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MC - Neurologia, Neurocirurgia e Neurociência > SPINAL CORD > Flashcards

SPINAL CORD Flashcards

1
Q

SPINAL CORD

anatomy

(boundaries + gross anatomy)

A

starts: medulla below the pyramidal decussation
terminates: conus medullaris (L2)

fissures + sulcus

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2
Q

SPINAL CORD

anatomy

(gray and white matter)

A

GRAY MATTER

centrally located

butterfly

cell bodies + dendrites + proximal part of axon

WHITE MATTER

surrounds gray matter

tracts or fasciculli

axons

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3
Q

SPINAL CORD

components of gray matter

A

dorsal horn (sensory)

ventral horn (motor)

intermediate zone (autonomic)

T1 - L2 + S2 - S4

Clarke’s nucleus (T1 - L2)

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4
Q

SPINAL CORD

components of white matter

A

tracts and fasciculli

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5
Q

SPINAL CORD

spinal nerves

(31 roots)

A

8 cervical

12 thoracic

5 lumbar

5 sacral

1 coccygeal

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6
Q

SPINAL CORD

typical root

(spinal nerve)

A

ventral (motor) and dorsal (sensory) roots

dorsal root ganglion (sensory)

ventral and dorsal ramus (mixed)

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7
Q

SPINAL CORD

plexus

A

brachial: C5 - T1

(upper limbs)

lumbarsacral: L2 - S3

(lower limbs)

cervical + lumbar enlargement in spinal cord

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8
Q

SPINAL CORD

cauda equina

A

dorsal + ventral roots of

lumbar

sacral

coccygeal

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9
Q

SPINAL CORD

conus medullaris

A

caudal end of spinal cord

S3 - S5

adults: L2 vertebra

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10
Q

SPINAL CORD

filum terminale

A

slender pial extension

tethers the spinal cord to the bottom of the vertebral column

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11
Q

SPINAL CORD

types of nerve fibers

(Erlanger-Gasser)

A

Group A

heavily myelinated

Group B

moderataly myelinated

Group C

unmyelinated

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12
Q

SPINAL CORD

Group A nerve fiber

A

150 m/s

somatic fibers (sensory + motor)

subdivision

alpha

beta

gamma

delta

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13
Q

SPINAL CORD

Group B nerve fiber

A

15 m/s

sensory and motor autonomic fibers

sensory - general visceral afferent

motor - preganglionic

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14
Q

SPINAL CORD

Group C nerve fiber

A

no more than 2 m/s

sensory + motor fibers

sensory - pain + temp

motor - posganglionic (autonomic)

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15
Q

SPINAL CORD

other classification of fibers

(functional division)

A

motor fiber

(alfa, beta and gamma)

sensory fiber

(Ia, Ib, II, III and IV)

autonomic

(pre and postganglionic)

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16
Q

SPINAL CORD

motor fibers

A

alpha

A-alpha (Erlanger-Gasser)

extrafusal muscle fibers

beta

A-beta (Erlanger-Gasser)

gamma

A-gamma (Erlanger-Gasser)

intrafusal muscle fibers

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17
Q

SPINAL CORD

sensory fibers

A

Ia

A-alpha (Erlanger-Gasser)

muscle spindle (primary or annulospiral ending)

Ib

A-alpha (Erlanger-Gasser)

golgi tendon

II

A-beta (Erlinger-Gasser)

muscle spindle (flower-spray ending) + cutaneous mechanoreceptors

III

A-delta (Erlinger-Gasser)

free nerve ending (touch and pressure)

nociceptor (sharp pain)

cold receptors

IV

C (Erlinger-Gasser)

nociceptors (dull pain)

warmth receptors

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18
Q

SPINAL CORD

autonomic fibers

A

preganglionic fiber

B (Erlanger-Gasser)

posganglionic fiber

C (Erlanger-Gasser)

(pre is faster than post)

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19
Q

GRAY MATTER

rexed laminae

A

dorsal horn

I - VI

intermediate zone

VII

ventral horn

VIII - IX

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20
Q

GRAY MATTER

dorsal horn

(general statements)

A

sensory stimulation

(fibers enter the dorsolateral part of spina, via dorsal root)

+

neurons project to higher levels in CNS

+
part of neurons participate in reflexes

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21
Q

GRAY MATTER

dorsal horn

(rexed laminae)

