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Spinal Cord Pt 2 Flashcards

1
Q

what are the 3 somatosensory tracts in the SC that transmits somatosensory info up to brainstem and brain

A
  1. dorsal column-medial lemniscus system
  2. spinocerebellar tracts
  3. spinothalamic tracts
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2
Q

what is the function dorsal column-medial lemniscus system

A

discriminating touch, pressure, vibration and proprioception (joint position sense) from the body

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3
Q

what is the pathway of the dorsal column- medial lemniscus system

A
  1. sensory info enters POSTERIOR HORN and ascends in the IPSILATERAL posterior column up ot the medulla
  2. CROSSES MIDLINE AT THE MEDULLA
  3. ascends to the THALAMUS in medial leminiscus and projects to primary somatosensory cortex (3,1,2)

the name explains the 2 locastions the tracts is in

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4
Q

dorsal column-medial lemniscus system lesion ABOVE medulla

A

CONTRALATERAL loss of proprioception, discriminating touch and vibration

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5
Q

dosal column-medial lemniscus lesion BELOW medulla

A

IPSILATERAL loss of proprioception, discriminating touch and vibration below the level of the lesion

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6
Q

C3 lesion dorsal column-medial lemniscus

A

ipsilateral loss of proprioception, discriminating touch and vibration of UE + LE

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7
Q

T6 lesion dorsal column-medial lemniscus system

A

T6 ipsilateral loss of proprioception, discriminating touch and vibration of MID TRUNK + LE

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8
Q

what are teh clinical exams for the dorsal column-medial lemniscus system

A
  1. vibration sense test
  2. joint position sense test
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9
Q

what is the joint positon sense test for the dorsal column-medial lemniscus system

A

contact THE SIDE of finger/toe
move finger/toe up or down and assess if pt can determine direction
keep patient’s head turn away or eyes close

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10
Q

what is the function of the spinocerebellar tracts

A

transmits UNCONSCIOUS PROPRIOCEPTION to cerebellum

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11
Q

what is the pathway of the spinocerebellar tracts

A
  1. proproceptive info enters SC and ascends in the IPSILATERAL LATERAL COLUMN of SC
  2. ascend to brainstem and enter cerebellum

DOES NOT CROSS

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12
Q

lesion in the spinocerebellar tracts

A

ataxia but ISOLATED LESION IS RARE
any ataxia impairment from a lateral column injury/lesion is often overshadowed by co-existing hemiparesis

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13
Q

what are the 2 pathways from anterolateral system in the spinothalamic tract

A
  1. lateral spinothalamic tract
  2. anterior spinothalamic tract
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14
Q

what is the function of spinothalamic tracts

A

transmit pain and temp

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15
Q

what is the function of the lateral spinothalamic tract (spinothalamic tract)

A

mediates DISCRMINATIVE ASPECTS of pain/temp sensation from the body
DETECT AND LOCALIZES pain/temp from body
FAST PAIN PATHWAY

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16
Q

what is the pathway of the lateral spinothalamic tract (spinothalamic tract)

A
  1. nociceptive info enters SC and CROSS MIDLINE IMMEDIATELY
  2. ascends in the CONTRALATERAL LATERAL COLUMN
  3. up to the thalamus and projects to primary somatosensory cortex (3,1,2)
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17
Q

lesion to the lateral spinothalamic tract (spinothalamic tract)

A

CONTRALATERAL loss of pain and temperature below lesion

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18
Q

C3 lesion in the lateral spinothalamic tract

A

contralateral loss of pain and temp below C3

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19
Q

T6 lesion in the lateral spinothalamic tract

A

contralateral loss of pain and temp below T6

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20
Q

what are the clinical exams for the lateral spinothalamic tract

A
  1. pinprick/pinwhell test
  2. temperature test
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21
Q

what is the function of the anterior spinothalamic tract (spinothalamic tract)

A

mediates VISCERAL, CONSCIOUSNESS, AUTONOMIC AND EMOTIONAL/BEHAVIOR reactions to pain

central modulation of pain

SLOW PAIN PATHWAY WAY

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22
Q

what is the pathway of the anterior spinothalamic tract (spinothalamic tract)

A
  1. nociceptive info enters posterior horn
  2. immediately CROSSES MIDLINE IN SC
  3. ascends contralaterally in anterior column
  4. terminates in different CNS structures
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23
Q

what are the different CNS structures that terminate in the anterior spinothalamic tract pathway

