spinal cord - lesions / reflexes Flashcards
1
Q
Characteristic of spinal cord lesions in Multiple sclerosis
A
- mostly white matter of cervical region
- random and asymmetric lesions
- demyelination
2
Q
ALS means / AKA
A
amyotrophic lateral sclerosis (Lou Gehring disease)
3
Q
ALS pathophysiology
A
defect in superoxide dismutase 1 –> combined UMN and LMN deficits with NO sensory, occulomotor deficits, bowel, bladder or sensory deficits
4
Q
ALS - deficits
A
combined UMN and LMN deficits with no sensory or occulomotor deficits
NO SENSORY OR BOWEL BLADDER DEFICITS
5
Q
ALS - mutation in
A
superoxide dismutase 1
6
Q
ALS - clinical signs
A
both UMN and LMN signs
7
Q
ALS - treatment
A
Riluzole
8
Q
Riluzole action on ALS / mechanism of action
A
modestly increases survival by decrease glutamate excitotoxicity
9
Q
ALS - common presentation
A
asymmetric limb weakness (hands/feet), fasciculations, eventual atrophy
10
Q
spinal cord lesions - complete inclusion of anterior spinal artery
A
spares dorsal columns and Lissaeuer tract
11
Q
watershed area of anterior spinal cord (why)
A
upper throracic ASA territory, as Adamkiewicz artery supplies ASA below T8
12
Q
Adamkiewicz artery supplies ASA … (area)
A
below T8
13
Q
…… supplies ASA below T8
A
Adamkiewicz artery
14
Q
Tabes dorsalis is caused by
A
3 syphilis
15
Q
tabes dorsasis - spinal cord lesion?
A
degeneration (DEMYELINATION) of dorsal columns and roots
16
Q
tabes dorsasis –> …. (results)
A
- impaired sensation proprioception
2. progressive sensory ataxia
17
Q
tabes dorsalis - progressive sensory ataxia
A
inability to sense or feel legs –> poor coordination
18
Q
tabes dorsalis is associated with
A
- Charcot joints
- shooting pain (paresthesias)
- Argyll Robertson pupils
19
Q
Charcot joints is also called
A
Neuropathic arthropathy
20
Q
Charcot joints refers to
A
progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity.
21
Q
Argyll Robertson pupils
A
are bilateral small pupils that reduce in size on a near object (accommodate) they do not “react” to light
22
Q
Argyll Robertson pupils is AKA
A
prostitute’s pupils
23
Q
tabes dorasil - clinical examination
A
- absence of Deep Tendon Reflexes
- Romberg sign (+)
- Argyll Robertson
- Stroke without hypertension
24
Q
Syringomyelia - definition
A
syrinx expands and damage ANTERIOR WHITE COMMISSURE of spinothalamic tract (2nd neurons) –> can expand and affect other tracts
25
Syringomyelia - symptoms (and area) / seen with
bilteral loss of pain and temperature
usually C8-T1 --> cape - like
seen with Chiari I malformation
26
vitamin B12 deficiency - spinal cord lesions
sabacute combined degeneration --> demyelination of dorsal column, lateral corticospinal tracts, and spinocerebellar tracts
27
vitamin B12 deficiency - symptoms because of spinal cord lesions
1. ataxic gaits
2. paresthesia
3. impaired progression and vibration sense
4. weakness
28
poliomyelitis is caused by / root of transmission
poliovirus / fecal-oral
29
poliovirus to CNS (direction)
Replicates in oropharynx and small intestine before spreading via bloodstream to CNS
30
poliomyelitis - pathophysiology
infection causes destruction in anterior horn of spinal cord (LMN death)
31
poliomyelitis - death of ... cells
LMN
32
poliomyelitis - signs and symptoms
1. signs of infection --> malaise, headache, fever, nausea
| 2. LMN lesion signs --> weakness, hypotonia, flaccid paralysis, fasciculations, hyporeflexia, muscle atrophy
33
Werding-Hoffman disease is also called
Spinal mascular atrophy
34
poliomyelitis - virus recovered from
stool or throat
35
poliomyelitis - labs
1. CSF: increase WBCs and slight increase of protein, no change of glucose
2. virus recovered from stool or throat
36
poliomyelitis - glucose in CSF
no change
37
Spinal mascular atrophy is also called
Werding-Hoffman disease
38
Spinal mascular atrophy (Werding-Hoffman disease) - pathophysiology / mode of inheritance
congenital degeneration of anterior horns of spinal horn --> LMN lesion AR
39
Spinal mascular atrophy (Werding-Hoffman disease) - common appearance
floppy baby with marked hypotonia and tongue fasciculations
40
Spinal mascular atrophy (Werding-Hoffman disease) - prognosis
infantile type --> median age of death of 7 months
41
Poliomyelitis vs Spinal mascular atrophy (Werding-Hoffman disease) according to weakness
polio --> asymmetric
| SMA --> symmetric weakness
42
Freidreich ataxia - mode of inheritance (and genetics)
AR trinucleotide repeat disorder GAA on ch9 in gene that encodes frataxin
43
Friedreich's ataxia - Chromosome / trinucleotide
9 GAA
44
Friedreich's ataxia - gene / action of this gene
FRATAXIN --> iron binding protein
45
Friedreich's ataxia leads to (mechanism and findings)
problem of frataxin (iron binding protein) --> impairment in mitochondria functioning--> ROS --> degeneration of multiple spinal cord tracts --> muscle weakness, loss of DTRs, vibratory sense and proprioception
46
Friedreich's ataxia - cause of death
hypertrophic cardiomyopathy
47
Friedreich's ataxia - presents in childhood as
Kyphoscoliosis
48
Friedreich's ataxia - symptoms/presentation
1. Staggering gait 2. frequent falling 3. nystagmus
4. dysarthria 5. per cavus 6. hammer toes
7. diabetes mellitus 8. hypertrophic cardiomyopathy
9. kyphoscoliosis (childhood)
10. Loss of DTRs
49
Friedreich's ataxia - gait
Staggering gait
50
Friedreich's ataxia - appearance of foot (and definition of that
1. per cavus: foot is distinctly hollow when bearing weight
| 2. hammer toes: toes that are bent permanently downwards
51
hemisection of spinal cord?
