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Neuroscience-Spinal Nerve Roots > Spinal Nerve Root > Flashcards

Spinal Nerve Root Flashcards

1
Q

Segmental Organization

A
  • 8 cervical (C1-C8).
  • 12 thoracic (T1-T12).
  • 5 lumbar (L1-L5).
  • 5 sacral (S1-S5).
  • 1 coccygeal (Co).
  • Growth of bones after cord stops = conus medullaris, ~ L1-L2.
  • Cauda equina.
  • Filum terminal.
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2
Q

Spinal Cord

A
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3
Q

Organization

A
  • Motor & sensory roots (L & R) arise from each segment except C1.
  • C1 has no sensory roots, ONLY motor.
  • Cervical enlargement (C5-T1).
  • Lumbar enlargement (L1-S3).
  • Mixed spinal nerves from each segment (*except?)
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4
Q

Vertebae

A
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5
Q

Vertebrae

A
  • Provide mechanical support.
  • Anteriorly; vertebral body.
  • Posteriorly; superior & inferior articular processes.
  • Protection.
  • Spinal cord through the vertebral canal surrounded by meninges.
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6
Q

Vertebrae

A
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7
Q

Vertebrae

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8
Q

Vertebrae

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9
Q

Spinal Canal

A
  • As dura exits skull, outer layer becomes 1 with periosteum- indistinguishable.
  • Layer of epidural fat between dura & periosteum in spinal canal (landmark.)
  • Batson’s venous plexus; valveless.
  • Network connecting deep pelvic veins draining bladder, prostate & rectum to internal vertebral venous plexus.
  • *Mets.
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10
Q

Spinal Canal

A
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11
Q

Disc Herniations

A
  • N.R. involved usually corresponds to lower of 2 adjacent vertebrae.
  • C-spine PLL thick & N.R.s exit horizontally; herniates laterally.
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12
Q

Disc Herniations

A

•L & S-spine N.R.s travel down & into lateral recesses of canal of canal; closest to disc for posterolateral herniation.

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13
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A
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14
Q

Disc Herniations

A

•Far lateral disc herniation reach N.R. exiting at that level = impingement of next higher N.R.

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15
Q

Dermatomes

A
  • Sensory distribution on skin by a N.R.
  • A map but references vary some.
  • Face = trigeminal nerve.
  • Rest of head mostly C2 (greater & lesser occipital nerves.)
  • Torso; nipples T4, umbilicus T10.
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16
Q

Dermatomes

A
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17
Q

Dermatomes

A
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18
Q

Dermatomes

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19
Q

Myotomes

A

•Muscles innervated by a single nerve root.

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20
Q

Myotomes

A
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21
Q

Summary of Peripheral Nerves, muscles, Nerve Roos in the Upper and Lower Extremities

A
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22
Q

Summary of Peripheral Nerves, muscles, Nerve Roos in the Upper and Lower Extremities

A
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23
Q

Summary of Peripheral Nerves, muscles, Nerve Roos in the Upper and Lower Extremities

A
24
Q

Summary of Peripheral Nerves, muscles, Nerve Roos in the Upper and Lower Extremities

A
25
Q

Summary of Peripheral Nerves, muscles, Nerve Roos in the Upper and Lower Extremities

A
26
Q

Disorders of Nerve, NMJ, & Muscle

A
  • Peripheral sensory or motor patterns/deficits.
  • LMN lesions.
  • Atrophy, fasciculations, decreased tone, & hyporeflexia.
27
Q

Disorders of Nerve, NMJ, & Muscle

A
  • Causes:
  • Mechanical.
  • Toxic.
  • Metabolic.
  • Infectious.
  • Autoimmune.
  • Inflammatory.
  • Degenerative.
28
Q

Common Neuropathies

A
  • A nerve disorder.
  • Axon, myelin or both involved.
  • Large diameter, small diameter, or both involved.
  • Usually both motor and sensory involved.
  • Reversible or permanent.
  • Radiculopathy involved spinal nerve root.
29
Q

Important Causes-Neuropathies

A
  • Diabetes.
  • Mechanical disorders.
  • Infectious disease; HIV, CMV, Lyme disease, varicella-zoster virus, hep-B.
  • Toxins.
  • Malnutrition.
  • Immune disorders; Guillain-Barre, Charcot-Marie-Tooth disease…
30
Q

Diabetic Neuropathy

A
  • Compromised microvascular blood supply to peripheral nerves.
  • Distal symmetrical polyneuropathy.
  • Stocking glove distribution of sensory loss.
  • Mononeuropathy.
  • Cranial or spinal nerves but CNIII, femoral & sciatic commonly.
  • Sudden onset, maybe painful paresthesia.

Partial or complete recovery

31
Q

Mechanical Causes of Nerve Injury

A
  • Extrinsic compression, traction, laceration or entrapment.
  • Intrinsic compression by bone, or CT.
  • Neuropraxia; temporary impairment of NCV.
  • Wallerian degeneration; severe injury & distal death.
  • Axonal regeneration; 1mm/day.
  • RSD; regional pain syndrome following injury without specific nerve damage.
  • Causalgia; damage to specific nerve.
32
Q

Long Term Complications

A
  • Incomplete or aberrant reinnervation.
  • RSD (reflex sympathetic Dystropy Syndrome); regional pain syndrome following injury without specific nerve damage.
  • Causalgia; damage to specific nerve.

