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CNS CLERKSHIP > Spinal Cord Anatomy + Ascending and Descending Pathways > Flashcards

Spinal Cord Anatomy + Ascending and Descending Pathways Flashcards

1
Q

Which of the cranial meninges are also present in the spinal cord?

A
  • Dura mater.
  • Arachnoid mater.
  • Pia mater.
    i. e. all of them.
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2
Q

The cranial meninges are continuous with the spinal meninges via what?

A

Foramen magnum.

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3
Q

What suspends the spinal cord in the spinal canal?

A

the denticulate ligament.

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4
Q

What forms the denticulate ligament?

A

Pial and arachnoid tissue.

- NB it occasionally attaches to dura at points along its length.

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5
Q

What fills the subarachnoid space?

A

CSF

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6
Q

What is the inner layer (core) of the spinal cord composed of?

A

Grey matter.

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7
Q

What is the outer layer of the spinal cord composed of?

A

White matter.

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8
Q

What does white matter consist of?

A
  • Longitudinally oriented nerve fibres (Axons).
  • Glial cells.
  • Blood vessels.
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9
Q

What does grey matter consist of?

A
  • Neuronal soma.
  • Cell processes.
  • Synapses.
  • Glia.
  • Blood vessels.
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10
Q

The small central canal extending the length of the spinal cord opens rostrally into what?

A

The 4th ventricle.

NB google says rostrally means towards anterior part of brain.

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11
Q

The small central canal extending the length of the spinal cord opens caudally into what?

A

Nothing, caudally it is blind ending.

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12
Q

What are the fasciculi/columns that make up the white matter of the spinal cord?

A
  • Posterior fasciculi.
  • Lateral fasciculi.
  • Anterior fasciculi.
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13
Q

Into what is grey matter divided?

A 
The right:
- Anterior horn.
- Posterior horn.
The left:
- Anterior horn.
- Posterior horn.
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14
Q

The horizontal part of the “H” of the grey matter core of the spinal cord represents what?

A

The dorsal and ventral grey commisures that surround the central canal.

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15
Q

At what spinal segments exists a smaller lateral horn containing the preganglionic sympathetic neurons?

A

T1-L2.

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16
Q

What supplies blood to the spinal cord?

A
  • Three major longitudinal arteries.
  • Segmental arteries.
  • Radicular arteries.
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17
Q

Describe the segmental arteries that supply blood to the spinal cord.

A

Arteries derived from vertebral, intercostal and lumbar arteries.

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18
Q

Describe the radicular arteries supplying blood to the spinal cord.

A

They travel along the dorsal and ventral roots.

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19
Q

Describe the three major longitudinal arteries supplying blood to the spinal cord.

A
  • ONE anterior.
  • TWO posterior.
  • Originate from vertebral arteries and run along the length of the spinal cord.
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20
Q

An embolic occlusion in any of the arteries supplying the spinal cord may cause what?

A

Spinal cord infarction.

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21
Q

The space in the spinal canal found between dura and bone is known as what?

A

Epidural space.

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22
Q

What does the epidural space contain?

A
  • Adipose.
  • Anterior epidural venous plexus.
  • Posterior epidural venous plexus.
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23
Q

Why are sensations from the left side of the body represented on the right cortex and vice versa?

A

Sensory fibres cross in the midline.

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24
Q

How does information from peripheries reach the somatosensory cortex?

A

Via the spinal cord.

- Except face and scalp.

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25
Q

What happens to the proportion of white matter as the spinal cord descends?

A

White matter occupies a smaller proportion of the cord as it descends.

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26
Q

In which regions of the spine is the spinal cord larger?

A

Cervical and lumbar regions.

i.e. it is therefore smaller in sacral and thoracic regions.

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27
Q

Where do the fibres of the Dorsal Column/Medial Lemniscus system cross?

A

Fibres cross in the medulla.

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28
Q

What is the function of the Dorsal column/Medial Lemniscus system?