Brown-Sequard syndrome
52
Brown-Sequard syndrome?
hemisection of spinal cord
53
Brown-Sequard syndrome findings
1. ispilateral UMN signs below the level of lesion
2. ipsilateral loss of tactile, proprioception, vibration below the level of lesion
3. contralateral pain and temperature loss below the level of lesion
4. Ipsilateral loss of all sensation AT LEVEL OF LESION
5. ispilateral UMN sign at the level of lesion
6. Horner syndrome (if lesion above T1)
54
Brown-Sequard syndrome - Horner syndrome if lesion (when and why)
if lesion above T1
| due to damage of occulosympathetic pathway
55
Landmark dermatomes - C2
posterior half of a skull cap
56
Landmark dermatomes - C3
high turtle-neck shirt
57
Landmark dermatomes - C4
| Landmark dermatomes - C6
C4: low-collar shirt
C6: upper limb (includes thumbs)
58
Landmark dermatomes - T4
at the nipple
59
Landmark dermatomes - T7
xiphoid process
60
Landmark dermatomes - L1
at the inguinal ligament
61
Landmark dermatomes - L4
includes the kneecaps
62
Landmark dermatomes - S2, S3, S4
erection and sensation of penile and anal zone
63
diaphragm and gallbladder pain referred to the ... via ...
right shoulder
via
phrenic nerve
64
Landmark dermatomes - at the nipple
T4
65
Landmark dermatomes - low collar shirt
C4
66
Landmark dermatomes - includes the Kneecaps
L4
67
Landmark dermatomes - posterior half of a skull cap
C2
68
Landmark dermatomes - at the xiphoid process
T7
69
Landmark dermatomes - high turtleneck shirt
C3
70
Landmark dermatomes - T10
at the umbilicus
71
Landmark dermatomes - T10
at the umbilicus
72
Landmark dermatomes - T10 - important because ...
at the umbilicus --> early appendicitis pain referral
73
Landmark dermatomes - at the inguinal ligament
L1
74
A dermatome is an
area of skin that is mainly supplied by a single spinal nerve
75
clinical reflex - mc
bicepts
tricepts
patella
achlles
76
bicepts reflex - to check
C5, C6
77
triceps reflex - to check
C7, C8
78
Patella reflex - to check
L3, L4
79
Achilles reflex - to check
S1, S2
80
cremaster reflex - to check
L1, L2 (testicle move)
81
anal wink reflex - to check
S3, S4
82
anal wink reflex - mechanism
contraction of the external anal sphincter upon stroking of the skin around the anus
83
penis dermatome
S3
84
Primitive reflex?
CNS reflexes that are presents in a healthy infant, but are absent in a neurologically intact in adults
85
Primitive reflex are normally disappears within
1st year of life
86
Primitive reflex are inhibited by
a mature/developing frontal lobe
87
Primitive reflex - may re-emerge in adults (mechanism)
frontal lobe lesion --> loss of inhibition of these reflex
88
Primitive reflex - MC reflex
1. Moro reflex 2. Galant reflex 3. Rooting reflex
| 4. Sucking reflex 5. Palmar reflex 6. Plantar reflex
89
Moro reflex is AKA
Hang on life reflex
90
Moro reflex mechanism
abduct/extend arms when startled (sudden loss of support), and then draw together
91
Rooting reflex mechanism
movement of head toward one side if cheek or mouth is stroked
92
Sucking reflex mechanism
sucking response when roof of mouth is touched (akoma kai to diko tou daktilo)
93
Palmar reflex mechanism
curling of fingers if palm is stroked
94
Plantar reflex in infants mechanism
Dorsiflexion of large toe and fanning of other toes with plantar stimulation
95
Plantar reflex --> Dorsiflexion of large toe and fanning of other toes with plantar stimulation --> sign?
Babisnki sign
96
Babisnki sign in adults -->
UMN lesion
97
Galant reflex mechanism
Stroking along one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion (hip) of lower body toward stimulated side
98
movement of head toward one side if cheek or mouth is stroked - primitive reflex?
rooting reflex
99
Dorsiflexion of large toe and fanning of other toes with plantar stimulation - primitive reflex
Plantar reflex
100
Stroking along one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion (hip) of lower body toward stimulated side - primitive reflex
Galant reflex mechanism
