abduction
    • Foot dorsiflexion and plantar flexion
    • Great toe dorsiflexion
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28
Q

In muscle testing (neuro exam) you assign a grade for muscle strength out of 5. What is the scale?

A
  • 0 - paralysis
    • 1 - muscle flicker, no movement
    • 2 - movement is possible, but struggles aganst gravity
    • 3 - movement possible against gravity, not resistance
    • 4 - movement is possible against some resistance
    • 5 - normal strength
29
Q

What is the reflex grading system?

A
  • 0 - reflex is absent
    • 1+ - trace
    • 2+ - normal
    • 3+ - brisk
    • 4+ - nonsustained clonus (repetitive vibratory movements)
    • 5+ - sustained clonus
30
Q

How do you elicit the plantar response?

A

• Flexor, extensor or ambivalent
○ Extensor = babinski sign
• Scraping an object across the sole of the foof from the heel toward the small toe
• Then arcing toward big toe
• Normal response = flexion of toes
• Abnormal response = extension big toe and fanning of the others
○ Babinski sign (indicates UMN problem)
• Hoffman sign - abnormal response in upper extremity

31
Q

What syndrome is indicated in a scissoring of both legs upon tapping the medial aspect of the adductor tendons?

A
  • UMN syndromes

* Crossed adductor response

32
Q

The reflexes you have to know completely are…?

A 
• Biceps
		○ C5 root
		○ 10% of UE radiculopathies
	• Bracioradialis
		○ C6 root
		○ 20% of UE radiculopathies
	• Triceps
		○ C7 root
		○ 50% of UE rediculopathies
	• Patellar
		○ L4 root
		○ 10% of LE rediculopathies
	• Achilles
		○ S1 root
		○ L5-S1 level
		○ 45% of LE rediculopathies
	• (not a reflex, but an motor group)
		○ Foot dorsiflexion, big toe extension, foot eversion and inversion
		○ L5 root
		○ 40% of LE rediculopathies
	• Babinski sign
		○ Extension of big toe and fanning of other toes when scraping bottom of foot
		○ Indicative of UMN syndromes
33
Q

When worried about the C5 root what motor functions do you examine?

A

• Deltoid
• Infraspinatus
• Biceps
○ Biceps reflex

34
Q

When worried about the C6 root what motor functions do you examine?

A

• Wrist extension
• Biceps
○ Biceps and brachioradialis reflexes

35
Q

When worried about the C7 root what motor functions do you examine?

A

• Triceps

○ Triceps reflex as well

36
Q

When worried about the S1 root what motor functions do you examine?

A

• Foot plantarflexion

○ Achilles reflex

37
Q

When worried about the L5 root what motor functions do you examine?

A 
• Foot dorsiflexion
	• Big toe extension
	• Foot eversion
	• Foot inversion
		○ No reflex to examine
38
Q

When worried about the L4 root what motor functions do you examine?

A

• Psoas
• Quads
○ Patellar reflex

39
Q

What disc is usually involved in a C5 root problem?

A

• C4-5 disc

40
Q

What disc is usually involved in a S1 root problem?

A

• L5-S1

41
Q

What disc is usually involved in a L5 root problem?

A

• L4-5

42
Q

What disc is usually involved in a L4 root problem?

A

• L3-4

43
Q

What disc is usually involved in a C7 root problem?

A

• C6-7

44
Q

What disc is usually involved in a C6 root problem?

A

• C5-6

45
Q

If you find a sensory abnormality in:Shoulder, upper lateral arm

A

• Look for damage to C5

46
Q

If you find a sensory abnormality in:Lateral foot, small toe and sole of foot

A

• Look for damage to S1

47
Q

If you find a sensory abnormality in:Dorsum of foot and great toe

A

• Look for damage to L5

48
Q

If you find a sensory abnormality in:Knee, medial leg

A

• Look for damage to L4

49
Q

If you find a sensory abnormality in:3rd digit

A

• Look for damage to C7

50
Q

If you find a sensory abnormality in:1st and 2nd digits of hand

A

• Look for damage to C6

51
Q

In a complete cord transsection, what are the tracts affected and what is the expected deficit?

A
  • All ascending sensory tracts
    • All descending motor tracts
    • Sensory + motor levels below lesion are lost
    • Spinal shock followed by UMN syndrome
52
Q

In a central lesion what tracts are effected and what’s the expected deficit?

A

• Tracts
○ Initially involve crossing Spinothalamic tract
§ Pain and temp
• Deficit
○ PP/Temp loss at level of lesion with sparing of proprioception
• Note
○ Cape-like distribution if in C-spine
• Possible cause
○ Syringomyeli (fluid filled cavity in cord)

53
Q

In a posterior column syndrome what tracts are affected and what’s the expected deficit?

A 
• Tracts
		○Posterior column/Medial Lemniscus
			Fine touch and prop
	• Deficit
		○ bilateral loss of position and vibration sensation
	• Note
		○ temp and pain are in place
	• Possible cause
		○ tabes dorsalis (form of neurosyphilis)
54
Q

In combined anterior horn cell-pyramidal tract syndrome what are the tracts affected and what is the expected deficit?

A 
• Tracts
		○ CS and LMN cells in the cord
			§ Motor problems
	• Deficit
		○ Loss of bilateral muscle strength
	• Note
		○ Fasciculations, atrophy, either repressed or hyperactive DTR, normal sensation
	• Possible cause
		○ Amyotrophic lateral scleoris = ALS
55
Q

In Brown-sequard syndrome what are the tracts affected and what is the expected deficit?

