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neurology FA > spinal cord - lesions / reflexes > Flashcards

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
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2
Q

ALS means / AKA

A

amyotrophic lateral sclerosis (Lou Gehring disease)

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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

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4
Q

ALS - deficits

A

combined UMN and LMN deficits with no sensory or occulomotor deficits
NO SENSORY OR BOWEL BLADDER DEFICITS

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5
Q

ALS - mutation in

A

superoxide dismutase 1

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6
Q

ALS - clinical signs

A

both UMN and LMN signs

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7
Q

ALS - treatment

A

Riluzole

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8
Q

Riluzole action on ALS / mechanism of action

A

modestly increases survival by decrease glutamate excitotoxicity

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9
Q

ALS - common presentation

A

asymmetric limb weakness (hands/feet), fasciculations, eventual atrophy

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10
Q

spinal cord lesions - complete inclusion of anterior spinal artery

A

spares dorsal columns and Lissaeuer tract

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11
Q

watershed area of anterior spinal cord (why)

A

upper throracic ASA territory, as Adamkiewicz artery supplies ASA below T8

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12
Q

Adamkiewicz artery supplies ASA … (area)

A

below T8

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13
Q

…… supplies ASA below T8

A

Adamkiewicz artery

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14
Q

Tabes dorsalis is caused by

A

3 syphilis

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15
Q

tabes dorsasis - spinal cord lesion?

A

degeneration (DEMYELINATION) of dorsal columns and roots

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16
Q

tabes dorsasis –> …. (results)

A
  1. impaired sensation proprioception

2. progressive sensory ataxia

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17
Q

tabes dorsalis - progressive sensory ataxia

A

inability to sense or feel legs –> poor coordination

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18
Q

tabes dorsalis is associated with

A
  1. Charcot joints
  2. shooting pain (paresthesias)
  3. Argyll Robertson pupils
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19
Q

Charcot joints is also called

A

Neuropathic arthropathy

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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.

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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

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22
Q

Argyll Robertson pupils is AKA

A

prostitute’s pupils

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23
Q

tabes dorasil - clinical examination

A
  1. absence of Deep Tendon Reflexes
  2. Romberg sign (+)
  3. Argyll Robertson
  4. Stroke without hypertension
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24
Q

Syringomyelia - definition

A

syrinx expands and damage ANTERIOR WHITE COMMISSURE of spinothalamic tract (2nd neurons) –> can expand and affect other tracts

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25
Q

Syringomyelia - symptoms (and area) / seen with

A

bilteral loss of pain and temperature
usually C8-T1 –> cape - like
seen with Chiari I malformation

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26
Q

vitamin B12 deficiency - spinal cord lesions

A

sabacute combined degeneration –> demyelination of dorsal column, lateral corticospinal tracts, and spinocerebellar tracts

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27
Q

vitamin B12 deficiency - symptoms because of spinal cord lesions

A
  1. ataxic gaits
  2. paresthesia
  3. impaired progression and vibration sense
  4. weakness
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28
Q

poliomyelitis is caused by / root of transmission

A

poliovirus / fecal-oral

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29
Q

poliovirus to CNS (direction)

A

Replicates in oropharynx and small intestine before spreading via bloodstream to CNS

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30
Q

poliomyelitis - pathophysiology

A

infection causes destruction in anterior horn of spinal cord (LMN death)

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31
Q

poliomyelitis - death of … cells

A

LMN

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32
Q

poliomyelitis - signs and symptoms

A
  1. signs of infection –> malaise, headache, fever, nausea

2. LMN lesion signs –> weakness, hypotonia, flaccid paralysis, fasciculations, hyporeflexia, muscle atrophy

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33
Q

Werding-Hoffman disease is also called

A

Spinal mascular atrophy

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34
Q

poliomyelitis - virus recovered from

A

stool or throat

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35
Q

poliomyelitis - labs

A
  1. CSF: increase WBCs and slight increase of protein, no change of glucose
  2. virus recovered from stool or throat
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36
Q

poliomyelitis - glucose in CSF

A

no change

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37
Q

Spinal mascular atrophy is also called

A

Werding-Hoffman disease

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38
Q

Spinal mascular atrophy (Werding-Hoffman disease) - pathophysiology / mode of inheritance

A

congenital degeneration of anterior horns of spinal horn –> LMN lesion AR

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39
Q

Spinal mascular atrophy (Werding-Hoffman disease) - common appearance

A

floppy baby with marked hypotonia and tongue fasciculations

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40
Q

Spinal mascular atrophy (Werding-Hoffman disease) - prognosis

A

infantile type –> median age of death of 7 months

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41
Q

Poliomyelitis vs Spinal mascular atrophy (Werding-Hoffman disease) according to weakness

A

polio –> asymmetric

SMA –> symmetric weakness

42
Q

Freidreich ataxia - mode of inheritance (and genetics)

A

AR trinucleotide repeat disorder GAA on ch9 in gene that encodes frataxin

43
Q

Friedreich’s ataxia - Chromosome / trinucleotide

A

9 GAA

44
Q

Friedreich’s ataxia - gene / action of this gene

A

FRATAXIN –> iron binding protein

45
Q

Friedreich’s ataxia leads to (mechanism and findings)

