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P2 Head, Neck and Neuro > Spinal cord lesion and cranial nerves > Flashcards

Spinal cord lesion and cranial nerves Flashcards

1
Q

Temporary suppression of all reflex activity below the level of injury describes what?

A

Spinal shock

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2
Q

When does spinal shock occur?

A

Immediately after injury

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3
Q

The return of what reflex indicates the end of spinal shock?

A

Bulbocavernosus reflex

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4
Q

What are the clinical effects of spinal shock?

A

Flaccid paralysis Areflexia Loss of sensation - nociception and proprioception Loss of bladder and bowel reflexes

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5
Q

What are the phases of spinal shock?

A

Areflexia Initial reflex return Initial hyperreflexia Hyperreflexia and spasticity

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6
Q

How is the motor function of someone with a spinal cord injury assessed?

A

ASIA charts

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7
Q

How is sensory function after a spinal cord injury assessed?

A

Pin prick Light touch Sacral sparing

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8
Q

Who are the people involved in caring for someone with a spinal injury?

A

Spinal injury unit Physiotherapist Occupational therapist Family

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9
Q

What is the role of the physiotherapist in spinal cord injury rehabilitation?

A

Teaches wheelchair skills, helps relearn balance, strengthens paralysed muscles and teaching to transfer skills

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10
Q

What is the role of the occupational therapist in spinal cord injury rehabilitation?

A

Helps patients reach high level of physical and psychological independence at home and work Help with wheelchairs, computer aids and other tools

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11
Q

What is the role of the family in spinal cord injury rehabilitation?

A

Helps with income support, modifying homes, facilitates community nursing care

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12
Q

In which of an upper motor neuron lesion or a lower motor neuron lesion, is there muscle wasting?

A

Lower

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13
Q

In which of an upper motor neuron lesion or a lower motor neuron lesion, is there fasciculations?

A

Lower = twitching, motor units contract asynchronously because of abnormal repetitive discharge set up in the nerves

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14
Q

Describe the tone in both an upper motor neuron lesion and a lower motor neuron lesion

A

Lower motor neurons lesions lead to flaccid tone Upper motor neurons lesions lead to spastic tone

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15
Q

Describe the weakness/paralysis seen in both an upper motor neuron lesion or a lower motor neuron lesion

A

Lower - loss of muscle bulk Upper - ineffective recruitment of alpha motor neurons

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16
Q

Describe tendon jerk reflexes in both upper and lower motor neuron lesions

A

Lower - reduced or absent Upper - hyperreflexia

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17
Q

What happens to respiration if C3, 4 or 5 are damaged?

A

Phrenic nerve damage - innervates diaphragm Patient will need artificial ventilation to survive

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18
Q

What happens to respiration is C6 or C7 are damaged?

A

These nerves innervate the intercostal muscle- paradoxical breathing Phrenic nerve remains intact

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19
Q

What happens to respiration if T1 or below are damaged?

A

No effect

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20
Q

How much movement can be achieved if there is a spinal injury at C4?

A

None below the neck - quadriplegia

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21
Q

How much movement can be achieved if there is a spinal injury at C5?

A

There will be some control of the should and biceps No wrist or hand control

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22
Q

How much movement can be achieved if there is a spinal injury at C7-T1?

A

Most upper limb control May have dexterity problems with their hands and fingers

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23
Q

How much movement can be achieved if there is a spinal injury at T1-T8?

A

There will be paraplegia - full use of arms Poor control of the trunk as the abdominal muscles are effected Balance - still quite good

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24
Q

How much movement can be achieved if there is a spinal injury in the lumbar of sacral regions?

A

Decreased control of hip flexors and legs

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25
Q

Do patients often lose their micturition reflex?

A

No - the micturition reflex remains intact or recovers unless direct damage to micturition centre S2-4

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26
Q

What is the ‘autonomic bladder’

A

Sensory bombardment of the cord from stretch receptors - bladder emptying occurs when threshold is reached

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27
Q

How can micturition be indirectly controlled?