A

medial division

proprioception (Ia and Ib, A-alpha fibers)

touch (II, A-beta fibers)

lateral division

sharp pain + cold (III, A-delta fibers)

dull pain, warmth (IV, C fiber)

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22
Q

GRAY MATTER

ventral horn

(general statements)

A

innervation of skeletal muscle

alpha + gamma motoneurons

dorsal fibers - flexors

ventral fibers - extensors

medial fibers - proximal musculature

lateral fibers - distal musculature

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23
Q

GRAY MATTER

ventral horn

(alpha and gamma motoneurons)

A

alpha motoneurons

A-alpha (Erlanger-Grasser)

extrafusal fibers

neuromuscular junction

gamma motoneurons

A-gamm (Erlanger-Grasser)

intrafusal fibers

muscle spindle (make more sensible to stretch)

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24
Q

GRAY MATTER

intermediate zone

A

T1 - L2

contains preganglionic sympathetic neuron cell bodies

+

Clarke nucleus (unconscious proprioception to the cerebellum)

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25
Q

NEURAL SYSTEMS

concept

A

systems in spinal cords use neurons in the gray matter and tracts or fasciculi of white matter

3 major (motor, sensory and autonomic)

can be found in all levels of CNS

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26
Q

MOTOR SYSTEM

voluntary innervation of skeletal muscle

(basic neural circuit)

A

voluntary contraction

basic neural circuit: two motoneurons

upper + lower

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27
Q

MOTOR SYSTEM

voluntary innervation of skeletal muscle

(lower motoneuron)

A

ventral horn (spinal cord) - fibers exit in ventral root

and

cranial nerve nuclei - fibers exit in cranial nerve

synapse directly in neuromuscular junction

(motor unit)

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28
Q

MOTOR SYSTEM

voluntary innervation of skeletal muscle

(upper motoneuron)

A

cell bodies in brain stem and cerebral cortex

axons descend via tract (spinal cord)

synapse with lower motoneuron or interneurons

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29
Q

MOTOR SYSTEM

voluntary innervation of skeletal muscle

(upper motoneuron)

cell bodies

A

red nucleus

reticular formation

lateral vestibular nuclei

cerebral cortex (most important)

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30
Q

MOTOR SYSTEM

voluntary innervation of skeletal muscle

(upper motoneuron)

pathway

A

note: UMNs have net inhibitory effect on muscle stretch reflexes

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31
Q

MOTOR SYSTEM

voluntary innervation of skeletal muscle

(corticospinal tract)

fibers distribution

A

60% of the fibers

precentral gyrus - primary motor cortex and premotor area (Brodmann 4 and 6)

40% of the fibers

somatosensory cortical areas (parietal lobe)

32
Q

MOTOR SYSTEM

voluntary innervation of skeletal muscle

(corticospinal tract)

pathway

A

cerebral cortex

internal capsule

brain stem (ventral portion)

decussation of the pyramids (80-90%)

lateral corticospinal tract (contralateral in spinal cord)

ventral horn to synapses

33
Q

MOTOR SYSTEM

voluntary innervation of skeletal muscle

(corticospinal tract)

clinical correlate

A

Lesions above pyramidal decussation

contralateral weakness

Lesions below this level

ipsilateral weakness

34
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(reflex)

A

sensory stimulus

(Ia, Ib afferents or pain fibers)

→

synapse in spinal cord

(mono or polysynapses)

→

lower motoneuron response

(contration or relaxation)

both alpha and gamma

35
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(flexor withdrawal reflex)

A

protective reflex

painful stimulus → spinal cord → withdrawal of stimulated limb

crossed extension reflex (to support the body)

36
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(myotatic reflex)

A

deep tendon reflex

(monosynaptic and ipsilateral)

in response to stretch

(spindles - Ia fibers)

basic mechanism for regulating muscle tone

(alpha motoneurons)

37
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(common myotatic reflexes)

5

A
38
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(inverse muscle stretch reflex)

A

collagenous tendon fibers

(golgi tendon organs - Ib fibers)

polysynaptic

(inhibition interneuron​)

facilitate antagonists and inhibit agonist

“stretch can be a risc”

39
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(inverse muscle stretch reflex)

mechanism

A

golgi tendon organs (Ib fibers)

