Spinal cord Dysfunction

Question 1

Name some descending motor tracts of the spinal cord

Answer 1

• Lateral Corticospinal Tract
• Pontine Reticulospinal tract
• Vestibulospinal Tract
• Tectospinal tract
• Anterior corticospinal tract

Question 2

What would you see in LMN injury?

Answer 2

Reduced Tone
Reduced reflexes
Muscle atrophy
Flaccid
Fasciculations
May have sensory disturbrances

Question 3

what would you see in UMN injury?

Answer 3

Spasticity
Increased tone
Increased muscle stretch reflexes
minimal atrophy
NO. fasciculations

Question 4

What would happen if you damaged the lateral corticospinal tract?
Are they upper or lower MNs?

Answer 4

Ipsilateral:
Paralysis
Paresis
hyperreflexia
Clonus
Babinkskis sign

Question 5

What would happen if you damaged Spinal Motor Neurons? Are they UMN or LMN

Answer 5

paralysis
paresia
Hypotonia
Hyporeflexia
fibrillations
muscle atrophy

Question 6

explain the process of urinary storage from the PONS

Answer 6

pons storage centre ->pelvic nerve
OR -> external bladder, inhibition of detrusor
&
- > pudendal nerve -> external urethral sphincter

Question 7

What are the main causes of spinal cord syndromes

Answer 7

1. Extra axial : extra dural or intradural
   b. Extradural: Structures related to the vertebral column
   c. Intradrual: meningeal based
2. Axial: arising within the spinal cord

Question 8

Name some common spinal cord syndromes

Answer 8

1. Complete sensorimotor myelopathy
2. Combined painful radiculopathy and transverse myelopathy
3. hemi-cord (brown sequard) syndrome
4. …
   …

Question 9

What is Brown Sequard Syndrome

Answer 9

lateral hemisection (cutting) of the spinal cord- causing SENSATION and MOTOR function loss (paralysis and anesthesia)

Question 10

What ipsilateral signs would you see?

Answer 10

Interruption of the LATERAL CORTICOSPINAL TRACTS:
Ipsilateral spastic paralysis below the level of the lesion
Babinski sign ipsilateral to lesion
Abnormal reflexes and Babinski sign may not be present in acute injury.

Interruption of DORSAL COLUMN/MEDIAL LEMN PATHWAY:
Ipsilateral loss of tactile discrimination, vibratory, and position sensation below the level of the lesion

Question 11

What contralateral signs would you see?

Answer 11

Spinothalamic tract: loss of pain and temp and crude touch

Question 12

Whats the difference in symptoms between an EARLY central cord lesion and a LATE central cord lesion? think location

Answer 12

EARLY lesion- would be very central- only get spinothalamic fibres which are crossing over:ie. crude touch, pain and temp from within 1 spinal segment, so only some loss

LATE: crossing spinothalamic fibres and motor tract neurons would be involved

Question 13

Vitamin B12 related myopathy

Answer 13

Combined system degeneration- ESPECIALLY:
Posterior column/medial lemniscal pathway AND
UMN signs

Question 14

What is the CAUDA EQUINA?

What is cauda equina syndrome?

Answer 14

L2-L5, Coxygeal and sacral nerves - >originate from the CONUS meularis of the spinal cord
CES is acute loss of function of CE causing acute loss of function of the lumbar plexus, (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord. CES is a lower motor neuron lesion.

Question 15

What do you see in CES?

Answer 15

Sciatic and nerve root pain
Bilateral and asymmetric, atrophic paralysis
Radocicular sensory loss and sphincteric disorder

->Severe back pain, saddle anesthesia, incontinence and sexual dysfunction are considered “red flags”

Question 16

What is conus medullaris syndrome?

What do you see?

Answer 16

L1-L2ish?
Early disturbance of bowel and bladder function
Symmetric sensory loss over legments
Lax anal sphincter, loss of anal and bulbocavernosus reflex
Impotence
Occasionally wekaness of legs

Question 17

High cervical cord-foramen magnum syndrome

Answer 17

-Quadraparesis
- Occipital headache and neck stiffness
- Weakness and atrophy of intrinsic hand muscles and dorsal neck muscles
= Marked imbalance
- Variable sensory changes

Question 18

The CAUSES of SPINAL CORD SYNDROMES
Can be remembered by a PNEUMONIC:
VIBRATED SPASMS

Answer 18

Vascular
Inflammatory
B12 deficiency
Radiation
ALS
Tumour, trauma, toxic
Epidural, abscess, electricity
Developmental and hereditary

Spondylosis and spine
Paraneoplastic and parasaggital
Arachnoiditis
Syringopmyelia
Multiple scleorisis and myelitis
Systemic Disorders

Question 19

classification in broadh terms 
if it is 
sudden
subacute 
chronis

Answer 19

Sudden: vascular
Subacute: inflammation
Chronic: mass

Question 20

How do you assess spinal cord dysfunction

Answer 20

History and Examination
Imaging: Xray, CT scan, MRI
LP and CSF analysis
Evoked potential testing
Serology

Question 21

What do you check for in cerebrospinal fluid after a LP?

Answer 21

• CS PROTEIN
• CS GLUCOSE
• CSF RBC count
• CSF white blood cell count
  (a) neutrophils
  (b) lymphocytes
• Xanthrochromia (subarachnoid haemorrhage)

Question 22

NAme some SEROLOGY/LAB STUDIES for spinal cord dysfunction

Answer 22

1. anti-neuromyelitis optica (NMO) antibodies
2. HTLV-1
3. HIV
4. Vitamin B12