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Spinal Cord Flashcards

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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
Which muscles are controlled by lateral pathways ?
Distal
26
Which group of pathways control posture?
Ventromedial
27
What are the two Ventromedial pathways ?
Vestibulospinal and Tectospinal
28
What does the VST do ?
Stabilises the head and neck movements
29
What does the TST do ?
Ensures the eyes remain stable when the body and head moves
30
Which pathways don't decussate ?
Pontine and medullary RST
31
What do the RST pathways do ?
Use information on balance, posture and limb position to reflexively maintain postion.
32
Which muscles does the RST innervate ?
Trunk and antigravity muscles
33
Which part of the 'motor brain' innervates distal muscle units ?
Supplementary motor area
34
Which part of the 'motor brain' innervates proximal muscle units via the RST ?
Premotor area
35
Where do decisions on movement from the frontal and parietal lobes converge ? (Broadmann's area)
Area 6
36
Which subcortical region does information come from that travels to area 6 ?
Thalamus (Vlo/Ventrolateral nucleus)
37
What part of the basal ganglia fibres before limb movements ?
Putamen
38
What part of the basal ganglia fibres before eye movements ?
Caudate nucleus
39
Describe the Direct pathway of control
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.
40
What happens during the Indirect pathway ?
The STN excited the GP and this inhibits the Vlo which means the SMA isn't activated. This pathway suppresses inappropriate actions.
41
What happens in the brain in Parkinson's disease ?
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
What are the 4 signs of Parkinson's disease/Parkinsonism ?
- Resting tremor - Postural instability - Bradykinesia - Rigidity
43
What happens in the brain in Huntington's disease ?
Loss of the Caudate nucleus, GP and Putamen so there is no inhibitory response.
44
What signs do patients with Huntington's disease show ?
- Jerking movements - Personality changes - Dementia - Unsteady gait
45
What is neglect syndrome ?
Show no concern about hemi-paresis and deny ownership of that limb
46
What is Ballism ?
Large, repetitive amplitude movements that arise from proximal parts of limbs
47
What is another name for the flocculonodular lobe and what system it is closely related to ?
Archicerebellum and the vestibular system
48
What is another name for the anterior lobe and what's it involved in ?
Paleocerebellum and muscle control
49
What is another name for the posterior lobe ?
Neocerebellum
50
What is GABAergic transmission ?
Activation of GABA receptors and release of GABA by endogenous or pharmacological modulators
51
What is Dysmetria ?
Lack of coordination of movement
52
Definition of Synergic ?
Adding together of many small parts
53
Dysdidochokinesia
Cannot rapidly alternate movements e.g. hand tapping
54
Where does the spinal cord extend from and to ?
C1-L2
55
What is the action of the C5 myotome ?
Elbow flexion
56
What is the action of the C6 myotome ?
Wrist extensor
57
What is the action of the C7 myotome ?
Elbow extension
58
What is the action of the C8 myotome ?
Finger extension
59
What is the action of the T1 myotome ?
Intrinsic hand muscles
60
What is the action of the L2 myotome ?
Hip flexors
61
What is the action of the L3 myotome ?
Knee extensors
62
What is the action of the L4 myotome ?
Ankle dorsiflexion
63
What is the action of the L5 myotome ?
Long toe extension
64
What is the action of the S1 myotome ?
Ankle plantar-flexion
65
Define myelopathy
Neurological deficit due to compression of the spinal cord
66
Define Radiculopathy
Compression of the nerve roots leading to dermatomal and myotomal deficits
67
How would you investigate spinal cord disease ?
- MRI - Bloods - X-Rays - History and examination
68
What is a disc prolapse ?
Acute herniation of the IV disc causing compression of the spinal cord or spinal roots
69
What is a central cervical compression called ?
Cervical myelopathy
70
What is lateral cervical compression called ?
Cervical radiculopathy
71
What is central lumbar compression called ?
Cauda equina syndrome
72
What is lateral lumbar compression called ?
Lumbar radiculopathy
73
How would a patient present with a disc prolapse ?
- Pain down arm or leg which has come on quickly - Numbness - Weakness
74
How would you investigate a disc prolapse ?
MRI
75
How do you treat a disc prolapse ?
- Discectomy - Nerve root injection - Rehabilitation
76
How do you diagnose Cauda Equina syndrome ?
- Usually clinically | - MRI to confirm
77
How do you treat Cauda Equina syndrome ?
Discectomy
78
What is the triad of symptoms for Cauda Equina syndrome ?
- Urinary dysfunction - Saddle anaesthesia - Bilateral sciatica
79
What 3 things may cause degenerative disease in the spinal cord ?
- Ligamentum hypertrophy - Disc prolapse - Osteophyte formation
80
Define cervical spondylosis
A name for the group of degenerative diseases occurring in the cervical spine
81
How does Lumbar spine stenosis occur ?
Lumbar spine thickens due to deposition of new bone (osteophytes) as a result of osteoarthritis
82
How does Lumbar spine stenosis present ?
- Pain down both legs | - Worse when walking and standing, relieved by sitting or leaning forwards
83
How do you treat Lumbar spine stenosis ?
Laminectomy
84
What are the 3 areas where a spinal tumour can form ?
1. Intramedullary 2. Extradural 3. Intradural
85
What tumour types can grow intramedullary ? (3)
1. Hemangiomas 2. Astrocytomas 3. Ependymomas
86
What tumour types can grow intradurally ? (2)
1. Meningiomas | 2. Lipomas
87
Where are the common metastases for brain tumours to arise (4) ?
Lung Colon Breast Melanoma
88
What are the signs of malignant cord compression ?
- Pain - Weakness - Sphincter disturbance - Back pain
89
How are malignant cord compressions diagnosed ?
MRI
90
What is the treatment for malignant cord compressions ?
Radiotherapy and surgical decompression
91
Define osteomyelitis ?
Infection of the vertebral body
92
What are the risk factors for osteomyelitis ? (3)
- Alcoholism - IV drug use - Diabetes
93
Define discitis
Infection of the IV disc
94
Define epidural abscess
Infection in the epidural space
95
How does an epidural abscess present ?
- Back pain - Fever - Focal neurology e.g. weakness, numbness
96
What organisms are likely to cause an epidural abscess ?
- Staph. aureus and E. coli
97
How do you manage an epidural abscess ?
- Long term IV antibiotics | - Surgical drainage/decompression
98
How do you investigate spinal cord infections ?
- Blood cultures/look at ESR and CRP levels - MRI with Gadolinium - Radionuclide scans
99
Name 4 causes of compressive spinal cord lesions
- Infection - Tumour - Trauma - Degenerative diseases

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