Syndromes Flashcards
most common cause of spinal stenosis
disc herniation
arthritic degeneration of vertebrae that narrows intervertebral foramina, whereby new bone can grow into the spinal canal, causing compression
spondylosis
the term given for pain experienced from disc herniation, resulting from inflammation of the spinal roots by the release of mediators like TNF
chemical radiculitis
C6/7 herniation affects what spinal root?
C7
most disc herniations occur at which spinal levels?
cervical (most frequent C6/C7) and lumbar (most commonly the L4-S1 region)
what is the usual presentation of spinal cord injury?
loss of function
An extrinsic lesion of the spinal cord will affect these levels first, and as the disease progresses, loss of pain, temperature and motor paresis appears to ascend.
sacral
An intrinsic (central) lesion of the spinal cord will affect the upper limbs first, resuting in a phenomenon known as what?
sacral sparing
These symptoms are likely the result of what kind of lesion?
- Loss of pain and temperature over L upper limb
- UMN signs in R forearm and hand
- LMN signs in R deltoid and biceps
R sided central lesion (C5)
These symptoms are likely the result of what kind of lesion?
- Loss of pain and temperature over L lower limb
- UMN signs in R leg and abdomen
- bowel and bladder problems
R sided external lesion
syndrome that describes the motor and sensory signs resulting from a left or right hemisection of the spinal cord
Brown-Séquard syndrome (rare)
syndrome that results from a lesion developing within the spinal cord itself (typically in the cervical cord), and is characterized by bilateral loss of pain and temperature over a limited area with sacral sparing
central cord syndrome
condition that results from a longitudinal cavity that forms in the cervical/thoracic spinal cord, destroying the ventral white commissure and producing bilateral loss of pain and temperature over (usually) the shoulder and lateral surface of the arm; results in ‘cape’ like sensory loss
syringomyelia
watershed areas occur in what area of the spinal cord?
thoracic
posterior spinal artery occlusions (posterior cord syndrome) can occur unilaterally and lead to predominantly what kind of signs? What is a common cause for this?
sensory loss (2-point discrimination, vibration and kinsthesia, and positive Romberg sign); commonly caused by syphilis
this syndrome results in complete, bilateral motor paralysis, as well as pain and temperature loss below the level of the lesion, with sparing of general sensory and proprioception
anterior cord (spinal artery) syndrome
anterior cord syndrome in the cervical portion of the spinal cord may result in damage to what cranial nerve, whose nucleus lies within the C1-C5 posterolateral ventral horn?
CN XI
Signs of this syndrome include weakness of the leg and foot, loss of pain, temperature, 2-point, and touch over S1-S5 dermatomes (“saddle anesthesia”), and loss of knee and ankle reflexes; other important signs include urinary retention and loss of tone in external anal sphincter
cauda equina syndrome
Bladder, bowel and sexual dysfunction occur early in this syndrome, with UMN signs and confined sensory loss to the perianal region (S4/5)
conus medullaris syndrome
Lesions in the autonomic (sympathetic) neurons at or above T2 result in ipsilateral anhidrosis, miosis, ptosis, and enophthalmos - all signs of what syndrome?
Horner’s syndrome
Lesions of what tract result in contralateral loss of pain and temperature sensations beginning in dermatomes one or two segments below the spinal cord lesion?
spinothalamic
Lesions of what tract result in ipsilateral loss of kinesthesia and discriminative touch at and below the level of spinal cord lesion?
dorsal column
Corticospinal tract lesions produce ______ motor neuron signs wile ventral horn lesions produce _____ motor neuron signs.
upper; lower
The medulla is supplied by branches of which artery?
vertebral
lesions of the medial medulla (medial medullary syndrome) may affect the corticospinal and medial lemniscus tracts as well as the hypoglossal nucleus. What signs would be associated with lesions here?
hypoglossal nucleus: tongue deviation to side of lesion
medial lemniscus: contralateral loss of 2-point discriminative touch, kinesthesia and vibration sense
corticospinal: contralateral UMN signs
lateral medullary syndrome (AKA Wallenberg’s syndrome, PICA syndrome) may affect multiple structures, including nucleus ambiguus, spinal n. of V, spinothalamic tract, hypothalamospinal tract, inferior cerebellar peduncle, vestibular nuclei and the reticular formation. What signs would be associated with lesions here?
Nucleus ambiguus: Dysphagia, displaced uvula, flaccid vocal fold
Spinal n. of V: Ipsilateral loss of pain, temp on face
Spinothalamic tract: Contralateral loss of pain/temp
Hypothalamospinal: Horner’s syndrome
Inferior cerebellar peduncle: ipsilateral ataxia
Vestibular nuclei: vertigo, nausea
Reticular formation: hiccups
pontine syndromes that are characterized by ipsilateral cranial nerve signs and contralateral sensory loss over body
tegmental pontine syndromes
pontine lesions that affect corticospinal, corticobulbar and VI and VII nerve fibers
basal pontine lesions
Bilateral damage to corticobulbar UMNs results in weakness to the muscles supplied by the affected cranial nerves, as well as dysphagia, dysarthria (speech problems) and inappropriate emotional outbursts. These signs are characteristic of what condition?
pseudobulbar palsy
syndrome that results from large lesions of the basal pons, which damage the corticospinal and corticobulbar pathways bilaterally, interfering with facial expression,
speech, and movement but sparing somatosensory and reticular formation (awareness)
locked-in syndrome
syndrome resulting from a deficit in the rostral part of the midbain (ie, PCA infarct) is known as what? What clinical signs would present?
Benedikt’s syndrome;
CN III nerve palsy on ipsilateral side
Contralateral tremor both at rest and on movement
Contralateral hemianesthesia (all modalities) due to
interruption of medial, spinal and trigeminal lemnisci
syndrome resulting from a deficit in the caudal part of the midbrain (ie, infarct of paramedian branches of the basilar artery) is known as what? What clinical signs would present?
Weber’s sydnrome;
CN III nerve palsy on ipsilateral side
Contralateral UMN signs due to corticospinal (corticobulbar) interruption