A

Patient increases sensory bombardment of sacral region by scratching the inner thigh, facilitating the reflex

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28
Q

Do somatic reflexes return after spinal injury?

A

Despite the fact that voluntary control of muscle never returns- somatic reflex do

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29
Q

Which reflexes return first?

A

Ankle Knee Hip- in sequence

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30
Q

Extensor reflexes return around 6 months after transection- what is different about them?

A

Exaggerated - leading to spastic paralysis

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31
Q

Describe autonomic dysrreflexia.

A

Stage of reflex activity that follows primary flaccidity of the shock Due to massive sympathetic discharge Trivial stimulus to body below the level of injury can trigger it

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32
Q

Signs and symptoms of autonomic dysrreflexia

A

Sweating Increased heart rate Hypertension Defecation Erection Micturition

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33
Q

What happens to blood pressure when the bladder fills in people with a spinal cord injury?

A

It increases - flushed face seen on urination

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34
Q

Does autonomic dysrreflexia resolve?

A

Primitive control of autonomic function is re-established - BP control remains more unstable than in normal people

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35
Q

What happens to the Babinski response reflex after spinal cord injury?

A

It initially disappears - and when it comes back, it occurs only in the abnormal form (positive response)

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36
Q

Which reflexes permanently disappear in a spinal cord injury?

A

Abdominal reflexes Cremasteric reflexes

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37
Q

In development, what do the alar and basal plates of the spinal cord become in humans?

A

Alar - dorsal horn Basal - ventral horn

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38
Q

What are the diagnostic reasons you would perform a lumbar puncture?

A

Withdrawal CSF Measure CSF pressure

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39
Q

What are the therapeutic reasons you would perform a lumbar puncture?

A

Administration of antibiotics Chemotherapy

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40
Q

Where would you perform a lumbar puncture?

A

Between L3 and L4 or between L4 and L5

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41
Q

What is the surface marker for the body of L4?

A

Supracristal line passes through the body of L4

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42
Q

In which part (superficial or deep) of the dorsal horn do the spinothalamic and dorsal column tracts terminate?

A
  • Spinothalamic - superficial
  • Dorsal column - deep
43
Q

Which descending tracts are involved in muscle movement?

A

Corticospinal and corticobulbar

44
Q

What descending tracts are involved with muscle tone maintainance?

A
  • Reticulospinal
  • Tectospinal
  • Vestibulospinal
45
Q

What commonly causes central cord syndrome?

A

Hyperextension injuries

Compression of the cord anteriorly by osteophytes and posteriorly by ligamentum flavum

46
Q

Describe what brown-sequard syndrome is, and what commonly causes it.

A

Hemi-section of the cord

  • stab wounds
  • gunshot wounds
47
Q

What does brown-sequard syndrome appear as clinically?

A
  • Paralysis on affected side (corticospinal)
  • Loss of proprioception and fine discrimination (dorsal column) on affected side
  • Loss of pain and temperature loss on the opposite side (spinothalamic)
48
Q

What causes cauda equina syndrome?

A

Due to bony compression or disk protrusion in the lumbar or sacral regions

49
Q

What clinical symptoms arise from cauda equina syndrome?

A
  • Back pain
  • Bowel and bladder dysfunction
  • Leg numbness/weakness
  • Saddles paraesthesia
50
Q

What is neurogenic shock?

A

The body’s response to the sudden loss of sympathic control - occurs in people who have a T6 injury or above - occurs in those who have a greater than 50% loss of sympathetic innervation

51
Q

What is the clinical triad for neurogenic shock?

A
  • Hypotension
  • Bradycardia
  • Hypothermia
52
Q

What is the desired BP to assure good perfusion of the injured spinal cord?

A

85 mmHG MAP

53
Q

What are people with a spinal cord injury high risk for, and require prophylaxis for?

