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Trauma > Spinal Injuries > Flashcards

Spinal Injuries Flashcards

1
Q

The neural pathway connecting sensory information from peripheral nerves to cerebral cortex, is known as the…

A

Ascending tract.

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2
Q

What are the two types of ascending tracts?

A

1) Conscious tract 2) Unconscious tract

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3
Q

What 2 pathways is the ascending conscious tract comprised of?

A

1) Dorsal column-medial lemniscal pathway 2) Anterolateral system

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4
Q

What does the unconscious tract consist of?

A

Spinocerebellar tracts.

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5
Q

The Dorsal Column-Medial Lemniscal Pathway (DCML) carries which functions?

A

1) Fine touch (tactile sensation) 2) Vibration 3) Proprioception (sense with which we perceive position and movement of our body).

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6
Q

For the Dorsal Column-Medial Lemniscal Pathway (DCML), when do the second order neurones decussate?

A

Within the medulla oblongata.

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7
Q

Where is the Dorsal Column-Medial Lemniscal Pathway (DCML) found within the spinal cord?

A

Dorsal (posterior) column.

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8
Q

What is the function of the anterolateral pathway?

A

It consists of two separate tracts: anterior tract (crude touch and pressure), posterior tract (pain and temperature).

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9
Q

Where do the second order neurones of the anterolateral system decussate?

A

They decussate within the spinal cord.

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10
Q

Injury to the anterolateral system results in what?

A

Contralateral loss of pain and temperature.

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11
Q

Injury to the Dorsal Column-Medial Lemniscal Pathway (DCML) results in what?

A

Ipsilateral loss of vibration, fine touch and proprioception.

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12
Q

Lesions of spinocerebellar tracts will result in?

A

1) Ipsilateral loss of muscle co-ordination. 2) Damage to descending motor tracts - muscle weakness/paralysis.

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13
Q

Define the Brown-Séquard syndrome.

A

Hemisection (one sided lesion) of the spinal cord, often due to traumatic injury.

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14
Q

Give 2 symptoms of Brown-Séquard syndrome.

A

1) Affects ascending tract - contralateral loss of pain/temperature, ipsilateral loss of touch/vibration 2) Affects descending tract - ipsilateral hemiparesis (weakness), contralateral hemianesthesia (loss of sensation).

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15
Q

Define the descending tract.

A

The pathway by which motor signals are sent from the brain to lower motor neurone (to innervate muscles and produce movement).

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16
Q

The motor tracts can be divided into which 2 groups?

A

1) Pyramidal tracts 2) Extrapyramidal tracts

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17
Q

What are the pyramidal tracts responsible for?

A

Voluntary control of the musculature of the body and face.

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18
Q

What are the extrapyramidal tracts responsible for?

A

The involuntary and automatic control of all musculature such as: muscle tone, balance, posture and locomotion.

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19
Q

What 2 tracts make up the pyramidal tract?

A

1) Corticospinal tract 2) Corticobulbar tract

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20
Q

State the 3 areas the corticospinal tract receive inputs from?

A

1) Primary motor cortex 2) Premotor cortex 3) Supplementary motor area

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21
Q

What is the internal capsule?

A

A white matter pathway located between the thalamus and basal ganglia. Neurones converge and descend through here.

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22
Q

The internal capsule is particularly susceptible to compression from…

A

Haemorrhagic bleeds (known as a ‘capsular stroke’).

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23
Q

Where do the corticospinal tract fibres decussate?

A

Cross over at the brainstem/medulla.

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24
Q

Where do the corticospinal tracts lie within the spinal cord?

A

Posterolaterally.

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25
Q

Where do the corticobulbar tracts arise from?

A

Lateral aspects of the primary motor cortex

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26
Q

Where do the neurones terminate on motor nuclei for the corticobulbar tract?

A

Cranial nerves. They synapse here with lower motor neurones, to carry motor signals to muscles of face and neck.

27
Q

For which nerves does the corticobulbar tract not innervate bilaterally?

A

1) Upper motor neurones for the facial nerve (CN VII). 2) Hypoglossal nerve (CN XII) only provide contralateral innervation.

28
Q

How many tracts make up the extrapyramidal pathway?

A

4.

29
Q

Name the 4 tracts that make up the extrapyramidal pathway.

A

1) Vestibulospinal 2) Reticulospinal 3) Rubrospinal 4) Tectospinal.

30
Q

State the function of the vestibulospinal pathway.

A

It controls the balance and posture, innervating the ‘anti-gravity’ muscles (flexors of the arm and extensors of the leg) via lower motor neurones.

31
Q

State the function of the reticulospinal pathway.

A

It affects voluntary movement and muscle tone.

32
Q

State the function of rubrospinal tracts.

A

It plays a role in the fine control of hand movements.

33
Q

State the function of tectospinal tracts.

A

It coordinates movements of the head in relation to vision stimuli.

34
Q

Define an upper motor neurone.

A

Upper motor neurones originate in the cerebral cortex and travel down the brain or spinal cord.

35
Q

Define a lower motor neurone.

A

Lower motor neurones begin in the spinal cord and go to innervate muscles and glands throughout the body.

36
Q

State 2 symptoms of an Upper Motor Neurone in relation to the corticospinal tract.

