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Brain Function and Malfunction > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

Function of spinal cord

A

co-ordinates movement and sensation

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2
Q

Where is the spinal cord found?

A

inside the vertebral column

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3
Q

What does the spinal cord arise from?

A

specialised dorsal ectoderm

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4
Q

Neural tube closure

A

occurs at multiple sites from anterior to posterior neuropore in multiple stages

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5
Q

genes for neural tube closure

A

82 in humans - MTHFR involved in folate metabolism

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6
Q

Primary neurulation

A

day 22-26

neural ectoderm fold and fuse to form neural tube

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7
Q

secondary neurulation

A

tail bid cells condense and form secondary neural tube caudally - coccyx and cauda equina

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8
Q

DRG formation

A

neural folds fuse to form brain and spinal cord

after fusion neural crest cells migrate peripherally to form sensory neurons of DRG

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9
Q

3 layers of the neural tube

A

ventricular - undifferentiated, lining of central canal
mantle - differentiating neurons form grey matter
marginal - nerve fibres - white matter

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10
Q

alar and basal plate

A

alar plate - dorsal - sensory

basal - ventral - motor

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11
Q

where do cells in DRG extend sensory fibres?

A

peripherally and centrally

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12
Q

5 main layers of spinal cord periphery

A

dura mater - tough, fibrous outer layer
epidural space - between dura and vertebra - loose connective tissue
arachnoid mater
subarachnoid space - CSF
pia mater - vascularised, attached to brain and spinal cord

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13
Q

How does the spinal cord transmit information?

A

ascending and descending white matter tracts

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14
Q

How does the spinal cord involve reflex integration?

A

grey matter - spinal reflexes eg knee jerk not initiated voluntarily by the brain

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15
Q

where does human spinal cord end?

A

L1

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16
Q

2 spinal cord enlargements

A

cervical C3-T1
lumbar T11-L2
control of limbs

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17
Q

What is the name for the nerve roots which radiate from L1 to coccyx?

A

cauda equina

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18
Q

How many spinal nerves and what do they contain?

A

31 pairs - sensory and motor

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19
Q

where are sensory nerve bodies located?

A

DRG

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20
Q

cervical plexus

A

C1-5 = neck, head and shoulders

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21
Q

brachial plexus

A

C5-T1 - shoulder and upper limb

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22
Q

lumbar plexus

A

T12-L4 - lower abdomen and lower limb

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23
Q

sacral plexus

A

L4-S4 - legs and feet

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24
Q

central pattern generator

A

produce rhythmic patterns eg walking
fictive motor patterns - motor output in paralysed/isolated spinal cord
alternate muscle extension and flexion

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25
what are CPGs co-ordinated by?
propriospinal neuron path | cervical and lumbar enlargements
26
what is cpg refined by?
supraspinal signals - motor cortex | sensory feedback to spinal cord
27
main problems with NTD
neural tissue exposed to amniotic fluid liable to damage and progressive degeneration over time before birth
28
examples of neural tube defects
anencephaly, encephalocele, spina bifida
29
types of spina bifida
occulta, myelomeningocele, meningocele
30
spina bifida stats
0.5-2/1000 regional variation 95% no FH
31
What medications can predispose to spina bifida?
antidepressants and anticonvulsants
32
surgery for spina bifida
in utero or after birth (within 48 hours)
33
what is often (90%) concomitant with spina bifida?
hydrocephalus - requirement for a shunt
34
Preventing spina bifida
supplement diet with 400mcg folate fortified foodstuff inositol (Vit B8)
35
spina bifida and shh
shh is responsible for d/v patterning of spinal cord and s present in cilium. Disruptions of signalling can lead to NTD
36
stats for SCI
2.5M globally, 50 000 UK age 16-30, males
37
causes for SCI
road accidents, sports, violence, alcohol
38
complete SCI
45% - total loss of sensation and function below injury level
39
incomplete SCI
partial loss of sensation and function below injury level - 55%
40
SCI above C3
usually results in death - diaphragm, phrenic nerve
41
4 causes of traumatic primary injury
hyperflexion hyperextension rotation vertical/axial compression
42
2 causes of non-traumatic primary injury
cord compression eg tumour, reduced blood flow | developmental
43
hyperflexion axial compression
eg fall on buttocks - vertebrae forced together and ligaments stretched
44
what is the primary injury?
vertebral disc rupture | disc material invades centre of spinal canal and compress cord
45
what can surgery do for primary injury?
relieve pressure, restore shape of cord but damage persists
46
where is greatest damage of primary injury?
centre - haemorrhage - grey matter more vascular so vulnerable
47
what is the secondary injury?
cell death in grey matter | wallerian degeneration in white matter - influx of calcium
48
tracts lost secondary injury
ascending above lesion and descending below lesion
49
fibroglial scar components
collagen - produce fibroblasts astrocytes - activated microglia macrophages
50
microlesion
minimally disrupt BBB, axons cannot regenerate
51
contusive lesion
meninges intact, astrocytes produce CSPGs, macrophages
52
How are SCI assessed?
ASIA scale A-E A is complete, always bladder and bower problems
53
Treatment of SCI
``` immobilise C-spine CT/MRI/X-ray within 48-72 hours test sensory and motor function drugs to reduce swelling, maintain bp surgery - remove bone fragments, clots, disc material ```
54
What is E on ASIA scale?
motor and sensory normal
55
ASIA scale and description
A - complete, no sensory or motor below injury through S4-5 B - incomplete. sensory but no motor C - incomplete - motor below injury and more than half key muscles grade<3 D - same as C but >3 E - normal
56
what ASIA grade are all complete SCI?
A
57
What % complete SCI recover significantly?
0.9%
58
Complications of SCI
pressure sores, infection, DVT, spasticity, autonomic dysreflexia
59
autonomic dysreflexia
life threatening increase in bp injury T5 or higher irritating stimulus below level of SCI eg full bladder
60
4 main barriers to recovery
cell loss scar is non-permissive for regeneration (fibroblasts, sema 3-A deflect growth, astrocyte CSPG and tenascin) spared cells in white matter demyelinated degrading myelin - Nogo-A, MAG
61
6 key things for successful repair
damaged nerves must survive or be replaced - prevent secondary injury surviving neurons must regrow axons despite scar and inhibitory molecules axons must migrate towards appropriate targets effective synapses respond to NT branching to replace circuitry
62
Different treatments for complete vs incomplete
``` incomplete = stimulate reorganisation of spared circuitry complete = neuron grafts, stimulate regrowth ```
63
PNS graft
permissive PNS environment encouraged CNS axon regrowth
64
Forms of axon growth after SCI
new synapse growth and remodelling of new axons branching and sprouting proximal and distal to lesion growth through spared tissue pass through scar
65
Some things that have been used for acute injuries
PNS grafts - no evidence of functional recovery cool injury site methylprednisolone - stopped in 2013 foetal spinal cord transplants - alone or with molecules inhibit mag/nogo-A, grwoth factors polymer scaffold seeded with stem cells
66
3 new ways emerging for SCI
modulate cAMP levels - overcome MAG inhibition stem cells electric fields
67
what direction do axons grow in EF?
cathode
68
EF with cathode distal or proximal to lesion
distal - prevent die back | proximal - enhance die back
69
acute injury
soon after primary injury
70
starting treatment timing
acute phase or wait? | acute - hostile, might be better to wait 2 weeks for inflammation and macrophage to stabilise
71
chronic injury treatment
Christopher Reeve's | exercise therapy - repattern cpgs?

Brain Function and Malfunction (7 decks)

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