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Neurology > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

How many spinal nerves are there?

A
  • 31 spinal nerves total
  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 1 coccygeal
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2
Q

Where do nerves C1-C7 exit?

A

Above the corresponding vertebra

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3
Q

Where do all other spinal nerves exit?

A

Below corresponding vertebra

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4
Q

What is Vertebral disc herniation?

A

Nucleus pulposus herniates through anulus fibrosus

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5
Q

Where does disc herniation usually occur?

A

Posterolaterally at L4-L5 or L5-S1

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6
Q

Where does the spinal cord extend to?

A

Lower border of L1-L2 vertebrae

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7
Q

Where does the Subarachnoid space extend to?

A

Lower border of S2 vertebra

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8
Q

Where is a lumbar puncture usually performed?

A

B/w L3-L4 or L4-L5

(level of cauda equina)

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9
Q

What is the goal of a lumbar puncture?

A

Obtain a sample of CSF w/o damaging the SC

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10
Q

What do the Dorsal columns control?

A

Pressure, vibration, touch & proprioception

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11
Q

What are the 2 dorsal columns?

A

Fasciculus cuneatus (UE)

Fasciculus gracilis (LE)

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12
Q

What are the 3 spinal arteries?

A

2 Posterior & 1 Anterior

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13
Q

What do the Lateral spinothalamic tracts control?

A

Pain & temperature sense

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14
Q

What are the Intermediate horn sympathetics?

A

T1-L2/L3

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15
Q

What do the Anterior spinothalamic tracts control?

A

Crude touch & pressure sense

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16
Q

What do the Lateral corticospinal tracts control?

A

Voluntary motor

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17
Q

What is the tract of the Dorsal column?

A

Medial leminiscal pathway

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18
Q

What is the 1st order neuron of the Dorsal column?

A

Sensory nerve ending→ cell body in dorsal root ganglion→ enters SC, ascending ipsilaterally in dorsal column

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19
Q

What is synapse 1 for Dorsal columns?

A

Ipsilateral nucleus cuneatus or gracilis (medulla)

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20
Q

What is the 2nd order neuron of the Dorsal column?

A

Decussates in medulla→ ascends contrallaterally in medial lemniscus

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21
Q

What is synapse 2 for Dorsal columns?

A

VPL (thalamus)

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22
Q

What is the 3rd order neuron for Dorsal columns?

A

Sensory cortex

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23
Q

What is the 1st order neuron of the Spinothalamic tract?

A

Snesory nerve ending (A delta & C fibers) (cell body in dorsal root ganlion)→ enters SC

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24
Q

What is the synapse 1 of the Spinothalamic tract?

A

Ipsilateral gray matter (SC)

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25
Q

What is the 2nd order neuron of the Spinothalamic tract?

A

Decussates at anterior white commissure→ ascends contralaterally

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26
Q

What is the synapse 2 for the Spinothalamic tract?

A

VPL (thalamus)

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27
Q

What is the 3rd order neuron for the Spinothalamic tract?

A

Sensory cortex

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28
Q

What is the 1st order neuron of the Lateral corticospinal tract?

A

UMN: cell body in 1° motor cortex→ descends ipsilaterally (through internal capsule) until decussating at cuadal medullar (pyrimdal decussation)→ descends contralaterally

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29
Q

What is the synapse 1 for the Lateral corticospinal tract?

A

Cell body of anterior horn (SC)

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30
Q

What is the 2nd order neuron for the Lateral corticospinal tract?

A

LMN: leaves SC

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31
Q

What is the synapse 2 for the lateral corticospinal tract?

A

NMJ

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32
Q

What happens in a Lower motor neuron lesion?

A
  • Everything lowered
  • Less muscle mass
  • Dec muscle tone
  • Dec reflexes
  • Downgoing toes
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33
Q

What happens in an Upper motor neuron lesion?

A

Everything up (tone, DTR, toes)

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34
Q

What is Fasiculation?

A

Muscle twitching

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35
Q

When is a + Babinski sign considered normal?

A

In infants

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36
Q

What are the signs in an UMN lesion?

