spinal cord lesions

Question 1

brown-sequard syndrome

Answer 1

ipsilateral loss of proprioception and vibratory sensations from the body below the level of the lesion (posterior columns)

ipsilateral spastic paralysis below the level of the lesion due to destruction of descending motor tracts (UMN)

contralateral loss of pain and temp sensations from body 2 sensory dermatooma segments below the level of the lesion (LSTT)

PULSTT

Question 2

vertebral-artery courses through

Answer 2

vertebral a courses through transverse foramina of C6 through C1, goes to foramen magnum

Question 3

subclavian steal syndrome

Answer 3

obstuction of subclavian artery proximal to verterbal artery

episodic increase in perihperal circulatory demand in associated extremity, usually due to physical work or exercise

Question 4

vertebro-basilar insufficiency signs and symptoms

Answer 4

dizziness
cranial nerve dysfunction
paralysis
loss of consciousness

Question 5

transection of the spinal cord btwn _____ results in quadriplegia

Answer 5

C5-6

Question 6

transection of the spinal cord between the levels of ____ result in paraplegia

Answer 6

T1-L2

Question 7

what can cause spinal shock

Answer 7

trauma, ischemia, or pathological process

Question 8

bell’s cruciate paralysis

Answer 8

characterized by midline involvement of upper portion of pyramidal decussation resulting = paralysis of upper extremity without lower extremity involvment

• UE motor fibers in medulla decussate more superior and medial
• LE motor fibers decussate more inferior and lateral at lower boundary of cervicomedullary junction
• together make up CST with lateral fibers being LE and medial being UE
• may be caused by damage to the dens bec of proximity to medial deussating arm fibers

Question 9

onset of cauda equina
spontaneous pain
sensory deficits
motor deficits
reflexes
sphincters
sexual dysfunction

Answer 9

onset: gradual, unilateral

spont pain: severe: prominent feature unilateral or bilateral asymmetrical (perineum, thig, legs)

sensory deficits: unilateral in saddle region

motor deficits: asymm, no fasiculations, some atrophy

reflexes absent: paterllar and achilles

sphincters: lesser degree of involvement and at later stage

sex dys: less makred

Question 10

anterior spinal artery disruption results in ___

Answer 10

central cord syndrome

Question 11

syringomyelia presentation

Answer 11

destruction of anterior white commissure (bilateral loss of p/t to upper extremities

asymmetrical destruction of LCST (UMN) = pastic paralysis in LE

anterior horns (LMN) may be destroyed causing flaccid paralysis in the UE

posterior columns may be affected causing ipsilateral anesthesia below level of lesion

Question 12

tabes dorsalis presentation

Answer 12

pts complain of lightning pains from lower limbs last several years

atonic bladder from dorsal root involvment

locomotor ataxia (broad based gait and slapping of feet)

postive romberg test (posterior column involvment and or cerebellum)

argyll robertson pupils present

Question 13

what causes tabes dorsalis

Answer 13

meningovascular inflammation of blood vessels as they piere through pia at jnct of dorsal rootlets and posterior columns

-occurs during late stage of syphillis, = bilat ischemic necoriss of postieor columns and dorsal roots at this level

Question 14

holmes adie pupil

Answer 14

benign condition which may be due to a lesion of the ciliary ganglion

-may be confused with argyll roberston pupil bc of simlar light reflexes, distinguised by diff reactions to accomodation

Question 15

holmes adie pupil signs

Answer 15

initially tonic pupil does not appear to react to convergence

if convergence is maintained for everal seconds, pupil will slowly constrict. in argyl robertson happens immediately

• eye drops with methacholine or pilocarpine witll constrict tonic pupil but no effect on normal pupil
• more common in young adult females

Question 16

korsafoff’s syndrome can be from

Answer 16

bilateral destuction of mammillary bodies
can be from alcoholism or pituitary tumors

bitemporal hemianopsia is usually present

-memory problems too

Question 17

homonymous hemianopia with macular sparing

Answer 17

unilateral lesion of visual cortex, could be due to obsturction of the posterior cerebral artery

• if left hom hem then pca infarct on right
• if right hom hem then pca infarct on left