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Neuro Block 5 > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

Where are motor and sensory primarily found in brain

A

Cerebrum (longitudinal)

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2
Q

What is at the C8 level

A

NO C8 vertebra

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3
Q

Where does the sacral cord end

A

L2

Conus medularis

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4
Q

What is the cauda equina formed by

A

Descending roots

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5
Q

What does the dural sleeve cover?

A

Spinal cord, roots and DRG

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6
Q

This spans from dura to pia/cord and help to stabilize the spinal cord in the horizontal plane. Arachnoid trabecula have similar effect

A

Denticulate ligament

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7
Q

Where is the CSF in the spinal cord?

A

Subarachnoid space

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8
Q

What is the only thing present from L3 and caudally

A

Cauda equina

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9
Q

Space between the dura and the bone

A

Epidural space

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10
Q

Space between the arachnoid and pia

A

Subarachnoid space

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11
Q

What’s the difference between the roots and the horns?

A

The roots are the beginnings of the spinal cords, and horns are the projections of gray matter within the spinal cord

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12
Q

What cell or cell parts are present in the gray matter

A
  • neuronal cell bodies
  • glia (mostly astrocytes, microglia)
  • dorsal/posterior horn
  • ventral/anterior horn
  • intermediate gray zone
  • some myelinated and unmyelinated axons
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13
Q

What cells or cell parts are present in the white matter

A
  • glia (astrocytes, microglia, and oligodendrocytes)
  • axons
  • highly myelinated
  • no neuronal cell bodies
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14
Q

What are the parts of hte fluid filled neural tube

A
  • central canal
  • gray matter
  • white matter
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15
Q

Where is glia found

A

In both gray and white

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16
Q

Where are neurons found

A

Only in grey

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17
Q

Why is there a lot more gray matter on levels of the spinal cord close to extremities?

A

Because of the different plexuses
C5-T1
L1-L4

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18
Q

What lamina/nuclei are in the dorsal horn of gray matter?

A
  • substantia glatinosa (lamina II) pain/temp
  • nucleus proprius of posterior horn (III, IV, V) crude touch
  • nucleus dorsalis
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19
Q

What lamina/nuclei are in the intermediate gray?

A

Intermediolateral cell column; sympathetic preganglionic neurons (VII)

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20
Q

What lamina/nuclei are in the ventral gray horn

A
  • VII, IX motorneurons

- of limbs and lumbar enlargements

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21
Q

Nuclei names and lamina # where pain/temp fibers terminate and synapse

A

Lamina II
Substantial gelatinosa

Part of anterolateral system

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22
Q

Nuclei names and lamina number where crude pain touch fibers terminate and synapse

A

Lamina III, IV, V

  • Nucleus proprius of posterior horn
  • nucleus dorsalis

Part of anterolateral systme

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23
Q

Where are preganglionic sympathetic and parasympathetic fibers located

A

Lamina VII

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24
Q

Where is the central canal?

A

Right down the central longitudinally through spinal cord

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25
Q

Where is the posterior funiculus and what kind of matter

A
  • white matter

- located from the posterior median sulcus to the posterolateral sulcus

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26
Q

Where is the lateral funiculus located and what kind of matter is it

A
  • white

- located from the posteriolateral sulcus/tract to about the line of the denticulate ligament

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27
Q

Where is the anterior funiculus and what kind of matter is it

A
  • white

- located from the anterior median fissure to about the denticulate ligament

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28
Q

What divides the posterior funiculus up?

A

Posterior median sulcus/septum and the posterior intermediate sulcus

29
Q

What is the fasiclus gracilis?

A

It s a subdivision of the posterior fasiculus that is most medial
Bordered by the posterior median sulcus/septum and the posterior intermediate sulcus/septum

30
Q

What is the fasiculus cuneatus

A

Division of the postieor funiculus that is more lateral

Bordered by the posterior intermediate sulcus/septum and the posterolateral tract/sulcus

31
Q

What is the anterior white commissure?

A

Bundle of nerve fibers which cross midline of the spinal cord just anterior to the gray commissure

32
Q

What cord level mediates the patellar tendon reflex?

A

L4

33
Q

What level of spinal cord is the biceps reflex located

A

C5

34
Q

What level of spinal cord is the brachioradialis reflex located

A

C6

35
Q

What level of spinal cord is the triceps reflex located

A

C7

36
Q

What level of the spinal cord is the ankle jerk reflex located

A

S1

37
Q

How would the patellar reflex be affected if there was only damage to the dorsal horn?

A

Descending projections to motoneurons regulate the stretch reflex and myotatic reflex usually inhibitory. Disruption of this inhibitory input leads to exaggerated reflexes

38
Q

What is clonus

A

Hyperactive extensions.felxions

39
Q

How are stretch reflexes tested?

A

Circuit function on side of tendon tap

  • mimics knee flexion
  • sensory arc of reflex activated (DRG)
  • sensory input activates motoneurons for knee extension
  • knee extends
  • sensory arc also inhibits knee flexion

Can also be activated by passive stretch by examiner, whihc activates the muscle spindle

40
Q

Stretch reflex rating

A

2/4 is considered normal

4/4:clonus 
3/4: increased, brisk
2/4: normal
1/4: reduced
0/4: absent
41
Q

What is damaged if clonus happens?

