Spinal Cord Pathology Flashcards
What are some effects of a ventral horn ipsilateral segmental motor syndrome?
- Paralysis (decreased voluntary motor unit recruitment)
- Hypotonia
- Areflexia
- Muscle atrophy
- Fasciculation, Fibrilltation
[Of the affected segments]
What type of symptoms is Polio characterized?
- LMNL symptoms
How is nerve conduction affected by Polio?
- Normal
What 3 phases does polio follow?
- Fever
- Myalgia (cramping, pain), and malaise
What type of representation does Polio have in terms of weakness?
Either:
- Unilateral
- Focal
How are the sensory systems affected by Polio?
Unaffected
What symptoms would be present in a dorsal column lesion?
- Discriminitive touch
- Proprioception
- Kinesthetic sense
All profoundly affected on the same side
- From the affected segment downwards
Will a patient with a dorsal column lesion have difficulty balancing with their eyes open?
Not necessarily
What are the motor symptoms and signs of Tabes Dorsalis?
There are none –> Psych!
What are the sensory symptoms and signs of Tabes Dorsalis?
- Posterior roots lesioned
- Especially in lumbosacral region
What results from the lesioned dorsal roots of Tabes Dorsalis?
Degeneration of the dorsal columns
What are 4 common complaints of patients with Tabes Dorsalis?
- unsteadiness
- Sudden lacerating somatic pain
- Urinary incontinence
- Excruciating abdominal pain
What 7 Neuro Exam markers will be present in a patient with Tabes Dorsalis?
- Marked impairment of vibration & joint position
- Severe deficits in touch and pressure
- Ataxic gait
- Postitive Rhomberg
- Abadie’s Sign (pressure on achilles tendon does not elicit pain)
- Pain fibers can also be affected
What representation do the symptoms of Tabes Dorsalis have? At what spinal levels?
- Ipsilateral
- At and below the level of the lesion
What is another name for a hemi-section of the spinal cord?
Brown Sequard Syndrome
What are the 4 ipsilateral signs of Brown Sequard Syndrome?
- Upper motor neuron signs below level of lesion
- Loss of kinesthesia and discriminitive touch at level of lesion and below
- Segmental lower motor neuron signs at level of lesion
- Autonomic signs
What is the controlateral signs of Brown Sequard Syndrome?
- Loss of Pain and Temperature
What is the bilateral sign of Brown Sequard Syndrome?
- Pain and temperature loss
What are the 5 aspects of Horner’s Syndrome?
- Ptosis
- Dry Face
- Red
- Warm
- Miosis (constricted pupil)
In a C5 segmental hemi-section, will babinski be positive or negative? Will Hoffman be positive or negative?
+ Babinski
- Hoffman
Which cell column must be lesioned at what level for Horner’s Syndrome to occur?
- Lateral cell column above T3
What symptoms will be present in a lesioning of the ventral funiculus?
- Weakness due to loss of bilateral motor drive
- Gross touch system gone, but fine motor in tact
What symptoms/ signs will be present with a lesion of the anterior white commisure?
- Bilateral loss of pain and temperature 1 or 2 levels lower than the level of the lesion
What fibers are affected by an early syringomyelia lesion? What does this cause?
- Crossing spinothalamic fibers
- Contralateral loss of concious pain and temperature
What is affected by a late syringomyelia lesion? What does this cause?
- Crossing spinothalamic fibers
- Motor neurons
- LMNS at level of lesion
- Concious pain and temeprature loss
Where are syringomyelia more dangerous?
- More dangerous are plexuses
- Not as dangerous in trunk
What areas are affected by amyotrophic lateral sclerosis?
- Anterior and lateral corticospinal tracts
- Eventually the ventral horn and pyramidal tracts
What type of disease is amyotrophic lateral scleorsis?
- Autoimmune disease with a hardening of areas forming plaques
What ipsilateral symptoms may present in amyotrophic latearl sclerosis?
- Paralysis
- Spasticity
- Hyper-reflexia
- Clonus
- Babinski
- Hypotonia
- Hypo/ areflexia
- Fibrillations
- Muscle atrophy
What representation does amyotrophic lateral scleorsis have?
- Bilateral
- Symptoms are ipsilateral, but both sides are affected
What is another name for amyotrophic lateral scleorsis?
- Lou Gherig’s Disease
Which spinal segments are more commonly affected by ALS?
- Cervical and lumbar regions
How does ALS typically progress?
From superior to inferior spinal segments
What are 2 common complaints of patients with ALS?
- Weakness in legs and arms
- Atrophy or fasciculations
What 5 signs may be present in a patient with ALS?