Local, intense burning pain with edema, sweating, & changed skin blood supply

33
Q

Guillain-Barre Syndrome
Acute Inflammatory Demyelinating Polyneuropathy (AIDP)

A
  • Immune-mediated demyelination of PNS.
  • 1-2 weeks post viral infection.
  • Camphylobacteri jejuni enteritis, HIV…
  • Progressive weakness, areflexia, tingling paresthesias of hands, feet with more severe motor involvement.
  • Wort 1-3 weeks after onset; recovery = months.

Dx: symptomatology & elevated CSF proteins wo increased WBC s & (+)EMG for demyelination

34
Q

Disorders of NMJ

A
  • Motor weakness without sensory deficits.
  • Causes:
  • M.G.
  • NM blocking agents & other drugs.
  • Lambert-Eaton myasthenic syndrome.
  • Botulism.
35
Q

Myasthenia Gravis

A
  • Immune-mediated disorder.
  • Postsynaptic nicotinic acetylcholine receptor antibodies.
  • Sometimes runs with other autoimmune dys(fx).
  • Hypothyroidism.
  • SLE.
  • R.A.
  • Vitiligo.
36
Q

Myasthenia Gravis

A
  • Onset:
  • 20-30y.o.; females
  • 60-70y.o.;males.
  • Generalized symmetrical weakness, proximal limb, neck, diaphragm, eye muscles, & bulbar muscles (CN IX-XII): facial weakness, nasal voice & dysphagia.
  • **WEAKNESS BECOMES MORE SEVERE WITH REPEATED USE.

IF JUST EYES=

OCULAR MYASTHENIA

(15%).

37
Q
A
38
Q

Myasthenia Gravis

A
  • Diagnosis:
  • Clinical features.
  • Ice pack test (ptosis.)
  • Repetitive nerve stimulation.
  • Measurement of antibodies.
  • Tensilon test (old-2008 DQ)
  • Neostigmine.

CMAP=characteristic decrement in amplitude

39
Q

Dermato- & Polymyositis

A
  • Immune-mediated inflammatory myopathies.
  • Increased blood CPK.
  • (+) EMG for myopathy.
  • Dermatomyositis: characteristic violet-colored skin rash on extensor surface knuckles & other joints.
  • Duchenne M.D. most common form M.D>
  • X-linked inheritance
  • Male children.
  • Progressive proximal weakness.
40
Q

Back Pain

A
  • One of the most common causes to seek medical attention.
  • Diverse causes.
  • Importance of careful Hx & P.E.
  • NMS causes are most common.
  • > 50… neoplasm?
  • Never neglect bowel, bladder, & sexual fx.
41
Q

Differential Diagnosis of Back Pain

A
42
Q

Clarifying Definitions for Degenerative Disorders of the Spine

A
43
Q

Disc Herniation

A
  • Most common
  • C5-C6, C6-C7.
  • L4-5, L5-S1
  • L/S are 2-3 x more common than cervical disc herniations.
  • Osteophyte formation.
  • Spinal stenosis.
  • >>>chronic injury to cord.
44
Q

Orthopedics

A
  • SLR
  • (+)=10-60 degrees with reproduction of radiculopathy.
  • Crossed SLR
  • 90% (+) for L/S N.R. compression.
  • Valsalva’s maneuver.
  • Percussion of spine.
  • (+)Metastatic disease, epidural abscess, osteomyelitis, & other bone disorders.
45
Q

Straight Leg Raise

A
46
Q

Radiculopathy

A
  • Stenosis; narrowing of the spinal canal; congenital or degenerative.
  • Lumbar stenosis.
  • Neurogenic claudication.
  • Bilateral leg pain & weakness with ambulation.
  • Cervical stenosis.
  • Radicular signs.
  • Long tract signs.
  • Trauma; compression, traction, avulsion.
  • Diabetic neuropathy.
  • Epidural mets; usually to vertebral body but can extend laterally & compress N.R.
47
Q

Radiculopathy

A
  • Many causes of neuropathies have preference for N.R. so can be a radiculopathy.
  • Guillain-Barre syndrome.
  • Varicella-zoster virus in DRG > herpes zoster=shingles.
  • Post herpetic neuralgia or pain syndrome.
  • Lyme disease.
  • CMV polyradiculopathy in patients with HIV.
  • HIV (milder than CMV)
  • Tumors.
  • Schwannomas.
  • Neurofibromas.
48
Q

Three important Nerve Root in the Arm

A
49
Q

Dermatomes of the Arm

A
50
Q

Three important Nerve Roots in the Leg

A
51
Q

Dermatomes of the Leg

A
52
Q

Cauda Equina Syndrome

A
  • Impaired fx of multiple N.R.s below L1 or L2.
  • If deficit at S2 or lower – maybe not see L.E. motor weakness.
  • S2-S5 sensory loss = saddle anesthesia.
  • S2, S3, S4 = distended atonic bladder, urinary retention, incontinence, constipation, decreased rectal tone, loss of erections. (S2,3,4 keeps the Ps off the floor.)
  • Central disc, epidural mets, schwannoma, meningioma, neoplastic meningitis, trauma, epidural abscess, arachnioditis, CMV polyradiculitis.
53
Q

Surgery

A
  • Usually disc herniation resolves without surgery.
  • Surgical emergency:
  • Cauda equina syndrome.
  • Progressive or severe motor deficit.
  • Intolerable, medically intractable pain.
  • Conservative care first 1-3 months.
54
Q

Common Surgical Approaches

A

Posterior approach:

  • Laminectomy
  • Discectomy.
  • Foraminotomy.
  • Hardware if necessary.

Anterior approach to C-spine:

  • Discectomy.
  • Fusion (bone graft.)
  • Also for T-spine discs (rare.)
55
Q
A

Neuroscience-Spinal Nerve Roots (4 decks)

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