A

To convey fine touch and conscious proprioception - particularly from upper limb.

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29
Q

Where is the primary motor cortex located?

A

Dorsal portion of frontal lobe.

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30
Q

This reflects the relative space occupied on the primary motor cortex by each part of the body.

A

Cortical motor homunculus.

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31
Q

Which tract is responsible for fine, precise movement - particularly of distal limb muscles e.g. digits?

A

Corticospinal tract.

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32
Q

This tract forms visible ridges - “pyramids” on the anterior surface of the medulla to form the pyramidal tract.

A

Corticospinal tract.

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33
Q

Where do the majority (85%) of fibres of the corticospinal tract cross?

A

In the caudal medulla at the decussation of the pyramids.

(the lower medulla).

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34
Q

Crossed fibres of the corticospinal tract form what?

A

The lateral corticospinal tract.

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35
Q

Uncrossed fibres of the corticospinal tract form what?

A

The ventral corticospinal tract.

- These cross segmentally.

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36
Q

CVA of the internal capsule may have what effect?

A

Spastic paralysis with hyperflexion of the upper limbs - DECORTICATE POSTURING.

Due to lack of descending control of the corticospinal tract.

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37
Q

The collective term for the motor systems existing outwith the pyramidal tract.

A

Extrapyramidal system.

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38
Q

Which tract is thought to mediate reflex head and neck movement due to visual stimuli?

A

Tectospinal tract.

  • input mostly to cervical segments.
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39
Q

What forms the central core of the brainstem?

A

Reticular formation.

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40
Q

Composed of many nuclei receiving input from virtually all areas of CNS. Functions include influencing voluntary movement.

A

Reticular formation.

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41
Q

Fibres originate in areas of the reticular formation in the pons and medulla, from which they then descend.

A

Reticulospinal tract.

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42
Q

In general, fibres of the reticulospinal tract originating from the pons facilitate and inhibit what?

A
  • Facilitate extensor movements.

- Inhibit flexor movements.

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43
Q

In general, fibres of the reticulospinal tract originating from the medulla facilitate and inhibit what?

A
  • Facilitate flexor movements.

- Inhibit extensor movements.

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44
Q

The vestibulospinal tract conveys excitatory input to what?

A

“anti-gravity” extensor muscles.

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45
Q

Where do the fibres of the vestibulospinal tract originate?

A

Vestibular nuclei of pons and medulla.

NB these receive input from vestibular apparatus and cerebellum.

46
Q

A tract thought to have an important role in those exhibiting decerebrate rigidity and paraplegia in extension.

A

Vestibulospinal tract.

47
Q

Lesions where may cause a lack of descending cortical control of the vestibulospinal tract?

A

Lesions of the brainstem at the level of the midbrain.

48
Q

Lesions of the brainstem at the level of the midbrain may cause reduced descending control of the vestibulospinal tract resulting in what?

A

Dominating extensor muscle tone and hyperextended spastic paralysis.

49
Q

Lateral hemisection of the spinal cord gives rise to what condition?

A

Brown-Sequard’s Syndrome.

50
Q

List the signs/symptoms indicative of Brown-Sequard’s Syndrome.

A
  • Ipsilateral paralysis.
  • Ipsilateral hyperreflexia and extensor plantar reflex.
  • Ipsilateral loss of vibratory sense and proprioception.
  • Contralateral loss of pain and temperature sense.
51
Q

The spinal cord extends from where to terminate where?

A
  • Extends from medulla oblongata.

- Terminates at L1/L2.

52
Q

What is the spinal cord made up of?

A
  • Grey and white matter.
53
Q

What is the “H-shape” of the spinal cord made up of?

A

Grey matter.

54
Q

What is the “H-shape” of the spinal cord surrounded by?

A

White matter.

55
Q

The dorsal (posterior) horns of the spinal cord receive what kind of information?

A

Somatosensory.