A
  • DVT
  • Pulmonary embolism
54
Q

What are the causes of spinal cord injury?

A
  • Trauma - contusion or penetration/transection of neural tissue
  • Compression - tumour haematoma or bony encroachment
55
Q

Name the mechanism of spinal cord injury

A
  • Hyperflexion
  • Hyperextension
  • Compression
56
Q

What are the secondary effects of spinal cord injury

A
  • Oedema
  • Inflammatory/immune processes
  • Ischaemia
57
Q

What is neurogenic shock

A

Form of disruptive shock caused by the loss of brainstem and higher centre control of the sympathetic nervous system

58
Q

What are the consequences of neurogenic shock?

A

Loss of sympathetic outflow:

  • hypotension caused by peripheral vasodilation
  • bradycardia
  • reduced venous return
  • loss of impulses from the thermoregulatory centre in the brain
  • no sweating
59
Q

What is the Babinsky response in lower motor lesion and upper motor lesion?

A

Lower - negative = normal toe flexion

Upper - Positive = abnormal toe extension

60
Q

At what level is bladder control lost?

A

S2-4 and above - micturition centre If below S4-5 then some control left

61
Q

Why do patients may find it hard to empty their bladder?

A

Loss of sympathetic control via hypogastric nerve - T12 - L1 - this nerve acts on beta3 receptors and keeps the detrusor muscle constricted

62
Q

What is the timing of the 1st phase (areflexia and flaccidity) following spinal cord injury?

A

0 - 1 day

63
Q

What is the underlying physiology of phase 1 (areflexia and flaccidity) following a spinal cord injury?

A

Loss of descending facilitation -> neurones involved in various reflex arcs lose the basal level of excitatory stimulation they normally receive from the brain

64
Q

What is the timing of the 2nd phase (Initial reflex return) following spinal cord injury?

A

1 - 3 days

65
Q

What is the underlying physiology of phase 2 (Initial reflex return) following a spinal cord injury?

A

Denervation supersentivity –> reflexes return due to the hypersensitivity of reflex muscle following denervation as more receptors for neurotransmitters are expressed, easier to stimulate - restoration of reflexes from polysynaptic to monosynaptic

66
Q

What is the timing of the 3rd phase (Initial hyperreflexia) following spinal cord injury?

A

1 - 4 weeks

67
Q

What is the underlying physiology of phase 3 (Initial hyperreflexia) following a spinal cord injury?

A

Axon-supported synapse growth - internerones and lower motor neurons below the transection begin sprouting, attempting to re-establish synapses - 1st synapses to form are shorter axons

68
Q

What is the timing of the 4th phase (Hyperreflexia and spasticity) following spinal cord injury?

A

1 - 12 months

69
Q

What is the underlying physiology of phase 4 (Hyperreflexia and spasticity) following a spinal cord injury?

A

Soma-suported synapse growth - takes longer since synapse formation is some-mediated

70
Q

List all the cranial nerves

A

I Olfactory

II Optic

III Oculomotor

IV Trochlear

V Trigeminal

VI Abducens

VII Facial

VIII Vestibulocochlear

IX - Glossopharyngela

X - Vagus

XI - Spinal accessory

XII - Hypoglossal

71
Q

What is the periaqueductal grey?

A
  • The primary control center for descending pain modulation
  • Contains enkephalin-producing cells that suppress pain, located around the aqueduct
72
Q

What is the red nucleus?

A

Structure in the rostral midbrain next to the substantia nigra involved in motor coordination

73
Q

What are the cerebral peduncles?

A

Structures at the front of the midbrain which arise from the front of the pons and contain large ascending and descending nerve tracts that run to and from the cerebrum and the pons

74
Q

What is the monosynaptic circuit for the knee jerk reflex?