A
  1. reticular nuclei
  2. tectum-superior colliculi
  3. pretectal (periaqueductal gray)
  4. thalamus project to limbic
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24
Q

what are the clinical exam procedures for anterior spinothalamic tract

A

response to stimuli
“pain response test” such as Glasgow Coma Scale

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25
what is a primary injury in the spinal cord
physical impact directly IMMEDIATELY damages the spinal cord cells and causes necrosis
26
what is a secondary injury in the spinal cord
occurs within hours cellular necorsis cause immune (inflammatory) responses, neuro excitatory reponses and ischemia that damage surrounding area
27
what are the medical strategies for primary injury in the SC
stabilize the primary injury address emergency life threatening concerns
28
what are the medical strategies for a secondary SC injury
minimize secondary injury cascade research is ongoing on best ways for this to be managed
29
(T/F) spinal shock occurs slowly after acute spinal cord injury
FALSE occurs IMMEDIATELY
30
what is spinal shock
spinal cord injury causes an acute/immediate loss of reflex, motor and sensory functions below level of injury
31
what specific reflex is loss with spinal shock
DTR
32
what type of paralysis comes with spinal shock and where is it
flaccid paralysis bowel/bladder dysfunction respiratory dysfunction if high cervical injury complete ANESTHESIA
33
what are the phases of spinal shock reflex progression
phase 1: areflexia/hyporeflexia phase 2: initial reflex return phase 3: initial hyperreflexia phase 4: final hyperreflexia and spasticity
34
what is phase 2 of spinal shock
initial reflex returns bulbocavernosus relfex returns within 24-48hrs after injury considered a marker for “end of spinal shock” compress the glans penis or by applying pressure to the clit and observe for anal sphincter contraction or use foley catheter DTR REMAIN ABSENT
35
what is phase 3 of spinal shock reflex progression
initial hyperreflexia some DTR return 1-4 weeks after the injury and become HYPER - REFLEXIC (transition phase from hypo-hyperreflexia)
36
what is phase 4 of spinal shock reflex progression
final hyperreflexia and spasticity occurs ALL DTR BELOW THE LEVEL OF INJURTY have returned and are HYPERREFLEXIC flaccid paralysis is REPLACED by HYPERTONICITY/SPASTICITY during 1-12 months of injury
37
what is neurogenic shock
severe loss of sympthathetic function that occurs when a SCI disrupts the sympathetic pathways in the SC occurs less than or equal to 10% of sc injuries and is associated with sc injuries about T6 POTENTIALLY FATAL
38
what is the pathophysiology of neurogenic shock
loss of sympathetic tone allows UNOPPOSED PARASYMPATHETIC ACTIVITY hypotension bradycardia hypothermia
39
how do we manage neurogenic shock
1. intravenous fluid resusitation 2. meds to promote vascontriction and increase the strength of cardiac contractions 3. anticholinergic meds for bradycardia
40
what is autonomic dysreflexia
extreme hypertension with bradycardia life threatening hypertensive episode occurs from noxious stimuli spinal cord injury above T6 potential complications, surgeries, and labor
41
what is the pathophysiology for autonomic dysreflexia
cutaneous or visceral stimulation massive vasoconstriction in lower 2/3 of body and EXTREME HYPERTENSION PERSIST
42
what is the treatment for autonomic dysreflexia
emergency condition unless resolved if not treatly immediately may lead to seizures, cerebral hemorrhage/stroke and potential DEATH IMMEDIATELY SIT UP PATIENT remove irritating stimulus ASAP blad
43
what is the most common cause of autonomic dysreflexia
bladder distension
44
what are the 6 incomplete spinal cord syndromes
1. brown sequard syndrome 2. anterior cord syndrome 3. posterior cord syndrome 4. central cord syndrome 5. conus medullaris syndrome 6. cauda equina syndrome
45
what is brown sequard syndrome
incomplete lesion - one half cord damaged ipsilateral loss of motor and sensory below lesion - (discriminating touch and vibration) CONTRALATERAL loss of pain/temp below level lesion BETTER PROGNOSIS mechnaism of injury: penetrating injury
46
what is anterior cord lesion
incomplete lesion - anterior 2/3 of cord is damaged bilateral motor and sensory (somatosensory) loss below level of injury POOR PROGNOSIS ASSOCIATED WITH FLEXION INJURIES DIVERS!!!
47
what is posterior cord lesion
incomplete lesion - posterior column damaged bilateral loss of proprioception, discriminating touch, and vibration below level of lesion no loss of pain/temp POSITIVE ROMBERG TEST MOI: hyperextension injuries (cervical) disc compression
48
what is a central cord lesion