56
Q

The ventral (anterior) horns of the spinal cord contain what?

A

Motor neurons for innervating muscles.

57
Q

What is the lateral horn (interomediolateral grey column) of the spinal cord?

A

A triangular projection between the dorsal and ventral horns.

58
Q

Where is the lateral horn (interomediolateral grey column) of the spinal cord present?

A

Only in the thoracic and upper lumbar segment of spinal cord.

59
Q

What does the lateral horn of the spinal cord contain?

A

Autonomic neurons (sympathetic T1-L2).

60
Q

Function of dorsal column-medial leminiscus pathway?

A
  • Fine touch.
  • Pressure.
  • Vibration.
61
Q

Describe the dorsal column-medial leminiscus pathway.

A
  • Primary sensory fibres travel via posterior root ganglion > spinal cord to synapse with secondary neurons in medulla at nucleus cuneatus/nucleus gracilis.
  • Fibres decussate to contralateral medial leminiscus > synapse in thalamus.
  • Sensory signals relayed from thalamus to ipsilateral somatosensory cortex.
62
Q

Function of spinothalamic tract?

A

Conveys pain and temperature.

63
Q

Describe the spinothalmic tract pathway.

A
  • Primary sensory axons enter spinal cord via posterior root ganglion > up for 1/2 segments at spinal cord periphery through tract of Lissauer to synapse in dorsal horn.
  • Cross to contralateral side of spinal cord > synapse in thalamus.
  • Sensory signals relayed from thalamus to ipsilateral somatosensory cortex.
64
Q

Function of the spinocerebellar pathway?

A

Relays unconscious proprioceptive information to the cerebellum to coordinate posture + movement of lower + upper limb muscles.

65
Q

Describe the Dorsal/Posterior Spinocerebellar pathway.

A
  • Carries unconscious proprioceptive information (mostly from muscle spindles) from lower limbs.
  • Synapses in dorsal nucleus of clarke > secondary neuron fibres ascend to ipsilateral cerebellum.
66
Q

Where does the dorsal/posterior spinocerebellar pathway synapse?

A

Nucleus of Clarke.

67
Q

After synapsing in the nucleus of Clarke, secondary neuron fibres of the dorsal/posterior spinocerebellar pathway ascend to where?

A

Ipsilateral cerebellum.

68
Q

The dorsal/posterior spinocerebellar pathway carries what kind of information?

A

Unconscious proprioceptive info from lower limbs.

69
Q

The cuneocerebellar pathway carries what kind of information?

A

Unconscious proprioceptive info from upper limbs.

70
Q

Where does the cuneocerebellar pathway relay its information from and to?

A
  • from upper limbs to ipsilateral cerebellum.
71
Q

What kind of information does the ventral/anterior spinocerebellar pathway carry?

A

Unconscious proprioceptive info (mainly from golgi tendon organs) from lower limbs.

72
Q

How does information from lower limbs reach the cerebellum in the ventral/anterior spinocerebellar pathway?

A

Fibres decussate twice in order to reach the ipsilateral cerebellum.

73
Q

The spinocerebellar tract transmits unconscious proprioceptive information to which cerebellum?

A

Ipsilateral.

74
Q

The spinothalamic tract transmits pain/ temperature information to which somatosensory cortex?

A

Contralateral.

75
Q

The dorsal column-medial leminiscus pathway transmits fine touch/pressure/vibration information to which somatosensory cortex?

A

Contralateral.

76
Q

Corticospinal tracts are responsible for what?

A

Voluntary movements.

77
Q

Corticospinal tracts originate form where?

A

Motor cortex (precentral gyrus) and descend to pyramid of medulla.

78
Q

The majority of fibres of the corticospinal tracts decussate where?

A

Pyramid of medulla - pyramidal decussation.

79
Q

After decussating at pyramid of medulla, fibres of the corticospinal tracts descend via what?

A

The lateral corticospinal tract.

80
Q

The lateral corticospinal tracts supply what?