A

2 neuorne reflex arc with a single central synapse

75
Q

Describe the chain of events when a jerk reflex is elicited

A

1 - stimulus - tendon tap stretches the muscle 2 - activates muscle spindle 3 - conduction along afferent sensory fibres 4 - transmission at synapses between ia afferent and motor neurone 5 - conduction along efferent motor fibre 6 - neuromuscular transmission 7 - excitation contraction coupling 8 - twitch contraction of skeletal muscle

76
Q

Where is the synapse of the monosynaptic reflex circuit?

A

In the ventral horn

77
Q

What is the Jendrassik’s maneuver?

A

Reinforcing the reflex by recruiting more motorneurons and thus reaching the threshold for the reflex

78
Q

What is the role of stretch reflex normally?

A

Prolonged stretch produces prolonged contraction - stretch reflex acts to maintain a constant muscle length and control muscle tone

79
Q

What is the impact of sensory homunculus on the discrimination of touch?

A

Greater representation of some body parts - high degree of sensitivity and spatial discrimination in highly represented body parts e.g. hands and face

80
Q

What are receptive fields and what creates them?

A

Each receptor formed by a peripheral endings of sensory receptor branch forms a receptive field

81
Q

How do you test the receptive fields?

A

2-point discrimination test - at what distance can you recognize that it is 2 points touching not just one - to activate separate receptors it must fall within separate fields

82
Q

What is the segmental root level of Jaw-jerk reflex?

A

Trigeminal nerve

83
Q

What is the segmental root level of biceps reflex?

A

C5/6

84
Q

What is the segmental root level of supinator/brachioradialis reflex?

A

C6/7 - radial nerve

85
Q

What is the segmental root level of triceps reflex?

A

C6/7

86
Q

What is the segmental root level of knee jerk reflex?

A

L2/3/4

87
Q

What is the segmental root level of ankle jerk?

A

S1

88
Q

What is the vestibulo-ocular reflex?

A

A gaze stabilizing reflex: the sensory signals encoding head movements are transformed into motor commands that generate compensatory eye movements in the opposite direction of the head movement, thus ensuring stable vision.

89
Q

Label

A
90
Q

What is the structure called and what nerves pass through?

A
91
Q

Label

A
92
Q

Label

A
93
Q

Label

A
94
Q
A
95
Q
A

A - optic chiasm

B - optic tract

C - Pituitary stalk

D - Cerebral peduncle

E - Pons

F - Pyramids

G - Pyramidal decussation

96
Q

What 2 main types of spinal cord injury can occur?

A

Complete

Incomplete

97
Q

List the type of incomplete spinal cord injuries

A

Central cord syndrome

Anterior cord syndrome

Posterior cord syndrome

Brown - Sequard syndrome

Cauda equina syndrome

98
Q

What part of spinal cord is affected in central cord syndrom and what is the group at increased risk?

A

Central area of the spinal cord

Elderly are more susceptible

99
Q

What are the secondary sensory problems arising from spinal cord injury?

A

Asensate skin resulting in:

  • Pressure soars
  • Recumbency - The condition of leaning or reclining
  • Death
100
Q

What are the secondary bladder problems arising from spinal cord injury?

A

Intermittent - feeling pain and pressure in the area, can also be a catheter that is put in and removed

Management techniques:

  • Indwelling catheter - stays in for long periods
  • Suprapubic - inserted through abdominal wall
  • Lofric catheter
  • Silver coated
  • Antibiotic
  • Bladder stimulators
101
Q

What are the secondary problems with bowel following spinal cord injury?

A

Diet

Lactulose

Senna - laxative

Manual evacuation

Bowel regime

102
Q

What are the secondary problems with pain following spinal cord injury?

A

Acute vs chronic

Degenerative disease

Neuropathic pain

103
Q

What are the secondary problems with sexual function following spinal cord injury?

A

Recreational and reproduction:

  • Viagra and Cialis
  • Stimulation
  • Electro-ejaculation

Female

  • Assisted conception
  • Pregnancy - may not feel contractions or would not be able to push
  • Can achieve vaginal birth

P2 Head, Neck and Neuro (11 decks)

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