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Head, Neck and Neurological Systems > Spinal Cord and Injury > Flashcards

Spinal Cord and Injury Flashcards

1
Q

Describe the gross anatomical make up of the spinal cord

A

H-Shaped grey matter - dorsal, intermediate and ventral horns

Surrounding white matter - Dorsal, lateral and ventral funiculi

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2
Q

Describe the make up of the meningeal layers

A 
Dura Mater
Arachnoid Mater 
(Sub arachnoid space)
Pia Mater
(Subpial space - spinal cord, very tiny)
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3
Q

Where does the dura mater fuse with endosteum of cranium?

A

Foramen magnum

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4
Q

What separates the dura mater from vertebrae in spinal cord?

A

epidural space

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5
Q

Where within the meningeal layers is CSF found?

A

Subarachnoid space

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6
Q

Where is CSF made?

A

Choroid plexus of ventricular system

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7
Q

What laterally forms from the pia mater?

A

21 dendriculate ligaments - stabilise spinal cord

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8
Q

What spinal vasculature is important for the mestastasis of lower abdomen tumours?

A

Bastons Venous Plexus

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9
Q

Describe the arterial supply of gthe spinal cord

A

Aorta - intercostal arteries - single anterior and 2 posterior spinal arteries

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10
Q

What is the artery of adamkiewicz and what is its clinical significance regarding surgery?

A

Arises from left posterior intercostal artery to supply lower third of spinal cord.

Can become occluded following surgical procedures

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11
Q

Where does the supracristal line lie and what is its functional importance?

A

through body of L4 - landmark for epidural and spinal tap

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12
Q

Which route through the spinal cord so sensory pathways take?

A

Dorsal

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13
Q

Which route through the spinal cord so Motor pathways take?

A

Ventral

Descending - Ds dont go together - descending and dorsal

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14
Q

List and describe the functions of the different sensory axons:

A

A-alpha - proprioceptors of skeltal muscle. Thick and fast

A-beta - mechanoreceptors of skin - medium thickness and fairly quick

A-Delta - Pain and temperature receptors. thin and slow

C - polymodal - thinnest and slowest

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15
Q

Name and describe the pathway responsible for discriminative touch

A

Dorsal column/Medial lemniscus pathway:

 - primary neuron enters dorsal column and travels up to medulla where is synapses at gracile nucleus with internal arcuate fibres
 - These decussate and pass through medial lemniscus of vertebrae to the VPL of thalamus
 - synapses here to pass through internal capsule and onto sensory cortex
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16
Q

Where does the medical lemniscus pathway decussate?

A

Dorsal column nuclei (Gracile nucleus) in medulla

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17
Q

Where does the spinothalamic pathway decussate?

A

At level of entry

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18
Q

Name and describe the pathway responsible for pain

A

Spinothalamic pathway:

 - Primary afferent neuron enters superficial dorsal horn via spinothalamic pathway, using A-delta or C fibres
 - Synapses otno second order neuron and decussates at level of entry
 - Travels up thoracic and cervical white matter in antero-lateral funiculus, through spinothalamic tract and through spinal lemniscus in brainstem
 - synapses onto 3rd order neuron at internal capsule to target sensory cortex
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19
Q

What are the two ascending sensory pathways?

A

Medial lemnisus and spinothalamic

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20
Q

Which of the descending motor pathways are responsible for voluntary movement?

A

Corticospinal tract - movement of torso, arms and legs

Corticobulbar tract - non oculomotor cranial nerve movements

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21
Q

Name and describe the pathway responsible for arm/leg/torso movement

A

Lateral Corticospinal tract (85%):

 - axons leave primary motor cortex to medulla where they decussate. 
 - travel down lateral corticospinal tract to synapse with spinal nerves

Anterior corticospinal tract (15%):

 - axons leave primary motor cortex and travel straight down spinal cord in anterior corticospinal tract
 - Decussate to synapse with spinal nerves at level of exit
22
Q

Name and describe the pathway responsible for movement controlled by cranial nerves

A

Corticobulbar tract:
- axons from primary motor cortex pass through cerebral peduncle of midbrain and to the corresponding cranial nerves in pons (facial) or medulla (hypoglossal) where they decussate

23
Q

What is the difference in the decussation of the lateral and anterior corticospinal tracts?

A

Lateral - medulla

Anterior - at exit point of spinal nerves

24
Q

Name and describe the pathways responsible for maintaining posture (muscular tone)

A

Reticulospinal - made up of pontine (extensor) and medullary (flexor) tracts to modulate alpha motor neurones

Tectospinal - only prejects to cervical segments, modulating alpha and gamma motor neurons

Vestibulospinal -runs entire length of cord, modulating activity of alpha motor neruons

25
Q

What pathway is responsible for subconscious regulation of upper limb muscle tone and movement?