A

Ventral horn

42
Q

Explain how sensory fibers enter the spinal cord and what the dermatome means

A

To the dorsal horn

Dermatomes are areas on the skin that correlate to the level of the spinal cord where the sensory nerve receives information enter through

43
Q

Loss of sensation in a dermatome

A

A sign of a focal or segmental pathology of the spinal cord, dorsal root, or proximal spinal nerves at the same level corresponding segmental level

44
Q

Explain the function of the nociceptive withdrawal reflex?

A

Ipsilateral withdrawal

  • pain input activates ipsilateral knee flexion and ipsilateral Doris flexion of foot
  • pain input INHIBITS ipsilateral leg extensors

Contralateral anti-gravity
-sensory input activates contralateral motoneurons for anti gravity response: activates hip and knee extension and inhibits knee flexor motoneurons

45
Q

What is the nociceptive withdrawal reflex clinically significant

A

Because reflexes do not require conscious state, the nociceptive reflex can be used to test the arousability and motor system of a patient with an impairment of loss of consciousness

46
Q

Describe how a muscle spindle works and how it can be tested by examiner

A
  • tap mimics knee flexion
  • tap detected as mild muscle stretch by the muscle spindle
  • sensory arc of reflex is activated (DRG)
  • sensory input activates motoneurons for knee extension
  • knee extends
  • sensory arc also inhibits knee flexion

Tested by knee tap or passive stretch

47
Q

What does muscle tone mean and why is it clinically significant?

A

Degree of resistance to passive stretch

  • Provide clues about the neurological basis causing motor weakness or paralysis
  • excitability of muscle itself
  • excitability of lower neurons
  • status of upper neurons that synapse on lower motorneurons
  • status of reflex circuitry: stretch and myotatic reflex circuits
48
Q

Describe different definitions and locations of upper motor neurons and lower motor neurons

A
  • Upper motor neurons are in precentral gyrus and synapse onto lower motorneurons in the anterior horn
  • lower motorneurons actually project onto muscles
49
Q

What aspects of motor function is served by the corticospinal system?

A

Voluntary movement

-control cranial motor nerves, contralateral limbs, and axial bilaterally

50
Q

Describe how strength or power is evaluated

A

Measured on a 1-5 scale, 5 being normal

51
Q

Describe an example of stretch reflex circuit and explain how it works.

A
  • tap mimics knee flexion
  • tap detected as mild muscle stretch by muscle spindle
  • sensory arc involves DRG
  • sensory input activates motorneurons for knee extension
  • knee extends
  • sensory arc also inhibits knee flexion by activating an interneuron whihc inhibits the motor neuron for flexion
52
Q

How is a stretch reflex response evaluated

A

On a scale of 1-4, 2/4 being normal

53
Q

Explain how autonomic nervous system and sacral spinal cord can activate or inhibit urinary voiding (micturition)

A

Sympathetic

  • inhibits detrusor
  • activates external sphincter

Parasympathetic

  • activates detrusor
  • inhibits external sphincter

Long reflex circuit

  • stimulates detrusor
  • inhibits sphincter

Short reflex circuit
-stimulates detrusor

54
Q

What is the origin of blood to the spinal cord outside the vertebral column?

A

Blood is supplied from the basilar artery which gets its supply for the ICA

55
Q

Where are spinal veins found

A

Subarachnoid

56
Q

Where is the internal venous plexus found (meningeal layer)

A

Epidural space

57
Q

What meningeal layer is the external venous plexus found

A

Outside dura

58
Q

How would the patellar reflex be affected if there was damage to the ventral horn only

A

No reflex would occur

59
Q

How would the patellar reflex be affected if there was damage to the dorsal horn only?

A

Impaired reflex

60
Q

Where are all of the upper motorneurons located?

A

Precentral gyrus or brain stem, mostly the precentral gyrus though

61
Q

Where in the spinal cord are lower motorneurons located?

A

Ventral horn of the spinal cord

62
Q

How many times do the axons of upper motorneurons cross the midline?

A

One time at the pyramidal decussation

63
Q

What side of the body doe s the left precentral gyrus control

A

Right

64
Q

Which side of the body does the right precentral gyrus control?

A

Left

65
Q

Describe the clinical rating scale for scoring motor strength (from cases)

A

On a 1-5 scale with 5 being normal, can overcome resistance from examiner

66
Q

Does anterior horn damage produce lower motor neuron signs or upper motorneuron signs?

A

Lower motorneuron signs (segmental deficits)

67
Q

Does damage to the lateral corticospinal tract produce lower motorneuron signs or upper motorneuron signs

A

Upper motor neuron signs (with level down paresis) suprasegmental

68
Q

Does damage to the anterior corticospinal tract produce produce upper motorneuron sign or lower motor neuron sign

A

Lower

69
Q

If both the anterior horn and the lateral corticospinal tracts on one side are damaged, are there lower motorneuron signs or upper motorneuron signs

A

Paresis on opposite side of body

Neuro Block 5 (11 decks)

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