A
  • Weakness
  • Inc reflexes
  • Inc tone
  • Babinski
  • Spastic paralysis
  • Clasp knife spasticity
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37
Q

What are the signs in an LMN lesion?

A
  • Weakness
  • Atrophy
  • Fasiculations
  • Dec reflexes
  • Dec Tone
  • Flaccid paralysis
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38
Q

What are the characteristics of Poliomyelitis & Werding-Hoffman dz?

A
  • LMN lesions only
  • Due to destruction of anterior horns
  • Flaccid paralysis
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39
Q

What are the characteristics of Multiple sclerosis?

A
  • Scanning speech
  • Intention tremor
  • Nystagmus
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40
Q

What region of the SC does Mutliple sclerosis effect?

A
  • Mostly white matter of cervical region
  • Random & asymmetric lesions
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41
Q

What are the characteristics of Amyotrophic lateral sclerosis (ALS)?

A

Combined UMN & LMN deficits w/ no sensory, cognitiev or oculomotor deficits

42
Q

What can cause ALS?

A

Defect in superoxide dismutase 1

43
Q

How does ALS present?

A

Fasiculations w/ eventual atrophy

progressive & fatal

44
Q

What is the tx for ALS?

A

Riluzole tx modestly inc survival by dec presynaptic glutamate release

45
Q

What is ALS also know as?

A

Lou Gehring’s dz

46
Q

What are the characteristics of Complete occlusion of anterior spinal artery?

A
  • Spares dorsal columns & Lissauer’s tract
  • Upper throracic ASA territory is a whatershed area, as artery of Adamkiewiez supplies ASA below ~T8
47
Q

What causes Tabes dorsalis?

A

3° syphilis

48
Q

What does Tabes dorsalis result from?

A

Demyelination of dorsal columns & roots→ impaired sensation & proprioception & progressive sensory ataxia (inability to sense or feel legs)

49
Q

What is Tabes dorsalis assoc w/?

A
  • Charcot’s joints
  • Shooting pain
  • Argyll Robertson pupils
50
Q

What are Argyll Robertsons pupils?

A

Small bilateral pupils that further constrict to accommodation but not to light

51
Q

What will Tabes dorsalis demonstrate on PE?

A

Absence of DTR’s & + Romberg

52
Q

What are the characteristics of Syringomyelia?

A

Syrinx expands & damages anterior white commissure of spinothalamic tract (2nd order neurons)→ bilateral loss of pain & temp sensation (us. C8-T1)

Can expand & affect other tracts

53
Q

What can Syringomyelia be seen w/?

A

Chiari I malformations

54
Q

What are the characteristics of Vit B12 or Vit E def?

A

Subacute combined degeneration–demyelinations of dorsal columns, lateral corticospinal tracts & spinocerebellar tracts; ataxic gait, paresthesia, impaired position & vibration sense

55
Q

What causes Poliomyelitis?

A

Poliovirus

56
Q

How does poliovirus infect the body?

A

Fecal-oral transmission

57
Q

Where does poliovirus replicate?

A

Oropharynx & SI before spreading via the BS to the CNS

58
Q

What does poliovirus infection cause?

A

Destruction of cells in anterior horn of SC (LMN death)

Poliomyelitis

59
Q

What are the LMN lesions signs in Poliomyelitis?

A
  • Weakness
  • Hypotonia
  • Flaccid paralysis
  • Atrophy
  • Fasciculations
  • Hyporeflexia
  • Muscle atrophy
60
Q

What are the signs of infection in Poliomyelitis?

A
  • Malaise
  • Headache
  • Fever
  • Nausea
61
Q

What are the findings in Poliomyelitis?

A

CSF w/ inc WBCs w/ slight elevation of protein (w/ no change in CSF glucose)

62
Q

Where can the poliovirus be recovered?

A

Stool or throat

63
Q

What is Werding-Hoffman dz?

A

Cogenital degeneration of anterior horns of SC→ LMN lesion. “Floppy baby” w/ marked hypotonia & tongue fasciculations

64
Q

What is the infantile type of Werdnig-Hoffman dz?

A

Median age of death of 7 months

AR inheritance

65
Q

What causes Friedreich’s ataxia?