A 
• Tracts
		○ Crossed ST + uncrossed PC + Crossed CS
			§ Hemi-section of cord
	• Deficit
		○ Below lesion,
			§ loss of CL PP/temp
			§ Loss of IL position
			§ Loss of IL strength
56
Q

In posterior cord syndrome what are the tracts affected and what is the expected deficit?

A

• Tracts
○ PC + CS
• Deficit
○ Bilateral loss of position + vibration + strength
• Possible cause
○ B12 deficiency (subacute combined degen)

57
Q

In anterior horn cell syndrome what are the tracts affected and what is the expected deficit?

A

• Tracts
○ No tracts, just LMN cells
• Deficit
○ Loss of bilateral muscle strength
• Note
○ Fasciculations, decreased tone, depressed DTR’s
○ Spares all sensory tracts and bladder function
• Possible cause
○ Spinal muscular atrophy - polio virus

58
Q

In anterior spinal artery occlusion what are the tracts affected and what is the expected deficit?

A 
• Tracts
		○ ST + CS
			§ Pain/temp, motor
	• Deficit
		○ Loss of bilateral muscle strength + loss of PP/Temp
		○ Sparing of position and fine touch
59
Q

In pyramidal tract syndrome what are the tracts affected and what is the expected deficit?

A 
• Tracts
		○ CS
			§ Motor problems
	• Deficit
		○ Bilateral UMN syndrome
		○ Increased DTRs
		○ Complete sparing of all sensory tracts and bladder function
	• Possible cause
		○ Primary lateral sclerosis
60
Q

In myelopathy with radiculopathy what are the tracts affected and what is the expected deficit?

A 
• Tracts
		○ Any or all tracts, but especially CS
			§ Motor problems in particular
	• Deficit
		○ Bilateral UMN syndrom, spastic gait
		○ Hyperactive DTRS
		○ IL or CL root signs
		○ Possible bladder dysfunciton
	• Possible cause
		○ Cervical spinal stenosis, congenital or degen
61
Q

What is the difference between conus medullaris problems and cauda equina syndrome?

A 
• Conus
		○ Late pain in thighs and butt
		○ Pelvic flor muscle weakness
		○ Symmetric saddle anesthesia
		○ Early bladder dysfucntion
		○ Early bowel and sexual dysfunction
	• Cauda equina
		○ Early root pain radiating to legs
		○ Leg weakness and decreased DTRs (LMN)
		○ Patchy, asymmetric saddle anesthesia
		○ Late bladder dysfunction
		○ Late bowel and sexual dysfunction
62
Q

What are the three main components of bladder continence control?

A 
• Detrusor muscle
		○ Smooth muscle
		○ Activated by preganglionic parasympathetic outflow from S2-4
	• Sphincter
		○ Smooth muscle
		○ Sympathetic outflow from T10-L2
	• Pelvic floor
		○ Skelatal muscle
		○ Innervated by alpha motor neurons from S2-4
63
Q

What happens neurologically as the bladder increases?

A
  • Afferent information from muscle spindles and sensory in bladder wall
    • Activates higher centers in brainstem and cortex
    • Send info down the medial LCST and coordinate inhibition of sympathetic tone and activaiton of parasympathetic contraction of the detrusor
    • Voluntary sphincter prevention of voiding is under control of frontal cortex via descending inputs to alpha motorneurons in anterior horn of S3,4 (descending alont LCST)
64
Q

What is onufs nucleus?

A
  • Involved in voluntary bladder control
    • Voluntary sphincter prevention of voiding is under control of frontal cortex via descending inputs to alpha motorneurons in anterior horn of S3,4 (descending alont LCST)
65
Q

What’s going on in flaccid bladder?

A
  • Overflow incontinence b/c body doesn’t recognize when bladder is full
    • Parasymp LMN are injured
    • Weakness, atrophy, hyporeflexia
66
Q

What’s going on in spastic bladder?

A
  • UMN syndrome of bladder control
    • Descending pathway so bladder control are injured
    • Initial flaccidity of bladder, followed by contractions due to small degrees of stretch
    • Result is urgency and frequency
    • Can also desynch the symp and para coordination, leading to kidney damage by ureteral reflux
67
Q

Presence of Lhermittes sign indicates what?

A

• Neck flexion results in electric shock sensation down back and into arms
○ Lhermitte sign
• Attributed to posterior column disease
○ MS, disc, B12 deficiency, posterior cord mass
What would cervical stenosis result in?
• UMN signs in legs +/- bladder dysfunction

68
Q

Spinal shock is loss of all spinal cord function after an injury. What are the 4 phases?

A

• 1 - complete loss of all reflexes below injury level
○ One day course, hyperpolarization due to lack of normal basal stimuli from brain
• 2 - over next two days
○ Return of some, not all, reflexes below injury
○ Polysynaptic reflexes first (bulbocavernosus)
○ More receptors for NT are expressed in muscles
• 3 and 4 - next couple weeks
○ Hyperreflexia
○ Interneurons and lower moter below injury begin sprouting and re-establishing synapses
○ First to form are shorter axons from interneurons
• 4 - chronic spasticity stage, one month out and possibly forever
○ Soma-dependent

69
Q

What is neurogenic shock?

A

• Don’t confuse with spinal shock
• Low blood pressure and slow heart rate
• Disruption of ANS within spinal cord
• Hypotension results from decreased systemic vascular resistance
○ Loss of sympathetic tone
• Bradycardia from unopposed vagal tone

Neuro (59 decks)

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