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Neuro II > Spinal Cord Disorders > Flashcards

Spinal Cord Disorders Flashcards

1
Q

What is the most useful sign to determine longitudinal localization?

A

spinal sensory level

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2
Q

The spinal cord how how many segments? How are they classified?

A

31 Total

8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

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3
Q

What is “around the clock” phenomenon? Why does this happen?

A
  • with cervicomedullary lesions, the pattern of weakness is as follows:
    • ipsilateral arm → ipsilateral leg → contralateral leg → contralateral arm

the pattern of decussation is that upper extremity fibers decussate rostral to lower extremities

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4
Q

What is the clinical presentation of a patient with a cervicomedullary lesion?

A
  • Pattern of weakness: ipsilateral arm → ipsilateral leg → contralateral leg → contralateral arm
  • +/- occipital or neck pain
  • If CSF is obstructed → (+) ICP → downbeat nystagmus & papilledema
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5
Q

Symptoms with a SC lesion at C3 or above?

A

death (w/o ventilation) d/t phrenic nerve disconnect

above C4: “onion skin” pattern facial numbness from spinal trigeminal nucleus involvement

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6
Q

Symptoms with a SC lesion at C4-C5?

A

diaphragmatic weakness

above C4: “onion skin” pattern facial numbness from spinal trigeminal nucleus involvement

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7
Q

Symptoms with a SC lesion at C5-C6?

A

quadripelegia

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8
Q

Symptoms with a SC lesion at C7-T1?

A

proximal arm power spared

hand/leg plegia

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9
Q

Symptoms with a SC lesion at T1-T8?

A

Paraplegia

inability to control trunk/sit independently

bowel/bladder dysfunction

+ T7 & above → autonomic dysreflexia/neurogeneic shock

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10
Q

Symptoms with a SC lesion at T9-T12?

A

paraplegia

bowel/bladder dysfunction

trunk stability is preserved

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11
Q

Symptoms with a SC lesion below L1?

A

Paraplegia

bowel/bladder dysfunction

can sit independently

cauda equina syndrome

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12
Q

Symptoms with a SC lesion below L4?

A

paraplegia

can sit independently

bowel/bladder dysfunction

hip flexors are spared

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13
Q

Symptoms with a sacral SC lesion?

A

must be bilateral to impact bladder, bowel & sexual function

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14
Q

How do SC lesions impact reflexes at the level of the lesion, above the lesion, & below the lesion?

A
  • at lesion: decreased
  • above: normal
  • below: increased
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15
Q

Describe the reflexes you would expect to see in a patient with a lesion in C5-C6?

A

decreased biceps & brachioradialis

increased triceps

L4 & S1 increased

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16
Q

Describe the reflexes you would expect to see in a patient with a lesion in C7?

A

decreased triceps

normal biceps & brachioradialis

L4 & S1 increased

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17
Q

Describe the reflexes you would expect to see in a patient with a lesion in L1?

A

increased patellar & ankle reflexes

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18
Q

Describe the reflexes you would expect to see in a patient with a lesion in L2-L4?

A

decreased patellar reflex

increased ankle reflex

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19
Q

Describe the reflexes you would expect to see in a patient with a lesion in L5?

A

normal patellar

increased ankle

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20
Q

Describe the reflexes you would expect to see in a patient with a lesion in C5-C6?

A

abolished ankle reflexes

normal patellar reflex

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21
Q

What is the clinical picture of a patient with conus medularis syndrome?

A

bilateral “saddle” sensory loss

mild bilateral lumbosacral LMN weakness

flaccid bladder dysfunction (early)

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22
Q

What is the clinical picture of a patient with cauda equina syndrome?

A

radicular pain

asymmetric sensory loss

marked asymmetric lumbosacral LMN weakness

flaccid bladder dysfunction (late)

absent patellar/ankel reflexes

23
Q

What are the common causes of conus medullaris syndrome?

A

lumbar disease, trauma, epidural metastasis/abscess L1 or L2, CMV in AIDS, schistostomiasis, HSV type 2

24
Q

What are the common causes of conus cauda equina?

A

lumbar disc disease, trauma, epidural metastasis/abscess L3 or lower, CMV in AIDS, schistostomiasis, neoplasm

25
Q
A

lumbar disc disease, trauma, epidural metastasis/abscess L3 or lower, CMV in AIDS, schistostomiasis, neoplasm

26
Q

The posterior columns of the spinal cord mediate what senses?

A

proprioception

vibration

discriminative touch (fine touch)

27
Q

The spinothalamic tracts of the spinal cord mediate what senses?

A

pain

temperature

non-discriminative touch (crude touch)

pressure

28
Q

The corticospinal tracts of the spinal cord mediate what senses?

A

lateral corticospinal: contralateral muscles

anterior corticospinal: contralateral axial & girdle muscles

29
Q

What are the symptoms seen in a complete cord transection? If the transection is S4/S5?

A
  • sensory loss to all modalities 1-2 segments below the level of inquiry
  • flaccid paralysis w/ autonomic dysfunction
  • spasticity, hyperreflexia below the lesion w/ time
  • S4/S5
    • inability to contract anal sphincter voluntarily or feel pinprick/touch aroudn anus
30
Q

What is likely the cause of acute onset complete cord transection?

