Syndromes

Question 1

most common cause of spinal stenosis

Answer 1

disc herniation

Question 2

arthritic degeneration of vertebrae that narrows intervertebral foramina, whereby new bone can grow into the spinal canal, causing compression

Answer 2

spondylosis

Question 3

the term given for pain experienced from disc herniation, resulting from inflammation of the spinal roots by the release of mediators like TNF

Answer 3

chemical radiculitis

Question 4

C6/7 herniation affects what spinal root?

Answer 4

C7

Question 5

most disc herniations occur at which spinal levels?

Answer 5

cervical (most frequent C6/C7) and lumbar (most commonly the L4-S1 region)

Question 6

what is the usual presentation of spinal cord injury?

Answer 6

loss of function

Question 7

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.

Answer 7

sacral

Question 8

An intrinsic (central) lesion of the spinal cord will affect the upper limbs first, resuting in a phenomenon known as what?

Answer 8

sacral sparing

Question 9

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

Answer 9

R sided central lesion (C5)

Question 10

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

Answer 10

R sided external lesion

Question 11

syndrome that describes the motor and sensory signs resulting from a left or right hemisection of the spinal cord

Answer 11

Brown-Séquard syndrome (rare)

Question 12

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

Answer 12

central cord syndrome

Question 13

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

Answer 13

syringomyelia

Question 14

watershed areas occur in what area of the spinal cord?

Answer 14

thoracic

Question 15

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?

Answer 15

sensory loss (2-point discrimination, vibration and kinsthesia, and positive Romberg sign); commonly caused by syphilis

Question 16

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

Answer 16

anterior cord (spinal artery) syndrome

Question 17

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?

Answer 17

CN XI

Question 18

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

Answer 18

cauda equina syndrome

Question 19

Bladder, bowel and sexual dysfunction occur early in this syndrome, with UMN signs and confined sensory loss to the perianal region (S4/5)

Answer 19

conus medullaris syndrome

Question 20

Lesions in the autonomic (sympathetic) neurons at or above T2 result in ipsilateral anhidrosis, miosis, ptosis, and enophthalmos - all signs of what syndrome?

Answer 20

Horner’s syndrome

Question 21

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?

Answer 21

spinothalamic

Question 22

Lesions of what tract result in ipsilateral loss of kinesthesia and discriminative touch at and below the level of spinal cord lesion?

Answer 22

dorsal column

Question 23

Corticospinal tract lesions produce ______ motor neuron signs wile ventral horn lesions produce _____ motor neuron signs.

Answer 23

upper; lower

Question 24

The medulla is supplied by branches of which artery?

Answer 24

vertebral

Question 25

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?

Answer 25

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

Question 26

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?

Answer 26

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

Question 27

pontine syndromes that are characterized by ipsilateral cranial nerve signs and contralateral sensory loss over body

Answer 27

tegmental pontine syndromes

Question 28

pontine lesions that affect corticospinal, corticobulbar and VI and VII nerve fibers

Answer 28

basal pontine lesions

Question 29

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?

Answer 29

pseudobulbar palsy

Question 30

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)

Answer 30

locked-in syndrome

Question 31

syndrome resulting from a deficit in the rostral part of the midbain (ie, PCA infarct) is known as what? What clinical signs would present?

Answer 31

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

Question 32

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?

Answer 32

Weber’s sydnrome;
CN III nerve palsy on ipsilateral side
Contralateral UMN signs due to corticospinal (corticobulbar) interruption