Test 2 - cervical myelopathy

Question 1

what covers the medial posterior surface of the vertebral bodies and annular fibers of the discs

Answer 1

posterior longitudinal ligament

Question 2

what decreases the posterior medial disc buldge/herniation

Answer 2

posterior longitudinal ligament

Question 3

degeneration of the disc height from aging or trauma can lead to compression of the ________ decreasing perfusion of the spinal cord

Answer 3

anterior spinal artery

Question 4

what artery serves as one for the dorsal column and dorsal horn

Answer 4

posterior spinal artery

Question 5

what artery serves the anterior 2/3 of the spinal cord

Answer 5

anterior spinal artery

Question 6

decreased blood flow to _____ decreases this tracts function, therefore could see UMN signs in the lower limbs

Answer 6

watershed zone: posterior lateral white matter where the lateral corticospinal tract is located

Question 7

with spondylosis, ______ thickens, decreasing anterior and posterior diameter of the spinal canal

Answer 7

ligamentum flavum

Question 8

what results in sliding of superior articular process over the inferior decreasing the vertical and anterior/posterior dimensions of the IVF

Answer 8

spondylosis

Question 9

_____ of the neck and head may decrease signs and symptoms of myelopathy while increasing signs and symptoms of cervical radiculopathy

Answer 9

flexion: increases the a-p diameter of the cervical spinal canal, but stretches nerve roots

Question 10

myelopathy sign: UMN signs of lower extremity (uni or bilaterally)

Answer 10

• spasticity in quads and triceps surae
• weakness in hamstrings and tib anterior
• hyperreflexia in patella and ankle
• clonus (repetitive contraction with stretch and hold of ankle)
• pathological reflex (extensor plantar response)

Question 11

myelopathy signs: dorsal column dysfunction

Answer 11

dysequilibrium (decreased proprioception)

decreased touch and vibration

Question 12

myelopathy sign: LMN signs in upper limb

Answer 12

• weakness
• atrophy
• twitches (fasciculations)

Question 13

how to test for myelopathy

Answer 13

• touch and vibration with patients head in neutral pos
• test ankle reflex and plantar response
• patient extend their head and neck
• retest touch, vibration, ankle and plantar reflexes
• if normal in neutral and abnormal in extension, consider myelopathy

Question 14

trauma causing cervical myelopathy

Answer 14

• sudden extreme extension
• severe whiplash
• extension of head with tooth extraction
• cervical manipulation

Question 15

symptoms of cervical myelopathy

Answer 15

painful, stiff neck

shoulder arm pain

spastic weakness in legs (UMN)

Question 16

what is the finger escape sign

Answer 16

unable to maintain full finger extension and adduction of the ulnar digits

Question 17

symptoms of cord compression in LE

Answer 17

legs feel stiff and heavy

gives out quickly after exercise

toe scrapes floor during swing phase of gait

Question 18

exam reveeals of cervical myelopathy in LE

Answer 18

spasticity more than weakness

increased muscle stretch reflexes

Pt may believe only onel leg is affected but is common to see extensor plantar response bilaterally

Question 19

sensory changes in LE

Answer 19

numbness and/or tingling of soles of feet and around ankles

impaired vibration and position sense (dorsal columns)

asymmetrical

Question 20

AP diameter of spinal canal less than ____ mm leaves insufficient room for the cord

Answer 20

9-10

diameter decrease does no correlate well with presence and degree of spinal cord injury

Question 21

is there vision trouble in CM

Answer 21

no

Question 22

what three tracts are affected by MS

Answer 22

DC - paresthesias in all limbs and with loss of JPS ataxia

CST - lesion spastic legs, ext plantar response

SPTT - deep achiness and pain and thermal loss

Question 23

amyotrophic lateral sclerosis signs

Answer 23

LMN sings in UE

UMN signs in LE

preservation of reflexes in presence of weakness and atrophy

Question 24

could be due to a B12 problem/deficiency

peripheral nn early with ataxia developing later d/t sensory loss

extensor plantar response with absent reflexes d/t loss of peripheral fibers

Answer 24

subacute combined degeneration

DC degeneration

CST degeneration