A

The distal extremities.

81
Q

Undecussated fibres (minority) of the corticospinal tracts descend via what?

A

Anterior corticospinal tract.

82
Q

Where do undecussated fibres of the anterior corticospinal tract decussate?

A

At level of desired destination via the anterior white commisure.

83
Q

Fibres of the anterior corticospinal tract decussate to supply what?

A

Proximal and axial muscles.

84
Q

Corticobulbar tracts contain what?

A

UMN of cranial nerves.

85
Q

Function of corticobulbar tracts?

A
  • Innervate face, head and neck.

- Innervate cranial motor nuclei bilaterally (except hypoglossal and lower facial nuclei).

86
Q

Corticobulbar tracts innervate cranial motor nuclei bilaterally except what and why?

A
  • Hypoglossal and lower facial nuclei.

- Innervated contralaterally only.

87
Q

Clinical significance of innervation of facial nerve?

A
  • UMN lesion > CENTRAL FACIAL PALSY.

- LMN lesion > Bell’s palsy.

88
Q

What is central facial palsy?

A

UMN lesion of facial nerve causes paralysis of lower half of face unilaterally with forehead muscles unaffected.

89
Q

What is Bell’s palsy?

A

LMN lesion of facial nerve causes ipsilateral paralysis of half the face including the forehead.

90
Q

Vestibulospinal tract originates from where?

A

Vestibular nucleus in the pons.

91
Q

Vestibulospinal tract controls what?

A
  • Balance and posture.
92
Q

How does the vestibulospinal tract control balance and posture?

A

By innervating anti-gravity muscles.

  • Leg extensors.
  • Arm flexors.
93
Q

Origin of reticulospinal tracts?

A

Reticular formation in medulla and pons.

94
Q

Pontine reticulospinal tract facilitates what?

A
  • Voluntary/reflex responses and increases tone.
95
Q

The medullary reticulosponal tract inhibits what?

A
  • Voluntary/reflex responses and decreases tone.
96
Q

Origin of the rubrospinal tract?

A

Red nucleus in the midbrain.

97
Q

Function of the rubrospinal tract?

A

Upper body:

  • Excite flexor muscles.
  • Inhibit extensor muscles.
98
Q

Origin of tecto-spinal tract?

A

Superior colliculus in midbrain.

99
Q

Function of tecto-spinal tract?

A

Co-ordinates movements of head and neck to vision stimuli.

100
Q

Name the layers (7) traversed by a needle during lumbar puncture.

A
  1. Skin.
  2. Fascia.
  3. Supraspinous ligament.
  4. Interspinous ligament.
  5. Ligamentum flavum.
  6. Epidural space.
  7. Dura.
101
Q

Give the function of the anterior longitudinal ligament of the spine.

A

Connects the anterolateral aspects of vertebral bodies and intervertebral discs.

102
Q

Give the location of the posterior longitudinal ligament of the spine.

A

Runs within the vertebral canal posterior to the vertebral bodies.

103
Q

Give the function of the ligamentum flavum of the spine.

A

Aids maintenance of upright posture and assists straightening the spine after flexion.

104
Q

How did ligamentum flavum get its name?

A

It is rich in elastin and thus appears yellow.

105
Q

Give the location of ligamentum flavum.

A

Runs vertically connecting the lamina of adjacent vertebrae.

106
Q

Give the location of the supraspinous ligament.

A

Runs along tips of spinous processes.

107
Q

Give the location of the interspinous ligament.

A

Runs between spinous processes.

108
Q

Which spinal tract is responsible for:

fine touch, pressure and vibration?

A

DCML pathway.

109
Q

Which spinal tract is responsible for:

pain and temperature?

A

Spinothalamic tract.

110
Q

Which spinal tract is responsible for:

exciting flexor muscles and inhibiting extensor muscles of the upper body?

A

Rubrospinal tract.

CNS CLERKSHIP (43 decks)

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