spine and spinal cord Flashcards
What is a myelopathy?
impingement on the spinal cord (central)
What is a radiculopathy?
impingement on the nerve root (lateral)
What kind of impingement occurs below the conus?
polyridiculopathy- can lead to bladder and bowel disc function.
Can also get singular ridiculopathy if the impingement is more lateral
What occurs with hypertrophy of the ligamentum flavum?
Myelopathy due to impingement
What are the types of pain that can occur with spinal impingement?
Lhermitte’s sign- lightning bolt sensation with neck extension
What are the types of pain that can occur with nerve root impingement?
Spurling’s sign- Turn head toward narrow foramen- shock that radiates out with the nerve root
Lasegue’s sign- elevate leg to stretch sciatic nerve- pain
What is paresthesia?
abnormal sensation
What are some frequent symptoms of spinal cord and nerve root impingement?
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What is the somatotopy in the different tracts in the spinal cord?
Anterior Spinothalamic tract
Dorsal column
Lateral corticospinal tract
Which are the most important dermatomes?
C5- posterior shoulder and lateral arm C6- Thumb C7- Middle finger L4- Anterior aspect of the leg and medial malleolus L5- Dorsum of foot and great toe S1- small toe and heel T4- nipple T6- xyphoid T10- umbilicus
What are the motor effects of each nerve root?
C5- Deltoid, infraspinatus, Biceps (Biceps reflex)
C6- Wrist extens, biceps (Biceps, brachioradialis)
C7- ???????????????????????
L4- Psoas, Quads
L5-
S1
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What ridiculopathy can be produced by L4 disc herniation?
In lumbosacral spine, it is more likely to impinge on the traversing root, so it is most likely to actually cause radiculopathy in L5, not L4 (too lateral)
How do you know how full your bladder is?
Afferents from bladder wall and pelvic floor in lumrosacral cord to CNS.
How do you control bladder continence?
Sacral reflex due to stretch causes the detrusor to contract and relax external sphincter. ????????
How do you assess discriminative touch, vibration (dorsal column)?
Use a piece of gauze and have a patient tell you when they feel touch. Use a tuning fork and have a patient tell you when they feel vibration. Test proprioception by moving the toe up or down. Use two point discrimination
How do you assess pain and temperature?
Use a sterilized safety pin and ask if it is sharp or dull. use cold side of the reflex hammer.
How do you assess motor function?
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What are the reflexes that should be assessed
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What is the sequence of symptoms in lesions outside the cord (meningioma, schwannoma)?
Early pain, later loss of bladder and bowel control. Pain and temperature should develop in an ascending pattern
What is the sequence of symptoms in lesions inside the cord (often ependymomas or subependymomas)?
Weakness early, then paresthesias that work their way down and urinary incontinence. Very little pain.
What is the difference between conus medullaris and cauda equina syndromes?
Usually cauda equina is external and conus medularis is internal.
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What is lumbar spinal stenosis? What symptoms would you expect?
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What is spinal shock?
Physiologic disruption of the axons. You know it is resolved when the bulbocavernosus reflex returns
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What is neurogenic shock?
Disruption of descending sympathetic outflow.
How do you classify the spinal cord injury?
Complete- ????????
Incomplete- ????????????
What are the sequelae of spinal cord injury?
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