Spinal Cord and Root Disease Flashcards
ALS presentation
weak, wasted muscles, spasticity, fasciculations, extensor plantar responses, hyperreflexia
Pathophys of ALS
motor neuron damage in anterior horns of spinal cord
Presentation of damaged dorsal spinal roots
sensory deficit, areflexia
Presentation of damaged ventral spinal roots
weakness and wasting
NO spasticity or hyperreflexia
Purkinje Cell damage presentation
ataxia without much weakness
What is damaged in a lumbosacral myelomeningocele
dorsal aspect of the spinal column with an attendant outpouching of meninges and neural elements from spinal cord.
Tx options of syrinx
laminectomy, cyst aspiration, marsupialization of cyst, shunt
Spinal Shock progression
Initially: flaccid quadriplegic and areflexia
Within 3d-3wks: hyperreflexia and spasticity (exaggeration of normal stretch reflex in limbs disconnected from upper motor neuron control)
Note: this happens with cerebrocortical injuries too but not exactly the same timeline
Winging of scapula, what nerve and muscle is damaged
long thoracic nerve (C5-7), serratus anterior muscle
Likely trauma mechanism for vertebral body fracture; what about if not related to trauma
extreme flexion, falls while landing upright;
Not related to trauma: malignancy/osteomyelitis
Brown-Sequard syndrome; what’s the pattern of deficit of pain & temperature vs. proprioception in relation to the lesion and what is damaged?
What else is damaged?
spinothalamic damage: pain & temp deficit 1-2 levels below level of lesion on contralateral side
posterior column damage: proprioception loss ipsilateral to lesion
Corticospinal, rubrospinal tracts, motor neurons: ipsilateral motor paralysis
Pathophys of syringomyelic syndrome
lesion of central gray matter (that affect pain and temp fibers that cross at the anterior commissure; tactile sensation spared)
What is tabetic syndrome
damage to proprioceptive & dorsal root fibers, slassically by syphillis
sx: parasthesias, pain, abnormalities of gait, vibration sense issues.
Upper motor neuron damage progression after trauma
- severe quadriparesis
- rapid recovery of motor function
- spastic paralysis
Lower motor neuron damage (anterior horn cell or more distally) progression following a trauma
fasciculations, fibrillations, flaccid paralysis, hyporeflexia
Ascending sensory fibers pathway; specifically–where is the decussation
afferent fibers enter dorsally into the spine –> legs and trunk (gracillis-medial); arms and neck (cuneatus-lateral) –> MEDULLA –> DECUSSATE (internal arcuate fibers) –> medial lemniscus –> ventroposterolateral nucleus of the thalamus –> somatosensory cortex
Most common cause of abdominal aortic aneurysm
artherosclerosis
Decreased pinprick sensation b/l to T9, normal joint proprioception, inability to move legs (flaccid paralysis) in smoker with s/p recent abd aortic aneurysm repair think ____
anterior spinal artery infact
Arteria radicularis magne (artery of Adamkiewicz) enters at which spinal level?
T10-L1
Upper segment of spinal cord are suppled by branches from ____?
Vertebral arteries
Thoracic spinal cord hemisection – where does pain & temp abnormalities begin
1-2 segments below the lesion
What dermatome is the periumbilical area in
T10
Charcot joints
cumulative damage from loss of reflexes and diminished pain awareness, associated with syphilis and diabetes
Syrinx sx
atrophy of intrinsic hand muscles and weakness (sx of lower motor neurons because its an expansion of spinal canal that compresses on anterior horn or other lower motor neuron pathways)
Atrophy of 1st dorsal interosseous muscle. Where’s the damage?
ulnar nerve (C8-T1); likely at the elbow in the ulnar condyle
How does a syrinx form from trauma
s/p intraspinal contusion (cyst formation) –> damaged tissue removed
Best imaging for spinal processes
MRI
if vascular (like to see AV malformations): spinal angiography
Transverse myelitis CSF & MRI findings
elevated protein (slightly) & patchy enhancement
inflammation with no mass effect
tx transverse myelitis
steroids
Which schistosomiasis is endemic in puerto rico & S. America; and what does it look like?
s mansoni; ovum with spike
What does T. pallidum look like on spine MRI
granulomatous lesion (gumma) in spinal cord
motor descending pathway
where does it decussate
precentral gyrus (primary motor cortex)–> lateral corticospinal tract –> posterior limb of internal capsule –> middle cerebral peduncle –> enter basal pons –> pyramids in medulla –> decussate in PYRAMIDS –> down spinal cord
which tract is responsible for two-point discrimination and graphesthesia
spinothalamic tract
In spinal claudication, what causes leg pain?
shunting of blood to leg muscles, causing ischemia to sensory neurons in spinal cord
Spondylolisthesis vs spondylolysis
slippage of vertebral elements vs. idiopathic dissolution of vertebral elements
CSF finding with spinal cord infarction
relatively normal; slight increase in protein
CSF finding in MS
increased gamma globulin