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NEURO > Spinal Cord Disorders > Flashcards

Spinal Cord Disorders Flashcards

1
Q

LMN lesion

A
  • focal weakness
  • severe focal atrophy
  • fasciculations may be present
  • decreased muscle tone and dec MSR
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2
Q

UMN lesion

A
  • diffuse weakness
  • mild atrophy
  • no fasciculations
  • INC muscle tone (spasticity)
  • INC MSR
  • clonus
  • pathological reflexes (Babinski sign)
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3
Q

C5,C6

A

deltoids, biceps

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4
Q

C7,C8

A

triceps

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5
Q

C8,T1

A

interossei, flexor digitorum (finger flexors)

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6
Q

L2,3,4

A

iliopsoas (hip flexor), quadriceps

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7
Q

L4,5

A

tibialis anterior (foot dorsiflexor)

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8
Q

S!,2

A

gastrocnemius (foot plantar flexor)

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9
Q

radicular (root) pain

A

lightening, stabbing, shooting electrical pain in the dermal distribution of a dorsal root

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10
Q

what does radicular (root) pain indicate?

A

-dorsal root inflammation which occurs in shingles from Herpes zoster
OR
-compression by an extramedullary lesion with arises outside the spinal cord

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11
Q

extramedullary vs intramedullary pain

A
  • extra (herniated intervertebral disc or vertebral tumor) may also produce a more constant dull local pain
  • intra arises inside sc, creates diffuse or no pain
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12
Q

what indicates intramedullary lesion within the spinal cord itself

A

a suspended pattern of deficit with sacral sparing (since sacral is at the very edge; order: c.t.l.s)

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13
Q

what indicates an extramedullary lesion arising from outside the spinal cord

A

a sensory deficit for pain and temp up to a level with sacral involvement

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14
Q

what would a severe fracture and displacement of the T12 vertebral body approximately affect

A

the L3 level of the spinal cord itself

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15
Q

transection of transverse myelopathy

A

complete (or nearly complete) lesion encompassing cross-sectional extent of the sc at one or a few adjacent levels

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16
Q

transverse myelitis

A

when lesion is inflammatory or infectious in nature

17
Q

C8 transverse myelopathy

A
  • severely atrophic, weak hand muscles with fasciculations
  • spastic, hyper-reflexic, weak lower limbs with Babinski signs
  • bladder and bowel dysfunction may occur from impairment of descending motor tracts which control the sacral anterior horn cells that innervate the sphincter muscles
18
Q

what happens when the transection is due to severe, acute TRAUMA

A
  • the setting of spinal or neurogenic shock may initially be present
  • UMN aign emerge weeks or months later
19
Q

involvement of what may impair phrenic nerve function and cause respiratory failure

A

extensive involvement of anterior horn cells at levels C3,C4,C5 (keeps the diaphragm alive)

20
Q

What are some causes of transverse myelopathy

A
  • tumors (especially vertebral mets)
  • spinal stenosis (sc compression from degen of bony spinal column and herniated intervertebral discs)
  • extradural hemorrhage or abscess
21
Q

what causes transverse myelitis

A
  • viral infections
  • rxn to vaccines
  • ai demyelination of the sc (eg from MS)
22
Q

role of corticosteroids

A

rapidly help reduce sc edema from tumors or myelitis and improve recovery of those with severe sc trauma

23
Q

Brown-Sequard syndrome (sc hemisection)

A
  • contra deficit to pain and temp sensation
  • ipsi deficit of vibe and position sense
  • ipsi weakness
24
Q

what are common causes of hemisection

A
  • trauma
  • extramedullary tumors
  • herniated discs with regenerative disease of the bony spine
25
Q

syringomyelia

A
  • spinal cord lesions from a syrinx, or cavity, within or near the center of the sc
  • an intramedullary lesion, primarily affects gray matter
26
Q

where does a syrinx usually occur

A

in the cervical or thoracic spinal cord, may extend over several segments or levels in a longitudinal or r-c direction enlarging slowly over time

27
Q

syringomyelia cp

A
  • suspended sensory level with sacral sparing, shawl/cape
  • preservation of the vibration and position sense
  • may be a late residual of severe sc injury
28
Q

causes of syringomyelia

A
  • traumatic cervical sc hemorrhage will resorb if pt survives leaving a cavity/syrinx in its place
  • intramedullary sc tumors
  • impaired CSF flow (Chiari malformation)
29
Q

anterior spinal artery

A
  • supplied by several radicular branches of the aorta and has a midline longitudinal orientation
  • supplies anterior/ventral 2/3 of the spinal cord (sc stroke would occur if it were blocked or occluded)
30
Q

anterior spinal artery occlusion 1/2

A
  • usually occurs in lower thoracic or upper lumbar spinal cord
  • involvement of the corticospinal tracts there=paraplegia with UMN signs in lower limbs and a thoracic level of sensory loss, without sacral sparing, to pain and temp
  • vibe and position sense are nml
31
Q

anterior spinal artery occlusion 2/2

A
  • back pain or radicular pain are common initial s/s

- occurs suddenly and progresses over hours (like a stroke)

32
Q

posterolateral syndrome/subacute combined degeneration

A
  • classically due to vit b12 deficiency
  • in the sc demyelination and degeneration of the white matter takes place at thoracic levels
  • vibe and position sense are reduced/lost in lower limbs
  • spastic paresis from involvement of the corticospinal tract
  • pain and temp are not affected
  • may also be caused by copper deficiency or HIV
33
Q

ALS

A
  • diffuse motor neuron lesions: cerebral cortex, brain stem, spinal cord
  • sensory pathways are not affected
  • bowel and bladder function remain nml
  • radicular pain is not present
  • fasciculations are prominent
34
Q

when would you suspect a cervical myelopathy

A

if LMN signs developed in the upper limbs and UMN signs were found in the lower limbs

35
Q

tabes dorsalis

A

-neurosyphilis affecting the spinal cord

36
Q

tabes dorsalis path

A
  1. lumbosacral dorsal roots become infected and inflamed producing severe radicular lightening pains in the lower limbs
  2. dorsal and posterior columns degenerate=impairment of vibe and position sense
  3. loss of sensation in lower limbs where reflexes are lost (afferent reflex arcs are disrupted)
    - strength remains intact since motor neurons and corticospinal tract are spared

NEURO (21 decks)

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