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Neuro > Spinal Cord disorders > Flashcards

Spinal Cord disorders Flashcards

1
Q

what are LMN signs

A 
focal weakness
severe atrophy 
fasciculations
decreased muscle tone
decreased reflexes
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2
Q

What are UMN signs

A 
diffuse, severe weakness
mild atrophy
increased muscle tone (spasticity)
increased reflexes
possible clonus
posible babinski sign
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3
Q

when are LMN signs seen

A

when there is a spinal cord lesion affecting the anterior horn cells that innervate the muscles of the limb

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4
Q

when are UMN signs seen

A

in limbs below a spinal cord lesion that affects the corticospinal tract
•ipsilateral cervical or thoracic spinal cord lesion or
• contralateral brainstem or brain lesion

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5
Q

what is radicular (root) pain

A

lightning, stabbing or shooting electrical pain in the dermatomal distribution of a dorsal root.

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6
Q

what does radicular pain indicate

A

inflammation of the dorsal root

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7
Q

what are 2 examples that cause radicular pain

A

Herpes zoster

compression by an extramedullary lesion

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8
Q

what kind of pain does an extramedullary lesion itself cause (not the resulting compression)

A

constant dull, local pain

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9
Q

what kind of pain is caused by an intramedullary lesion

A

diffuse pain or none at all

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10
Q

how can radicular pain be relieved

A

analgesics, anti-inflammatory medications or nerve block procedures.

chronic root pain - anticonvulsants and antidepressants

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11
Q

what are the signs and symptoms of a spinal cord lesion in the spinothalamic tract

A

pain and temperature deficit in the contralateral body

dermatomal level of loss approximates the level of the lesion

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12
Q

what would a suspended patter of pain and temperature loss with sacral sparing indicate

A

intramedullary lesion

due to disruption of the decussating spinothalamic tract fibers and possibly medial portions of the STT

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13
Q

where are sacral fibers located in the STT

A

laterally

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14
Q

what would a sensory deficit for pain and temperature up to a level with sacral involvement indicate

A

extramedullary lesion (compressing from outside the spinal cord)

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15
Q

where would you expect position sense and vibration sense deficits due to a spinal cord lesion

A

ipsilateral side

lesion would affect the DCP (crosses in the medulla)

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16
Q

how would an extramedullary lesion present

A

radicular pain with sensory loss up to a level including sacral

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17
Q

how would an intramedullary lesion present

A

diffuse or no pain, sensory loss would be suspended with sacral sparing

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18
Q

what is a transverse myelopathy

A

complete lesion of the spinal cord

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19
Q

what is a transverse myelitis

A

a transverse myelopathy that is inflammatory in nature

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20
Q

what can be used to approximate the level of a transverse myelopathy (transection)

A

the dermatomal level of sensory loss and the presence of any lower motor neuron signs

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21
Q

what causes spinal or neurogenic shock

A

trauma

22
Q

what is spinal or neurogenic shock

A

weakness my be accompanied by decreased muscle tone and muscle stretch reflexes with the expected UMN signs only gradually emerging weeks to months later

23
Q

a lesion at what level could cause respiratory failure

A

involvement of anterior horn cells at C3, C4, C5 - may impair phrenic nerve function

24
Q

what are some examples of extramedullary lesions that could cause transverse myelopathy

A

tumors, spinal stenosis, extradural hemorrhage or abscess, severe spinal cord ischemia

25
Q

what are examples of inflammatory causes of a transverse myelopathy

A

viral infections, autoimmune demyelination (MS)

26
Q

how does a Brown-Sequard lesion present?

A
  • contralateral pain and temperature deficit
  • ipsilateral deficit of vicration and position sense
  • ipsilateral weakness with LMN and UMN signs
27
Q

what are common causes of Brown-Sequard hemisection lesions

A

trauma, extramedullary tumors and herniated discs with degenerative disease of the bony spine

28
Q

when would you see a Horner’s syndrome with a Brown-Sequard lesion

A

if it was above T1

29
Q

what is a syringomyelia

A

spinal cord lesion from a syrix or cavity within or near the center of the spinal cord (primarily affects the grey matter there) - intermedullary lesion

30
Q

what are the most common locations for a syrinx

A

the cervical or thoracic spinal cord and may extend over several segments or levels - enlarging slowly over time

31
Q

what tracts/fibers are interrupted by a syrinx

A

selectively interupts the decussating fibers of the STT

32
Q

what symptoms does syringomyelia cause

A

defitic of pain and temperature ofver the dermatomes involved but sparing of the sacral dermatomes = suspended sensory level with sacral sparing (cape-like pattern)

may expand causing weakness later on

preservation of vibration and position sense bc DCP is spared

33
Q

what causes syringomyelia

A

later residual of severe spinal cord injury
i.e. a traumatic cervical spinal cord hemorrhage will resob if the patient survives leaving a cavity or cyrix in its place

other causes- intramedullary spinal cord tumors or impaired CSF flow from a congenital abnormality of the posterior fossa (Chiari malformation)

34
Q

what is a congenital malformation that may cause a syringomyelia

A

Chiari malformation - abnormality in the posterior fossa that prevents the flow of CSF

35
Q

what does the anterior spinal artery supply

A

the anterior 2/3 of the spinal cord

36
Q

what happens if the anterior spinal artery is blocked

A

a “spinal cord stroke” occurs

37
Q

what causes occulsion of the anterior spinal artery

A

atherosclerotic disease of the aorta, or a complication of surgery for an aortic aneurysm, or an aortic dissection in a hypertensive patient

38
Q

what is the most common location of an anterior spinal artery occulsion

A

lower thoracic or upper lumbar spinal cord

39
Q

what are the symptoms of an anterior spinal artery occulsion

A

paraplegia with UMN signs in the lower limbs and a thoracic level of sensory loss, without sacral sparing to pain and temperature.

vibration and position sense remain normal (posterior dorsal columns are preserved)

back or radicular pain are common initial symptoms. Symptoms occur suddenly and progress over hours

40
Q

what causes posterolateral syndrome or combined degeneration

A

Vitamin B12 deficiency

rarely copper deficiency of HIV

41
Q

is posterolateral syndrome or combined degeneration reversible

A

yes if caught early

42
Q

what other problems may accompany posterolateral syndrome or combined degeneration

A

polyneuropathy, optic neuropathy and dementia - all can be caused by vit B12 deficiencies

43
Q

what happens in posterolateral syndrome or combined degeneration and where does it take place

A

demyelination and degeneration of the white matter usually at thoracic levels

44
Q

what does “combined degeneration” refer to

A

involvement of the posterior and lateral columns

45
Q

what are the symptoms/signs of posterolateral syndrome or combined degeneration

A

vibration and position sense are reduced or lost in the lower limbs (unsteadiness and falling if the patient walks in the dark or with eyes closed)

spastic paraparesis from involvement of the corticospinal tract

pain and temperature are not affected

46
Q

what is ALS

A

degenerative disease affecting UMN and LMN, lesions occur diffusely

47
Q

What important features of ALS helps distinguish it from a spinal cord lesion

A

it does not affect the sensory pathways, bowel and bladder functions remain normal, and radicular pain is not present

48
Q

what is tabes dorsalis

A

nervous system involvement by infection with syphilis

49
Q

where is the lesion in tabes dorsalis

A

lesion of the dorsal roots and dorsal spinal cord

50
Q

what are the symptoms of tabes dorsalis

A

first - severe radicular pains in the lower limbs
then impairment of vibration and position sense in the lower limbs, eventually all sensation in the lower limbs is lost, and loss of reflexes

strength remains in tact

Neuro (11 decks)

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