incomplete lesion - area around central canal of the cord is damaged impair spinothalamic tracts as they CROSS MIDLINE sensory: cervical level loss of pain/temp in classic CAPE distribution of UE
49
what is conus medullaris syndrome
injury to sacral cord and lumbar nerve roots combo of UPPER and LOWER neuron injuries
50
what are the symptoms of conus medullaris syndrome
saddle anesthesia areflexic bladder and bowel variable degrees of lower extremity weakness
51
what is cauda equina syndrome
injury to lumbosacral nerve roots within neural canal NOT CONSIDERED a true SCI LOWER MOTOR NEURON INJURY
52
what are the symptoms of cauda equina syndrome
saddle anethesia bladder and bowel dysfunction
53
what is a transverse cord lesion
COMPLETE LESION all white and grey matter damaged bilateral motor and somatosensory loss below level of lesion
54
what is an upper motor neuron
cortex internal capsule brainstem/spinal cord terminal end of descending neuron before synapse with motor nucleus in the ANTERIOR HORN
55
What is a lower motor neuron
anterior horn - motor nucleus motor root MOTOR PORTION OF SPINAL NERVE ROOT AND PERIPHERAL NERVE
56
what is an UMN lesion
damage to the motor pathway anywhere ABOVE the anterior horn cell
57
what are the pathologies for UMN lesion
stroke SCI tumor MS ALS
58
what are the pathological reflexes that ARE present in UMNL
Positive Babin Positive Hoff
59
what are the reflex tests for UMNL
plantar reflex test Babinski test - extension of toes Hoff sign - flexion of thumb or index
60
what is an LMNL
damage to motor pathway to or distal to the anterior horn cell
61
what are the LMNL pathologies
radiculopathy peripheral nerve entrapment Guillian-Barre Syndrome ALS
62
what is pain
an unpleseant sensory and emotional experience associated with actual or potential tissue damage
63
what is nociceptive pain
pain from actual or threatened damage to non neural tissue WITH healthy somatosensory nervous system usually acute, develops in response to a specific injury/pathology and resolves
64
what is neuropathic pain
pain caused by a lesion/disease of the somatosenosry nervous sytem not caused from non-neural tissue damage dysfunctional signaling
65
what is central neuropathic pain
a pain caused by a lesion or disease of the central somatosensory nervous system
66
what is nociplastic pain
no clear evidence of actual or threatened tissue damage no clear evidence of disease or lesion to the somatosensory system causing the pain
67
what are the 2 types of nociceptors that transmit info to the SC dorsal horn
a delta fibers C fibers
68
what are A delta fibers
myelinated axons fast transmission
69
what are C fibers
unmyelinated axons slow transmission
70
A delta and C fibers enter the SC in the posterior horn and cross midline to ascend where?
anterolateral system or SPINOTHALAMIC TRACT
71
what is the nocicpetive pathway for A DELTA FIBERS
1. travels quickly to the posterior horn 2. immediately corsses midline to land in the 3. LATERAL SPINOTHALAMIC TRACT 4. then goes to the THALAMUS 5. from there it goes to the primary somatosensory cortex
72
what is the pathway for C FIBERS
1. travels SLOWLY to the posterior horn of the SC 2. immediately crosses midline to ascend 3. ANTERIOR SPINOTHALAMIC TRACT 4. terminates in different nuclei of the BRAINSTEM/DIENCEPHALON
73
what are the different nucleis in the brainstem/diencephalon that the C FIBERS end their pathway
1. reticular nuclei 2. periaqueductal gray area 3. tectum 4. thalamus then projects to limbic and insular lobes
74
what is allodynia
pain from a stimulus which would not normally provoke pain
75
what is hyperalgesia
increased sensitivity to pain
76
what is analgesia
inability to sense pain without loss of consciousness
77
waht is anesthesia
inability to detect all sensation w/o loss of consciousness
78
what is the gate control theory of pain modulation
stimulation of larger A BETA FIBERS will inhibit the smaller NOCICEPTIVE FIBERS (C AND A DELTA FIBERS)
79
what is descending pain modulation
ascending and descending pathways modulate pain the in the SC
80
what is the ascending pathway in descending pain modulation
ascending fibers of anterior spinothalamic terminate on and stimulate the PERIAQUEDUCTAL GRAY AREA (PAG), RAPHE NUCLEI
81
what is the descending pathway in descending pain modulation
neurons from PAG and raphe nucleus desend to the posterior horn and INHIBIT THE INCOMING PAIN SIGNALS
82
what are endogenous opiates
feel good endorphins are released with exercise inhibits imcoming pain EXERCISE INHIBITS PAIN EXERCISE IS MEDICINE
83
what are exogenous opiates
morphine fentanyl oxycodone trimodal NSAIDS cannabinoids
84
what do epidural nerve blocks do
inhibits all sensory info

Neuro Anat/Path (14 decks)

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