A

trauma

31
Q

What is likely the cause of onset within hours of complete cord transection?

A

transverse myelitis (MS, neuromyelitis optica, Lupus, Sjogren’s neurosarcoidosis, etc.)

32
Q

What is likely the cause of onset within days to weeks of complete cord transection?

A

transverse myelitis, paraneoplastic necrotizing myelopathy (anti-Hu, CRMP-5, anti-amphiphysin)

33
Q

What is likely the cause of late onset of complete cord transection?

A

radiation-induced myelopathy

34
Q

What is the major difference between spinal shock & neurogenic shock?

A

spinal shock: acute onset

neurogenic shock: delayed onset (hours-days)

35
Q

What is the cause & presentation of a patient with spinal shock?

A
  • d/t acute cervical spinal cord injury - acute onset
  • below level of injury
    • deceased/absent reflexes
    • loss of sensation
    • flaccid paralysis below injury
  • transiend <48 hrs
  • look for loss of bulbocavernous reflex & anal wink
36
Q

What is the cause & presentation of a patient with neurogenic shock?

A
  • d/t injury T6 & above
  • delayed on set (hours - days)
  • distributive d/t sympathectomy unopposed vagal function
    • hypotension - vasodilation
    • bradycardia
    • hypothermia - unable to regulate temperature
  • lasts 1-3 weeks
37
Q

What is the bulbocavernous reflex?

A

pressure to glans penis or clitoris → anal contraction

38
Q

Autonomic dysreflexia can be cause by lesions above what spinal level? Symptoms?

A

Above T6

increase sympathetics → increase vasoconstriction → increase blood pressure; relay inhibition via carotid & aortic baroreceptors is disrupted by trauma

  • >20% increase in HR
  • flushing
  • piloerection
  • headache
  • visual changes
  • at risk for malignant hypertension
39
Q

What are the possible triggers for autonomic dysreflexia?

A

bladder distension & fecal impaction

40
Q

What deficits are seen in patients with hemicord syndrome?

A
  • Posterior columns
    • ipsilateral vibration & position sensation below level
  • Corticospinal tract
    • ipsilateral UPM weakness below the level
    • if anterior horn → LMN weakness at level of lesion
  • Spinothalamic
    • contralateral pain & temp 1-2 segments below the lesion
  • damage to descending autonomic fibers
    • ipsilateral Horner (if C8-T1)
    • loss of sweat below the lesion
  • NO bladder dysfuncyion
41
Q

Most common causes hemicord syndrome?

A

penetrating trauma

knife, gunshot, metastases

42
Q

What deficits are seen in patients with central cord syndrome?

A
  • Spinothalamic tract
    • bilateral loss pain & temp - cape/vest pattern
  • may involve anterior horn cells → LMN weakness
  • may involve corticospinal tract & anterolatera tracts → UMN weakness + descending loss temp & sensation below lesion
43
Q

What is syringomyelia?

A

enlargement of central canal of spinal cord

44
Q

Cervical hyperextension injury may involve formation of fluid in the central spinal canal called what?

A

syrinx

45
Q

What is “man in a barrel syndrome”?

A

acute tramua → swelling w/ quadriplegia → as swelling decreases have proximal weakness of arms & legs

also, in cases cerebral hypoperfusion d/t watershed stroke

46
Q

What are the symptoms in a patient with extramedullary compression?

A

ascending contralateral pain/temp & sensory loss

UMN signs usually occur early

47
Q

What are the common causes of extramedullary compression?

A
  • Spinal Stenosis
    • mild (effacement CSF)
    • moderate (contact/displacement of spinal cord)
    • severs (compression of neural structures)
    • vere severe (compression spinal cord / myelomalacia)
  • tuberculosis
  • spinal tumors
    • breast, lung, melanoma, lymphoma
48
Q

What deficits are seen in patients with posterior cord syndrome?

A
  • impaired vibration & proprioception → sensory ataxia w/ “stomping gait”
  • dorsal root involvement
    • reflexes absent (esp legs)
  • strength preserved
  • may see Lhermitte sign: electric shock sensation on passive neck flexion
49
Q

What are the major causes of posterior cord syndrome?

A

cervical spondylotic myelopathy, neurosyphilis, radiation

50
Q

Repeated trauma to the feet can result in what condition?

A

Charcot arthropathy

osteoclastic resorption leading to neuropathic joints

51
Q

What is the acronym associated with posterior cord syndrome?

A
  • D - dorsal column degeneration
  • O - orthopedic pain (charcot joints)
  • R - reflexes decreased/absent
  • S - shooting pain
  • A - Argyll-Robertson pupils (accommodate but do not react)
  • L - locomotor ataxia
  • I - impaired proprioception
  • S - syphilis (tertiary)
52
Q

What deficits are seen in patients with posterolateral cord syndrome?

A
  • impaired vibration, proprioception, UMN
  • spastic/ataxic gain; reflexes may be increased or decreased
  • may have bladder spasticity from descending autonomic involvement
  • temp/pain generally spared
53
Q

What are the main causes of posteolateral syndrome?

A

vitamin B12 or copper deficiency, HIV, NO / zinc toxicity, vertebral disease

54
Q

What is the other name for posterolateral cord syndrome?

A

subacute combined degeneration

Neuro II (30 decks)

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