- Muscle atrophy of small muscles of hand and distal muscle groups
- Fasciculations
- Hyperactive reflexes
- Babinski and + Hoffman
- Bing’s reflex
What is Bing’s reflex?
- Extension of great toe following pricking of dorsum of toe or foot with a pin
In what types of lesions is Bing’s reflex present?
- Pyramidal tract
What is primary lateral sclerosis?
ALS with only pyramidal tracts affected
What is progressive muscular atrophy?
ALS with only the AHC affected
What is progressive bulbar palsy?
ALS in the motor nuclei of the brain stem
What are 2 symptoms of progressive bulbar palsy? What is a constant danger?
- Slurred speech
- Programs swallowing/ coughing
- Aspiration constant danger
What tracts are affected by a combined system disease?
- Dorsal columns
- Lateral corticospinal tracts
What is the hereditary form of combined system’s disease? What is also involved in the hereditary form?
- Friedreich’s Ataxia
- Spinocerebellar tracts also involved
What symptoms and signs are present in combined system disease?
- Loss of discriminitive touch
- Loss of proprioception
- Some UMNS
What specific force causes Combined Systems disease?
Compression force on spinal cord
What is often seen following pernicious anemia (B12 deficiency)?
- Subacute combined degeneration
What structures are affected in subacute combined degeneration?
- Dorsal and lateral funiculi
- Especially fibers of lumbosacral cord
What are 4 common complaints of patients with subacute combined degeneration?
- Distal paresthesias, dyesthesias, and weakness in the extremities (feet and hands first)
- Spastic paraparesis with ataxia (from impaired postural sensation in legs)
- Lhermitte’s sign (sudden electric-like shocks extending down the spine on flexing of the head
- Difficulty in walking
What will be the findings of a neuro exam of the subacute combined degeneration?
- Dosral column symptoms present
- Pyramidal deficit in legs
What 6 structures can be affected by multiple sclerosis?
- Subcortical white matter
- Corpus callosum and angles of lateral ventricles
- Internal capsule
- Pons
- Cerebellum
- Spinal cord
How will the plaques of multiple sclerosis show up on MRI?
As white highlights
Describe the progression of benign multiple sclerosis.
Mild early attacks, followed by a complete clearing of symptoms
Describe the progression of relapsing remitting multiple sclerosis.
- Frequent early attacks and incomplete clearing of symptoms, but long periods of stability
- Some degree of disability
Describe the progression of secondary chronic progressive multiple sclerosis.
- Frequent attacks
- Short and incomplete remissions
- More severe than benign and relapsing remitting
- Worsens for years, and then may level off
Describe the progression of primary progressive multiple sclerosis.
- Most severe form of MS
- Onset is severe
- Slowly progressive with no clearing of symptoms
What % of each type of MS affects patients?
Benign multiple sclerosis: 20 %
Relapsing remitting multiple sclerosis: 25 %
Secondary chronic progressive: 40 %
Primary progressive: 15 %
What is the early stage of spinal cord injury called?
- Spinal shock
What are the 4 aspects of spinal shock?
- Flaccid/ bilateral paralysis of all muscles of spinal segment and below
- Loss of all sensation at the level and below
- Loss of all bladder and bowel functions
- Loss of all sexual functions
What is the course of later stage SCI?
- UMNL symptoms
- Sensation lost at level and below
- Automatic reflex neurogenic bladder
- Intermittent automatic reflex defecation
- Reflex erection and ejaculation
- Possible tempory cessation of menstruation and irregularities in menstrual cycle
What is the most important aspect of treatment of a new patient with a SCI?
- Control the sympathetic nervous system
- BP can skyrocket
What level must a SCI occur above for autonomic dysfunction syndrome to occur?
- SCIs above T5
What 5 symptoms are caused by bladder or bowel distention in autonomic dysfunction syndrome?
- Excessive sweating
- Cutaneous flushing
- Hypertension
- Pounding headache
- Reflex bradycardia
What respiratory dysfunction may occur following SCI?
- Decreased vital capacity due to a weakened diaphragm and other respiratory muscles
- Decreased response to CO2 (due to loss of ascending spinoreticulo tract)
- Disruption of ascending and descending pathways
What type of lesion will cause Autonomic Respiratory Dysfunction Syndrome?
- High cervical lesions
What causes autonomic respiratory dysfunction?
- Loss of ascending pathways
What 5 symptoms may present in autonomic respiratory dysfunction syndrome?
- Respiratory arrest/ sleep apnea
- Hypotension
- Hypontremia (low levels of Na++ in blood)
- Inappropriate ADH secretion
- Hyperhidrosis