→

spinal cord - inhibition interneuron

→

direct inhibition action on alpha motoneurons

+

gamma motoneurons and upper motoneurons

(regulation of spindles sensitivity and making the alpha motoneurons increase in muscle tone)

40
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(stretch reflex vs inverse reflex)

A

spindles - in parallel with extrafusal fibers

golgi tendon organs - in series with extrafusal fibers

41
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(upper motor neuron function)

A

descending control over the reflexes

42
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(upper motoneurons lesions)

A

hyperactive muscle streth reflexes + oversensitive golgi tendon organs

(increase of muscle tone)

=

SPASTIC PARESIS

(ipsilateral - lesion in spinal cord)

(contralateral - lesion above the pyramidal decussation)

43
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(lower motoneurons lesions)

A

hyporactive muscle streth reflexes + golgi tendon organs

(reduction of muscle tone)

=

FLACCID PARALYSIS

(initially - muscles fasciculations + fibrilations)

(after - hypotonia + atrophy)

ipsilateral

44
Q

MOTOR SYSTEM

reflex innervation of skeletal muscle

(lower vs upper motoneurons lesions)

A
45
Q

SENSORY SYSTEM

Two ascending pathways with …

A

DORSAL COLUMN-MEDIAL LEMNISCAL

+

ANTEROLATERAL (SPINOTHALAMIC)

46
Q

SENSORY SYSTEM

Dorsal column-medial lemniscal system

(function)

5

A

Conscious proprioceptions

Fine touch

Vibration

Pressure

Two-point discrimination

47
Q

SENSORY SYSTEM

Dorsal column-medial lemniscal system

(receptor)

PMM

A

Pacinian corpuscle

(vibration)

Meissner corpuscle

(touch)

Muscle spindle

(proprioception)

48
Q

SENSORY SYSTEM

Dorsal column-medial lemniscal system

(primary afferent neurons)

A

Cell bodies in the dorsal root ganglia

Enter the cord via class II or A-beta dorsal root fibers

fasciculus gracilis and cuneatus

(dorsal funiculus)

49
Q

SENSORY SYSTEM

Dorsal column-medial lemniscal system

(fasciculus gracilis vs fasciculus cuneatus)

A

GRACILIS

all spinal cord levels

medial

lower extremities/trunk

CUNEATUS

only upper thoracic and cervical levels

lateral

upper extremities/trunk

50
Q

SENSORY SYSTEM

Dorsal column-medial lemniscal system

(secondary afferent neuron)

A

nucleus gracilis and nucleus cuneatus

(lower part of the medulla - “bulbo”)

cross the midline

(internal arcuate fibers)

ascending in medial lemniscus

51
Q

SENSORY SYSTEM

Dorsal column-medial lemniscal system

(thirdary afferent neuron)

A

Ventral Posterolateral nucleus of the thalamus

(VPL)

Thalamocortical fibers project to the primary somesthesic area (somatosensory)

Parietal lobe - postcentral gyrus

52
Q

SENSORY SYSTEM

Dorsal column-medial lemniscal system

(lesions)

A

Astereognosis

Negative vibratory testing (128Hz tuning fork)

Romberg

Ipsi or contralateral

53
Q

SENSORY SYSTEM

Anterolateral or spinothalamic tract

(function)

3

A

PAIN

TEMPERATURE

CRUDE TOUCH

54
Q

SENSORY SYSTEM

Anterolateral or spinothalamic tract

(primary afferent neuron)

A

Cell bodies in the dorsal root ganglia

Enter the spinal cord via class III or A-delta + class IV

Fibers ascend or descend a couple segments in the dorsolateral tract of Lissauer

55
Q

SENSORY SYSTEM

Anterolateral or spinothalamic tract

(secondary afferent neuron)

A

Cell bodies in the dorsal horn gray matter

Fibers cross in the white commissure

Spinothalamic tract

56
Q

SENSORY SYSTEM

Anterolateral or spinothalamic tract

(thirdary afferent neuron)

A

Ventral Posterolateral nucleus of the thalamus

(VPL)

Thalamocortical fibers project to the primary somesthesic area (somatosensory)

Parietal lobe - postcentral gyrus

57
Q

SENSORY SYSTEM

Anterolateral or spinothalamic tract

(lesions)

