Spinal tract clinical implications

Question 1

true or false: with UMN lesions we tend to see more spasticity, less atrophy, hypperreflexia, clonus and a positive babinskinsign

Answer 1

true

Question 2

true or false: with LMN lesions we tend to see normal or flaccid tone, muscle loss, hyporeflexia, fasiculatoin and a negative babinski sign

Answer 2

true

Question 3

true or false: strength of upper extremity flexors are greater than UE extensors?

Answer 3

true

Question 4

true or false: strength of LE extensors are greater than LE flexors?

Answer 4

true

Question 5

Why does a UMN lesion cause a positive Babinski sign?

Answer 5

Normally, when stroking the lateral plantar surface of the foot, you reflexively activate the S1 myotome which is toe flexion

Normally, UMNs inhibit other segments from firing when the S1 dermatome is stimulated, so when there is an UMN lesion the surrounding levels (eg. L5) are activated and you get toe extensor activation

Question 6

What is the most common SCI symptom?

Answer 6

central cord syndrom

Question 7

What is central cord syndrome?

Answer 7

Narrowing of the cervical spine in those with arthritis leads to vulnerability if a hyperextension injury occurs

Question 8

are lower or upper limbs more affected with central cord syndrome?

Answer 8

motor to upper-because of the somatotrophic organization of the tracts

Question 9

what is transection of the spinal cord? what are the symptoms?

Answer 9

bilateral loss of : sensation and voluntary movement below the level of the lesion

bilateral flaccid paralysis in segment of the lesion (LMN)

bilateral spastic paralysis below lesions (UMN damage)

Bilateral Babinski sign (UMN damage)

Question 10

What is brown sequard syndrome? what are the symptoms?

Answer 10

hemi-transection

lateral corticospinal pathway- ipsi- loss
PCML- ipsi- loss
Spinothalamic- contra-loss

Question 11

what is anterior cord syndrome? what are the symptoms?

Answer 11

lesion of the anterior cord due an infarct of the anterior spinal artery

motor deficit, pain/temperature deficit, often bladder dysfunction, proprioception/light touch relatively preserved

Question 12

what is the prognosis for anterior cord syndrome

Answer 12

poor motor return, worst prognosis of the SCI syndromes

Question 13

what is cauda equina syndrome?

Answer 13

its when a herniated disk crushes the cauda equina

often sudden onset- surgical emergency
saddle anesthesia

Question 14

On the ASIA impairment scale, what does A mean? B,C,D? E?

Answer 14

A- complete
B,C,D- incomplete
E- no neurological deficit

Question 15

what functional implications exist for a C1-3 injury?

Answer 15

Likely ventilator dependent, dependent for ADLs?

Question 16

What highest lesion level possible while still remaining functional indapendant?

Answer 16

C7

Question 17

A lesion at where and above puts you at risk for autonomic dysreflexia?

Answer 17

T6

Question 18

If the injury is at lumbar level and below, do we anticipate an UMN or a LMN injury?

Answer 18

LMN