Spinal Cord and Root Disease

Question 1

ALS presentation

Answer 1

weak, wasted muscles, spasticity, fasciculations, extensor plantar responses, hyperreflexia

Question 2

Pathophys of ALS

Answer 2

motor neuron damage in anterior horns of spinal cord

Question 3

Presentation of damaged dorsal spinal roots

Answer 3

sensory deficit, areflexia

Question 4

Presentation of damaged ventral spinal roots

Answer 4

weakness and wasting

NO spasticity or hyperreflexia

Question 5

Purkinje Cell damage presentation

Answer 5

ataxia without much weakness

Question 6

What is damaged in a lumbosacral myelomeningocele

Answer 6

dorsal aspect of the spinal column with an attendant outpouching of meninges and neural elements from spinal cord.

Question 7

Tx options of syrinx

Answer 7

laminectomy, cyst aspiration, marsupialization of cyst, shunt

Question 8

Spinal Shock progression

Answer 8

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

Question 9

Winging of scapula, what nerve and muscle is damaged

Answer 9

long thoracic nerve (C5-7), serratus anterior muscle

Question 10

Likely trauma mechanism for vertebral body fracture; what about if not related to trauma

Answer 10

extreme flexion, falls while landing upright;

Not related to trauma: malignancy/osteomyelitis

Question 11

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?

Answer 11

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

Question 12

Pathophys of syringomyelic syndrome

Answer 12

lesion of central gray matter (that affect pain and temp fibers that cross at the anterior commissure; tactile sensation spared)

Question 13

What is tabetic syndrome

Answer 13

damage to proprioceptive & dorsal root fibers, slassically by syphillis

sx: parasthesias, pain, abnormalities of gait, vibration sense issues.

Question 14

Upper motor neuron damage progression after trauma

Answer 14

1. severe quadriparesis
2. rapid recovery of motor function
3. spastic paralysis

Question 15

Lower motor neuron damage (anterior horn cell or more distally) progression following a trauma

Answer 15

fasciculations, fibrillations, flaccid paralysis, hyporeflexia

Question 16

Ascending sensory fibers pathway; specifically–where is the decussation

Answer 16

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

Question 17

Most common cause of abdominal aortic aneurysm

Answer 17

artherosclerosis

Question 18

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 ____

Answer 18

anterior spinal artery infact

Question 19

Arteria radicularis magne (artery of Adamkiewicz) enters at which spinal level?

Answer 19

T10-L1

Question 20

Upper segment of spinal cord are suppled by branches from ____?

Answer 20

Vertebral arteries

Question 21

Thoracic spinal cord hemisection – where does pain & temp abnormalities begin

Answer 21

1-2 segments below the lesion

Question 22

What dermatome is the periumbilical area in

Answer 22

T10

Question 23

Charcot joints

Answer 23

cumulative damage from loss of reflexes and diminished pain awareness, associated with syphilis and diabetes

Question 24

Syrinx sx

Answer 24

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)

Question 25

Atrophy of 1st dorsal interosseous muscle. Where’s the damage?

Answer 25

ulnar nerve (C8-T1); likely at the elbow in the ulnar condyle

Question 26

How does a syrinx form from trauma

Answer 26

s/p intraspinal contusion (cyst formation) –> damaged tissue removed

Question 27

Best imaging for spinal processes

Answer 27

MRI

if vascular (like to see AV malformations): spinal angiography

Question 28

Transverse myelitis CSF & MRI findings

Answer 28

elevated protein (slightly) & patchy enhancement

inflammation with no mass effect

Question 29

tx transverse myelitis

Answer 29

steroids

Question 30

Which schistosomiasis is endemic in puerto rico & S. America; and what does it look like?

Answer 30

s mansoni; ovum with spike

Question 31

What does T. pallidum look like on spine MRI

Answer 31

granulomatous lesion (gumma) in spinal cord

Question 32

motor descending pathway

where does it decussate

Answer 32

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

Question 33

which tract is responsible for two-point discrimination and graphesthesia

Answer 33

spinothalamic tract

Question 34

In spinal claudication, what causes leg pain?

Answer 34

shunting of blood to leg muscles, causing ischemia to sensory neurons in spinal cord

Question 35

Spondylolisthesis vs spondylolysis

Answer 35

slippage of vertebral elements vs. idiopathic dissolution of vertebral elements

Question 36

CSF finding with spinal cord infarction

Answer 36

relatively normal; slight increase in protein

Question 37

CSF finding in MS

Answer 37

increased gamma globulin