A

CONTRALATERAL LOSS OF PAIN AND TEMPERATURE

(unilateral lesions)

information crosses almost as soon as it enters

anesthesia - 1 to 2 segments below the lesion + everything below that level

(Lissauer’s tract)

58
Q

SENSORY SYSTEM

Spinocerebellar pathways

(two major pathways)

A

DORSAL SPINOCEREBELLAR TRACT

(lower extremities and trunk)

CUNEOCEREBELLAR TRACT

(upper extremities and trunk)

59
Q

SENSORY SYSTEM

Spinocerebellar pathways

(function)

A

Unconscious Proprioceptive

(muscle spindles + golgi tendon organ)

monitor + modulate moviments

60
Q

SENSORY SYSTEM

Spinocerebellar pathways

(primary afferent neuron)

A

Cell bodies in the dorsal root ganglia

receptor - muscle spindle and goldi tendon organ

61
Q

SENSORY SYSTEM

Spinocerebellar pathways

(secondary afferent neuron)

A

Cell bodies

  • Dorsal spinocerebellar tract - Clarke’s nucleus (T1 - L2)
  • Cuneocerebellar tract - external cuneate nucleus (medulla - bulbo)
62
Q

SENSORY SYSTEM

Spinocerebellar pathways

(lesions)

A

uncommon

hereditary diseases

(Friedreich ataxia - autossomal recessive)

ataxia of gait (initial symptom)

63
Q

SPINAL CORD LESIONS

Identify cord section

(three tips)

A

Large Ventral Horn

Both dorsal columns (gracilis + cuneatus)

Lateral Horn

64
Q

SPINAL CORD LESIONS

Identify cord section

(large ventral horn)

A

YES

C5 - T1 or L2-S2

NO

C1 - C4 or T2 - L1

65
Q

SPINAL CORD LESIONS

Identify cord section

(both dorsal columns)

A

YES

above T5

NO

below T5

66
Q

SPINAL CORD LESIONS

Identify cord section

(lateral horn)

A

YES

T1 - L2

NO

C1 - C8 or L3 - S5

67
Q

SPINAL CORD LESIONS

Brown-Séquard syndrome

A

hemisection of the cord

3 main neural systems

(corticospinal + dorsal columns + spinothalamic)

2 ipsilateral + 1 contralateral (spinothalamic)

68
Q

SPINAL CORD LESIONS

Poliomyelitis

A

lower motoneurons in ventral horn

→

flaccid paralysis

some patiens recover most function, but others progress to muscle atrophy and permanent disability

69
Q

SPINAL CORD LESIONS

Amyotrophic Lateral Sclerosis

A

pure motor system disease

(upper and lower motorneurons)

bilateral flaccid weakness - upper limbs

+

bilateral spastic weakness - lower limbs

70
Q

SPINAL CORD LESIONS

Occlusion of the anterior spinal artery

A

interrupts blood supply to ventrolateral part of spinal cord

→

corticospinal tract

+

spinothalamic tract

bilateral loss of pain and temperature and spastic paresis

71
Q

SPINAL CORD LESIONS

Syringomyelia

A

cavitation of the central canal

(cervical spinal cord)

early - white comissure (spinothalamic tract - “belt-like”)

lesion expands - lower motoneurons (ventral horn)

late - Horner syndrome (T1 - T4)

May be present in hydrocephalus and Arnold-Chiari I

72
Q

SPINAL CORD LESIONS

Tabes Dorsalis

A

Neurosyphilis

Bilateral degeneration of dorsal roots

+

secondary degeneration of dorsal columns

high-step stride and Argyll Robertson pupils

73
Q

SPINAL CORD LESIONS

Subacute Combined Degeneration

A

patchy losses of myelin in the dorsal columns and lateral corticospinal tracts

74
Q

SPINAL CORD LESIONS

Bladder vs level of the lesion

A

Above sacral level

spastic bladder

(problems in filing stage - destrusor muscle responds to a minimum amount of stretch)

Sacral level

atonic bladder

(loss of pelvic splanchnic motor innervation - continuous dribble of urine)

75
Q

SPINAL CORD LESIONS

Brown-Séquard Syndrome - Cervical level

A

MC - Neurologia, Neurocirurgia e Neurociência (13 decks)

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