spinal cord lesions

Question 1

diseases that affect motor neurons in anterior horn (LMN diseases)

Answer 1

poliovirus
west nile virus
spinal muscular atrophy (Werdnig Hoffman disease)

Question 2

AR disease
neuron death in anterior horn of spinal cord
infant: flaccid paralysis, die

Answer 2

spinal muscular atrophy (Werdnig Hoffman disease)

Question 3

disease affects oligodendroglia (CNS) →
demyelination of CNS (no saltatory conduction) →
random and symmetric lesions in white matter of spinal cord + brainstem + brain
`

Answer 3

multiple sclerosis

Question 4

autoimmune disease
more common in women 20-30 yo
charcot's triad: 
scanning speech
intention tremor
nystagmus
may also have: 
internuclear opthalmoplegia (lesion to MLF) - paralysis of adducting eye + nystagmus of abducting eye on attempted lateral gaze 
bowel/bladder incontinence
optic neuritis

Answer 4

multiple sclerosis

Question 5

CSF of poliovirus

Answer 5

lymphocytic pleocytosis

N/slight elevation of protein

Question 6

CSF of multiple sclerosis

Answer 6

very HIGH elevation of protein (immunoglobulin light chains = oligoclonal bands on electrophoresis)

Question 7

diagnosis of MS

Answer 7

lesions of brain + spinal cord

Question 8

treatment of MS

Answer 8

severe exacerbation: high dose steroids for 1 week
IFN-B
natalizumab
if bladder incontinence/neurogenic bladder: catheter
spastistity (no UMN): muscular relaxer
pain: opioids

Question 9

disease that affects motor neurons of anterior horn (LMN) + lateral corticospinal tracts (UMN)

Answer 9

amyotrophic lateral sclerosis (ALS)

Question 10

LMN signs  + UMN signs (no sensory deficit)
rapidly progressive weakness
muscle atrophy
fasiculations
spasticity
difficulty speaking (dysarthria)
difficulty swallowing (dysphagia)
difficulty breathing (dyspnea)

Answer 10

amyotrophic lateral sclerosis (ALS)

Question 11

defect in superoxide dismutase 1

Answer 11

amyotrophic lateral sclerosis (ALS)

Question 12

treatment of ALS

Answer 12

↑ survival time: Riluzole: ↓ presynaptic glutamate release since neurotoxic at high doses

Question 13

3° syphilis causes

Answer 13

tabes dorsalis

Question 14

disease with no dorsal columns: no light touch + proprioception
+ Romberg sign (need 2 of 3 variables to maintain balance - no visual + proprioception)
argyll robertson pupil
absent DTR
sensory ataxia at night: broad-gait

Answer 14

tabes dorsalis (3° syphilis)

Question 15

Argyll Robertson pupil

Answer 15

pupil accommodates but doesn’t react to light (3° syphilis - tabes dorsalis)

Question 16

loss of pain + temp sensation (spinothalamic)
loss of bilateral motor command: corticospinal tracts (UMN signs) + anterior horns (LMN signs)
BELOW lesion: complete motor paralysis, loss of pain + temp, areflexia

Answer 16

anterior spinal artery lesion (only spares dorsal columns + Lissauer’s tracts - light pressure, touch, vibration)

Question 17

cause of anterior spinal artery lesion

Answer 17

aortic aneurysm
aortic dissection
direct trauma to aorta
atherosclerosis

Question 18

cyst (syrinx) or cavity within spinal cord

usually between C2-T9

Answer 18

syringomyelia

Question 19

associated with Chiari malformation I

Answer 19

syringomyelia

Question 20

most commonly affects: C2-T9
damage to anterior white commisure + spinothalamic tracts
+/- chronic pain
may lose sensations in hands

Answer 20

syringomyelia

dorsal columns: fine touch proprioception spared

Question 21

complete hemisection of spinal cord:
below lesion:
ipsilateral UMN signs (no corticospinal tract)
ipsilateral loss of tactile, vibration, proprioception (no dorsal columns)
CONTRALATERAL loss of pain + temperature 2-3 (no corticospinal tracts) segments BELOW lesion
At lesion:
ISPILATERAL pain + temp loss for 2-3 segments (no Lissauer tract)
ipsilateral LMN signs (no anterior horn)

Answer 21

brown-sequard syndrome

Question 22

CSF of Guillain-Barre syndrome

Answer 22

↑ protein

normal cell count