A

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
Q

Friedreich’s ataxia - cause of death

A

hypertrophic cardiomyopathy

47
Q

Friedreich’s ataxia - presents in childhood as

A

Kyphoscoliosis

48
Q

Friedreich’s ataxia - symptoms/presentation

A
  1. Staggering gait 2. frequent falling 3. nystagmus
  2. dysarthria 5. per cavus 6. hammer toes
  3. diabetes mellitus 8. hypertrophic cardiomyopathy
  4. kyphoscoliosis (childhood)
  5. Loss of DTRs
49
Q

Friedreich’s ataxia - gait

A

Staggering gait

50
Q

Friedreich’s ataxia - appearance of foot (and definition of that

A
  1. per cavus: foot is distinctly hollow when bearing weight

2. hammer toes: toes that are bent permanently downwards

51
Q

hemisection of spinal cord?

A

Brown-Sequard syndrome

52
Q

Brown-Sequard syndrome?

A

hemisection of spinal cord

53
Q

Brown-Sequard syndrome findings

A
  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
Q

Brown-Sequard syndrome - Horner syndrome if lesion (when and why)

A

if lesion above T1

due to damage of occulosympathetic pathway

55
Q

Landmark dermatomes - C2

A

posterior half of a skull cap

56
Q

Landmark dermatomes - C3

A

high turtle-neck shirt

57
Q

Landmark dermatomes - C4

Landmark dermatomes - C6

A

C4: low-collar shirt
C6: upper limb (includes thumbs)

58
Q

Landmark dermatomes - T4

A

at the nipple

59
Q

Landmark dermatomes - T7

A

xiphoid process

60
Q

Landmark dermatomes - L1

A

at the inguinal ligament

61
Q

Landmark dermatomes - L4

A

includes the kneecaps

62
Q

Landmark dermatomes - S2, S3, S4

A

erection and sensation of penile and anal zone

63
Q

diaphragm and gallbladder pain referred to the … via …

A

right shoulder
via
phrenic nerve

64
Q

Landmark dermatomes - at the nipple

A

T4

65
Q

Landmark dermatomes - low collar shirt

A

C4

66
Q

Landmark dermatomes - includes the Kneecaps

A

L4

67
Q

Landmark dermatomes - posterior half of a skull cap

A

C2

68
Q

Landmark dermatomes - at the xiphoid process

A

T7

69
Q

Landmark dermatomes - high turtleneck shirt

A

C3

70
Q

Landmark dermatomes - T10

A

at the umbilicus

71
Q

Landmark dermatomes - T10

A

at the umbilicus

72
Q

Landmark dermatomes - T10 - important because …

A

at the umbilicus –> early appendicitis pain referral

73
Q

Landmark dermatomes - at the inguinal ligament

A

L1

74
Q

A dermatome is an

A

area of skin that is mainly supplied by a single spinal nerve

75
Q

clinical reflex - mc

A

bicepts
tricepts
patella
achlles

76
Q

bicepts reflex - to check

A

C5, C6

77
Q

triceps reflex - to check

A

C7, C8

78
Q

Patella reflex - to check

A

L3, L4

79
Q

Achilles reflex - to check

A

S1, S2

80
Q

cremaster reflex - to check

A

L1, L2 (testicle move)

81
Q

anal wink reflex - to check

A

S3, S4

82
Q

anal wink reflex - mechanism

A

contraction of the external anal sphincter upon stroking of the skin around the anus

83
Q

penis dermatome

A

S3

84
Q

Primitive reflex?

A

CNS reflexes that are presents in a healthy infant, but are absent in a neurologically intact in adults

85
Q

Primitive reflex are normally disappears within

A

1st year of life

86
Q

Primitive reflex are inhibited by

A

a mature/developing frontal lobe

87
Q

Primitive reflex - may re-emerge in adults (mechanism)

A

frontal lobe lesion –> loss of inhibition of these reflex

88
Q

Primitive reflex - MC reflex

A
  1. Moro reflex 2. Galant reflex 3. Rooting reflex

4. Sucking reflex 5. Palmar reflex 6. Plantar reflex

89
Q

Moro reflex is AKA

A

Hang on life reflex

90
Q

Moro reflex mechanism

A

abduct/extend arms when startled (sudden loss of support), and then draw together

91
Q

Rooting reflex mechanism

A

movement of head toward one side if cheek or mouth is stroked

92
Q

Sucking reflex mechanism

A

sucking response when roof of mouth is touched (akoma kai to diko tou daktilo)

93
Q

Palmar reflex mechanism

A

curling of fingers if palm is stroked

94
Q

Plantar reflex in infants mechanism

A

Dorsiflexion of large toe and fanning of other toes with plantar stimulation

95
Q

Plantar reflex –> Dorsiflexion of large toe and fanning of other toes with plantar stimulation –> sign?

A

Babisnki sign

96
Q

Babisnki sign in adults –>

A

UMN lesion

97
Q

Galant reflex mechanism

A

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
Q

movement of head toward one side if cheek or mouth is stroked - primitive reflex?

A

rooting reflex

99
Q

Dorsiflexion of large toe and fanning of other toes with plantar stimulation - primitive reflex

A

Plantar reflex

100
Q

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

A

Galant reflex mechanism

neurology FA (31 decks)

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