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Neurology > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

Where do corticobulbar fibres go ?

A

To the contralateral side

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2
Q

What information does the dorsal column carry information on ?

A

Fine touch, proprioception and vibration

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3
Q

Describe the path of the dorsal column

A

1st order neurone enters spinal cord through the dorsal horn and goes upwards to the nucleus in the medulla where it synapses. It then decussates and runs to the thalamus. Synapsing again the neurones run to the post central gyrus through the internal capsule.

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4
Q

What Brodmann’s numbers are given to the post-central gyrus ?

A

2, 1 and 3

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5
Q

What information is carried via the lateral spinothalamic tract ?

A

Pain and temperature

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6
Q

Describe the path of the lateral spinothalamic tract

A

Neurone enters spinal cord through the dorsal horn and synapses onto the 2nd order neurone. It then decussates and begins to run upwards to the thalamus. At the thalamus it synapses again onto a 3rd order neurone and runs through the internal capsule to the post-central gyrus.

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7
Q

What is a reflex ?

A

An involuntary movement brought about by a sensory stimulus

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8
Q

What type of reflex is the stretch reflex ?

Monosynaptic or polysynaptic

A

Monosynaptic

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9
Q

What type of reflex is the flexor reflex ?

Monosynaptic or polysynaptic

A

Polysynaptic

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10
Q

UMN signs (5)

A
  • Increased tone
  • Spasticity
  • Hyperreflexia
  • No muscle wasting
  • Babinski’s sign
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11
Q

LMN signs (4)

A
  • Decreased tone
  • Flaccidity
  • Absent reflexes
  • Muscle wasting
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12
Q

What are the 5 components of a reflex arc ?

A
  1. Receptor
  2. Sensory neurone
  3. Interneurone
  4. Motor neurone
  5. Muscles

May or may not include the interneurone.

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13
Q

What is Motor Neurone Disease ?

A

Disease affecting LWN in the ventral horn of the spinal cord. The neurone dies and as a result the muscle it supplied atrophies.

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14
Q

What is dysarthria ?

A

Dysarthria is a speech disorder caused by disturbance of muscular control. Leads to slurred speech.

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15
Q

What is dysphasia ?

A

Dysphasia can be receptive or expressive. Receptive dysphasia is difficulty in comprehension, whilst expressive dysphasia is difficulty in putting words together to make meaning.

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16
Q

What is dysphagia ?

A

Difficulty swallowing

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17
Q

What is reciprocal inhibition ?

A

When inhibitory interneurones inhibit the activation of a motor neurone.

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18
Q

What does Babinski’s sign show us ?

A

Extension of the toes indicates an UMN lesion.

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19
Q

How does a spinal cord transection present?

Think spinal shock

A

Initially there is flaccid areflexive paralysis with autonomic refeatures. After some days to weeks spinal cord shock wears off and this then present with spasticity and hyperrefelxia.

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20
Q

What motoneurones innervate extramural muscle fibres ?

A

Alpha

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21
Q

What motoneurons innervate intramural muscle fibres ?

A

Gamma

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22
Q

What sensory fibres respond to the rate of change of muscle length ?

A

1a

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23
Q

What sensory fibres respond to the change in tension of a GTO ?

A

1b

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24
Q

What type of fibres provide information of position sense of a still muscle ?

A

Type 2

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25
Q

Which muscles are controlled by lateral pathways ?

A

Distal

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26
Q

Which group of pathways control posture?

A

Ventromedial

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27
Q

What are the two Ventromedial pathways ?

A

Vestibulospinal and Tectospinal

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28
Q

What does the VST do ?

A

Stabilises the head and neck movements

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29
Q

What does the TST do ?

A

Ensures the eyes remain stable when the body and head moves

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30
Q

Which pathways don’t decussate ?

A

Pontine and medullary RST

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31
Q

What do the RST pathways do ?

A

Use information on balance, posture and limb position to reflexively maintain postion.

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32
Q

Which muscles does the RST innervate ?

A

Trunk and antigravity muscles

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33
Q

Which part of the ‘motor brain’ innervates distal muscle units ?

A

Supplementary motor area

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34
Q

Which part of the ‘motor brain’ innervates proximal muscle units via the RST ?

A

Premotor area

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35
Q

Where do decisions on movement from the frontal and parietal lobes converge ?

(Broadmann’s area)

A

Area 6

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36
Q

Which subcortical region does information come from that travels to area 6 ?

A

Thalamus (Vlo/Ventrolateral nucleus)

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37
Q

What part of the basal ganglia fibres before limb movements ?

A

Putamen

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38
Q

What part of the basal ganglia fibres before eye movements ?

A

Caudate nucleus

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39
Q

Describe the Direct pathway of control

A

At rest the GP is constantly firing inhibitory messages to the Vlo. When the putamen is activated this inhibits the inhibitory signals from the GP and result in the Vlo activating the SMA. This results in the selection of specific motor actions.

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40
Q

What happens during the Indirect pathway ?

A

The STN excited the GP and this inhibits the Vlo which means the SMA isn’t activated. This pathway suppresses inappropriate actions.

41
Q

What happens in the brain in Parkinson’s disease ?

A

There is degeneration of neurones in the Substantia Nigra and so less dopamine is produced. Less activation of movements via the direct pathway but also less regulation via the indirect pathway.

42
Q

What are the 4 signs of Parkinson’s disease/Parkinsonism ?

A
  • Resting tremor
  • Postural instability
  • Bradykinesia
  • Rigidity
43
Q

What happens in the brain in Huntington’s disease ?

A

Loss of the Caudate nucleus, GP and Putamen so there is no inhibitory response.

44
Q

What signs do patients with Huntington’s disease show ?

