spinal cord lesions Flashcards
diseases that affect motor neurons in anterior horn (LMN diseases)
poliovirus
west nile virus
spinal muscular atrophy (Werdnig Hoffman disease)
AR disease
neuron death in anterior horn of spinal cord
infant: flaccid paralysis, die
spinal muscular atrophy (Werdnig Hoffman disease)
disease affects oligodendroglia (CNS) →
demyelination of CNS (no saltatory conduction) →
random and symmetric lesions in white matter of spinal cord + brainstem + brain
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multiple sclerosis
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
multiple sclerosis
CSF of poliovirus
lymphocytic pleocytosis
N/slight elevation of protein
CSF of multiple sclerosis
very HIGH elevation of protein (immunoglobulin light chains = oligoclonal bands on electrophoresis)
diagnosis of MS
lesions of brain + spinal cord
treatment of MS
severe exacerbation: high dose steroids for 1 week
IFN-B
natalizumab
if bladder incontinence/neurogenic bladder: catheter
spastistity (no UMN): muscular relaxer
pain: opioids
disease that affects motor neurons of anterior horn (LMN) + lateral corticospinal tracts (UMN)
amyotrophic lateral sclerosis (ALS)
LMN signs + UMN signs (no sensory deficit) rapidly progressive weakness muscle atrophy fasiculations spasticity difficulty speaking (dysarthria) difficulty swallowing (dysphagia) difficulty breathing (dyspnea)
amyotrophic lateral sclerosis (ALS)
defect in superoxide dismutase 1
amyotrophic lateral sclerosis (ALS)
treatment of ALS
↑ survival time: Riluzole: ↓ presynaptic glutamate release since neurotoxic at high doses
3° syphilis causes
tabes dorsalis
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
tabes dorsalis (3° syphilis)
Argyll Robertson pupil
pupil accommodates but doesn’t react to light (3° syphilis - tabes dorsalis)
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
anterior spinal artery lesion (only spares dorsal columns + Lissauer’s tracts - light pressure, touch, vibration)
cause of anterior spinal artery lesion
aortic aneurysm
aortic dissection
direct trauma to aorta
atherosclerosis
cyst (syrinx) or cavity within spinal cord
usually between C2-T9
syringomyelia
associated with Chiari malformation I
syringomyelia
most commonly affects: C2-T9
damage to anterior white commisure + spinothalamic tracts
+/- chronic pain
may lose sensations in hands
syringomyelia
dorsal columns: fine touch proprioception spared
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)
brown-sequard syndrome
CSF of Guillain-Barre syndrome
↑ protein
normal cell count