A

All appear on the opposite side - 1) Hypertonia (increased muscle tone) 2) Hyperreflexia (increased muscle reflexes) 3) Clonus (involuntary, rhythmic muscle contractions 4) Babinski sign (extension of the hallux in response to blunt stimulation of the sole of the foot) 5) Muscle weakness.

37
Q

State a symptom of an Upper Motor Neurone in relation to the corticobulbar tract.

A

1) Deviation of the tongue to the contralateral side - lesion of the hypoglossal nerve (CN XII) causes spastic paralysis of the contralateral genioglossus muscle. 2) Spastic paralysis of muscles in the contralateral lower quadrant of the face due to lesion to the upper motor neurones for CN VII.

38
Q

State a symptom of an Upper Motor Neurone in relation to the Extrapyramidal tract.

A

1) Dyskinesias (involuntary/erratic movements of the face, arms, legs or trunk) - seen in degenerative diseases, encephalitis and tumours.

39
Q

What causes anterior cord syndrome?

A

Ischaemia of spinal artery.

40
Q

State a symptom of the central cord syndrome?

A

Loss of motion and sensation in arms and hands.

41
Q

State a symptom of anterior cord syndrome.

A

Loss of function of 2/3 of the spinal cord - complete paralysis and loss of pain/temperature.

42
Q

Define a neurogenic shock.

A

Life-threatening condition caused by irregular blood circulation in the body. Can be caused by trauma/injury. Results in the sudden loss of sympathetic nervous system signals.

43
Q

Define a spinal shock.

A

Loss of reflexes below level of a spinal cord injury. It occurs immediately after injury.

44
Q

State 3 symptoms of a neurogenic shock.

A

1) Hypotension 2) Warm flushed skin 3) Bradycardia 4) Priapism (persistent/painful erections)

45
Q

What is the pathology of Cauda Equina Syndrome?

A

Compression of the nerve roots distal to L1.

46
Q

Give 2 causes of Cauda Equina Syndrome (CES)?

A

1) Lower back disc herniation 2) Spinal stenosis 3) Cancer 4) Trauma 5) Haematoma

47
Q

State 3 symptoms of Cauda Equina Syndrome (CES).

A

1) Pain 2) Numbness (perianal - numb when wiping, bladder - altered bladder sensation) 3) Weak (bowel - faecal incontinence, bladder - reduced flow/emptying, urinary incontinence) 4) Sexual - erectile dysfunction 5) Lower extremities - leg weakness

48
Q

State 3 risk factors of Cauda Equina Syndrome (CES).

A

1) Disc prolapse 2) Trauma 3) Surgey 4) Anticoagulants 5) Cancer 6) Immunocompromised

49
Q

State 3 things observed from a Cauda Equina Syndrome (CES) examination.

A

1) Sensory - perianal loss 2) Motor - rectal tone reduced, lower extremity weakness 3) Absence of lower limb reflexes 4) Bladder - high post voidal residual volume

50
Q

State how a Cauda Equina Syndrome (CES) is diagnosed.

A

1) MRI of the spine - compression of S2-S4 nerve roots by mass/herniation

51
Q

State a cause of Spinal Cord Compression.

A

1) Secondary malignancy e.g. from breast, lungs 2) Infection 3) Cervical disc prolapse

52
Q

State 2 symptoms of Spinal Cord Compression.

A

1) Bilateral leg weakness 2) Back pain 3) Bladder and anal sphincter involvement

53
Q

State a treatment for Spinal Cord Compression.

A

1) Urgent dexamethasone (corticosteroid to prevent inflammation) 2) Consider radiotherapy

54
Q

State 3 factors for which a Full in-line spinal immobilisation would be present.

A

1) Spinal pain 2) Intoxicated 3) Confused/uncoorperative 4) Reduced GCS 5) Hand/foot weakness 6) Altered/absent sensation hand/feet 7) Priapism 8) Spinal injury history

55
Q

State 2 stages to trauma assessment and management.

A

1) Full in-line spinal immobilisation 2) Imaging

56
Q

State 3 fractures.

A

1) Jefferson fracture 2) Bilateral facet fracture 3) Odontoid process fracture 4) Atlanto-occipital fracture 5) Hangman fracture 6) Tear drop fracture

57
Q

Define a Jefferson fracture.

A

Burst fracture of C1 (2 fractures anteriorly and posteriorly),

58
Q

State a cause of the Jefferson fracture.

A

Diving - injury to the top of the head (lateral margins displaced and odontoid process displaced - PEG view).

59
Q

State 2 features of a Hangman’s fracture.

A

1) C2 pars interarticularis 2) Prevertebral soft tissue swelling 3) Anterior dislocation of the C2 vertebral body

60
Q

State 2 things to look at on a X-ray of the thoracic spine.

A

1) Widening of the intervertebral space 2) Check if the spinous and transverse processes align 3) Look for A+P displacement.

61
Q

State the 3 types of column injury.

A

1) 1st column injury 2) 2nd column injury 3) 3rd column injury

62
Q

What is 1st column injury?

A

Disruption of anterior column.

63
Q

What is 2nd column injury?

A

Disruption of middle column.

64
Q

What is a 3rd column injury?

A

Disruption of the posterior column.

Trauma (15 decks)

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