A
  • Jerking movements
  • Personality changes
  • Dementia
  • Unsteady gait
45
Q

What is neglect syndrome ?

A

Show no concern about hemi-paresis and deny ownership of that limb

46
Q

What is Ballism ?

A

Large, repetitive amplitude movements that arise from proximal parts of limbs

47
Q

What is another name for the flocculonodular lobe and what system it is closely related to ?

A

Archicerebellum and the vestibular system

48
Q

What is another name for the anterior lobe and what’s it involved in ?

A

Paleocerebellum and muscle control

49
Q

What is another name for the posterior lobe ?

A

Neocerebellum

50
Q

What is GABAergic transmission ?

A

Activation of GABA receptors and release of GABA by endogenous or pharmacological modulators

51
Q

What is Dysmetria ?

A

Lack of coordination of movement

52
Q

Definition of Synergic ?

A

Adding together of many small parts

53
Q

Dysdidochokinesia

A

Cannot rapidly alternate movements e.g. hand tapping

54
Q

Where does the spinal cord extend from and to ?

A

C1-L2

55
Q

What is the action of the C5 myotome ?

A

Elbow flexion

56
Q

What is the action of the C6 myotome ?

A

Wrist extensor

57
Q

What is the action of the C7 myotome ?

A

Elbow extension

58
Q

What is the action of the C8 myotome ?

A

Finger extension

59
Q

What is the action of the T1 myotome ?

A

Intrinsic hand muscles

60
Q

What is the action of the L2 myotome ?

A

Hip flexors

61
Q

What is the action of the L3 myotome ?

A

Knee extensors

62
Q

What is the action of the L4 myotome ?

A

Ankle dorsiflexion

63
Q

What is the action of the L5 myotome ?

A

Long toe extension

64
Q

What is the action of the S1 myotome ?

A

Ankle plantar-flexion

65
Q

Define myelopathy

A

Neurological deficit due to compression of the spinal cord

66
Q

Define Radiculopathy

A

Compression of the nerve roots leading to dermatomal and myotomal deficits

67
Q

How would you investigate spinal cord disease ?

A
  • MRI
  • Bloods
  • X-Rays
  • History and examination
68
Q

What is a disc prolapse ?

A

Acute herniation of the IV disc causing compression of the spinal cord or spinal roots

69
Q

What is a central cervical compression called ?

A

Cervical myelopathy

70
Q

What is lateral cervical compression called ?

A

Cervical radiculopathy

71
Q

What is central lumbar compression called ?

A

Cauda equina syndrome

72
Q

What is lateral lumbar compression called ?

A

Lumbar radiculopathy

73
Q

How would a patient present with a disc prolapse ?

A
  • Pain down arm or leg which has come on quickly
  • Numbness
  • Weakness
74
Q

How would you investigate a disc prolapse ?

A

MRI

75
Q

How do you treat a disc prolapse ?

A
  • Discectomy
  • Nerve root injection
  • Rehabilitation
76
Q

How do you diagnose Cauda Equina syndrome ?

A
  • Usually clinically

- MRI to confirm

77
Q

How do you treat Cauda Equina syndrome ?

A

Discectomy

78
Q

What is the triad of symptoms for Cauda Equina syndrome ?

A
  • Urinary dysfunction
  • Saddle anaesthesia
  • Bilateral sciatica
79
Q

What 3 things may cause degenerative disease in the spinal cord ?

A
  • Ligamentum hypertrophy
  • Disc prolapse
  • Osteophyte formation
80
Q

Define cervical spondylosis

A

A name for the group of degenerative diseases occurring in the cervical spine

81
Q

How does Lumbar spine stenosis occur ?

A

Lumbar spine thickens due to deposition of new bone (osteophytes) as a result of osteoarthritis

82
Q

How does Lumbar spine stenosis present ?

A
  • Pain down both legs

- Worse when walking and standing, relieved by sitting or leaning forwards

83
Q

How do you treat Lumbar spine stenosis ?

A

Laminectomy

84
Q

What are the 3 areas where a spinal tumour can form ?

A
  1. Intramedullary
  2. Extradural
  3. Intradural
85
Q

What tumour types can grow intramedullary ? (3)

A
  1. Hemangiomas
  2. Astrocytomas
  3. Ependymomas
86
Q

What tumour types can grow intradurally ? (2)

A
  1. Meningiomas

2. Lipomas

87
Q

Where are the common metastases for brain tumours to arise (4) ?

A

Lung
Colon
Breast
Melanoma

88
Q

What are the signs of malignant cord compression ?

A
  • Pain
  • Weakness
  • Sphincter disturbance
  • Back pain
89
Q

How are malignant cord compressions diagnosed ?

A

MRI

90
Q

What is the treatment for malignant cord compressions ?

A

Radiotherapy and surgical decompression

91
Q

Define osteomyelitis ?

A

Infection of the vertebral body

92
Q

What are the risk factors for osteomyelitis ? (3)

A
  • Alcoholism
  • IV drug use
  • Diabetes
93
Q

Define discitis

A

Infection of the IV disc

94
Q

Define epidural abscess

A

Infection in the epidural space

95
Q

How does an epidural abscess present ?

A
  • Back pain
  • Fever
  • Focal neurology e.g. weakness, numbness
96
Q

What organisms are likely to cause an epidural abscess ?

A
  • Staph. aureus and E. coli
97
Q

How do you manage an epidural abscess ?

A
  • Long term IV antibiotics

- Surgical drainage/decompression

98
Q

How do you investigate spinal cord infections ?

A
  • Blood cultures/look at ESR and CRP levels
  • MRI with Gadolinium
  • Radionuclide scans
99
Q

Name 4 causes of compressive spinal cord lesions

A
  • Infection
  • Tumour
  • Trauma
  • Degenerative diseases

Neurology (16 decks)

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