A

AR trinucelotide repeat disorder (GAA) in gene that encodes frataxin. Leads to impairment in mito functioning

66
Q

What are the characteristics of Friedreich’s ataxia?

A
  • Staggering gait
  • Frequent falling
  • Nystagmus
  • Dysarthria
  • Pes Cavus
  • Hammer toes
67
Q

How does Friedreich’s ataxia present?

A

In childhood w/ kyphoscoliosis

68
Q

What is the COD in Friedreich’s ataxia?

A

Hypertrophic cardiomyopathy

69
Q

What is Brown-Séquard synd?

A

Hemisection of SC

70
Q

What are the findings in Brown-Séquard synd?

A
  • Ipsi UMN signs BELOW level of lesion
  • Ipsi loss of tactile, vibration, proprioception sense BELOW
  • Contra pain & temp loss BELOW
  • Ipsi loss of all sensation AT level of lesion
  • Ipsi LMN signs AT level
71
Q

What happens if the lesion in Brown-Séquard is above T1?

A

Pt may present w/ Horner’s synd d/t damage of sympathetic ganglion

72
Q

What is Horner’s syndrome?

A

Sympathetctomy of face: Ptosis, Anhidrosis (& flushing of affected side of face) & miosis

73
Q

What is Ptosis?

A

Slight drooping of eyelid: superior tarsal muscle

74
Q

What is Anhidrosis?

A

Absence of sweating

75
Q

What is rubor?

A

Flushing

76
Q

What is Horner’s synd assoc w/?

A

Lesion of SC above T1

(Pancoast tumor, Brown-Séquard synd, late-stage syringomyelia)

77
Q

Where does the 3 neuron oculosympathetic pathway project?

A

Hypothalamus→ intermediolateral column of the SC→ superior cervical ganglion→ pupil, sm of the eyelids & sweat glands of the foreheard & face

78
Q

What is the landmark of the C2 dermatome?

A

Posterior half of a skull “cap”

79
Q

What is the landmark of the C3 dermatome?

A

High turtleneck shirt

80
Q

What is the landmark of the C4 dermatome?

A

Low-collar shirt

81
Q

What is the landmark of the T4 dermatome?

A

At the nipple

82
Q

What is the landmark of the T10 dermatome?

A

At the umbilicus (important for early appendicitis pain referral)

83
Q

What is the landmark of the L1 dermatome?

A

At the inguinal ligament

84
Q

What is the landmark of the L4 dermatome?

A

Includes the kneecaps

85
Q

What are the landmarks of the S2, S3, S4 dermatomes?

A

Erection & sensation of penile & anal zones

86
Q

What is the clinical reflex of the Biceps?

A

C5 nerve root

87
Q

What is the clinical reflex of the Triceps?

A

C7

88
Q

What is the clinical reflex of the Patella?

A

L4 nerve root

89
Q

What is the clinical reflex of the Achilles?

A

S1 nerve root

90
Q

What is the clinical reflex of the Babinski?

A
  • Dorsiflexion of the big toe & fannin of other toes
  • Sign of UMN lesion
  • Normal reflex in 1st year of life
91
Q

What are Primitive reflexes?

A

CNS reflexes that are present in a healthy infant, but are absent in a neurologically intact adult

92
Q

When do primitive reflexes disappear?

A

1st year of life

93
Q

What are primitive reflexes inhibited by?

A

Mature/developing frontal lobe

94
Q

When will primitive reemerge in adults?

A

Following frontal lobe lesions→ loss of inhibition of these reflexes

95
Q

What is the Moro reflex?

A

“Hang on for life” reflex

Abduct/extend limbs when startld & then draw together

96
Q

What is the Rooting reflex?

A

Movement of head toward one side if cheek or mouth is stroked (nipple seeking)

97
Q

What is the Sucking reflex?

A

Sucking response when roof of mouth is touched

98
Q

What is the Palmar reflex?

A

Curling of fingers if palm is stroked

99
Q

What is the plantar reflex?

A

Dorsiflexion of large toe & fanning of other toes w/ plantar stim (Babinski sign)

100
Q

What is the Galant reflex?

A

Stroking along one side of the spine while newborn is in vental supension (face down) causes lateral flexion of lower body toward stim side

Neurology (9 decks)

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