A

Rubrospinal - UMN originate in red nucleus in midbrain and decussate here

26
Q

Where in the rubrospinal tract do UMN originate?

A

red nucleus in midbrain

27
Q

Where does the rubrospinal tract decussate?

A

red nucleus in midbrain

28
Q

How can LBP be caused?

A
  • Mechanical - trauma, muscular pain, facet join syndrome, lumbar disc prolapse
  • Inflammatory - infective spinal lesions, ankylosing spodlitis/sacroilitis
  • Metabolic - osteoporotic fractures, osteomalacia, pagets
  • Neoplastic - metastases, tumour
  • referred pain
29
Q

How does cauda equina syndrome present?

A

bilateral leg pain, baack pain, urinary retention, perineal sensory loss, erectile dysfunction, reduced anal tone

30
Q

What will compression of L2 cause?

A
  • Sensory changes in front of thigh
  • No reflex loss
  • Weakened hip flexion and adduction
31
Q

What will compression of L3 cause?

A
  • Sensory changes in inner thigh and knee
  • Knee jerk reflex loss
  • Weakened knee extension
32
Q

What will compression of L4 cause?

A
  • Sensory changes in inner calf
  • Knee jerk reflex loss
  • Weakened knee extension
33
Q

What will compression of L5 cause?

A
  • Sensory changes in outer calf, upper foot, inner foot
  • No reflex loss
  • Weakened foot inversion and dorsiflexion of toes
34
Q

What will compression of S1 cause?

A
  • Sensory changes in posterior calf and lateral border of foot
  • Ankle reflex loss
  • Weakened plantar flexion of foot
35
Q

What is the best management of LBP?

A

Patient must remain active

Medical therapy - analgesics, muscle relaxants, rehab, anti-depressants etc

36
Q

What is Spinal Shock?

A

temporary suppression of all reflex activity below the injury, ocurring immediately after.

37
Q

What is the first sign of recovery from spinal shock?

A

Return of Babinksis sign

38
Q

What symbolises the end of spinal shock?

A

Bulbocavernous reflex (monitor internal/external anal sphincter in response to squeezing glans penis or clitoris)

39
Q

What is neurogenic shock and how does it present?

A

bodys response to sudden loss of sympathetic function due to an injury to T6 or above

Clincial triad - hypotension, bradycardia and hypothermia

40
Q

How will a cervical injury differ from a thoracic/lumbar/sacral injury in terms of movement?

A

Cervical - quaraplegia

Others - Paraplegia

41
Q

A patient has been stabbed, causing paralysis on same side and loss of pain and temperature on opposite. What is the most likely diagnosis?

A

Brown-Sequard Syndrome

42
Q

What chart measures neurological and sensory functions?

A

ASIA

43
Q

What is an UMN and how does a lesion present?

A
  • Neuron in primary motor cortex which excite alpha motor neurons either directly or via spinal nerves
  • hyperreflexia, muscle weakness, babinski sign, decreased power, pronator druft
44
Q

What is a LMN and how does a lesion present?

A
  • alpha motor neuron which runs from psinal cord to PNS

- hyporeflexia, decreased tone, fibriliations, decreased strenght, atrophy, fasciculations

45
Q

Regarding UMN and LMN lesion sgns, what will a lesion in C1-C5 show?

A

UMN and LMN in both limbs

46
Q

Regarding UMN and LMN lesion sgns, what will a lesion in T3-T12 show?

A

UMN in lower limb

47
Q

Regarding UMN and LMN lesion sgns, what will a lesion in T12-S2 show?

A

LMN in lower limb

48
Q

How will a lesion on C3, 4 or 5 affect breathing?

A

Wont be able to breathe as these supply phrenic nerve which innervates diaphragm

49
Q

How will a lesion on C6 or 7 affect breathign?

A

Paradoxical breathing as these innervate intercostal muscles

50
Q

Describe the physiology of a monosynaptic circuit reflex

A
  • stretch receptors cause signal down primary afferent fibres to spinal cord
  • Synapse with motor neuron which enter NMJ
  • excitation causes a twitch reflex
51
Q

Describe and explain how refelxes can be reinforced

A

Jendrassiks Manoeuvre causes extra polarisation in order to increase reflex response:

 - upper limb - clench teeth
 - lower limb - pull hands apart
52
Q

Why do muscle spindles have primary and secondary afferent fibres?

A

ensure that muscle length is signalled to account for angle contraction

Head, Neck and Neurological Systems (15 decks)

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