Thursday, 4-21-Spinal Cord Lesions (Stephens)

Question 1

__ fibers “open” the gate and enhance pain

___ afferents “close” the gate and diminish pain

Answer 1

Nociceptive C

Nonnociceptive (A alpha/beta fibers)

Question 2

Herpes zoster (shingles) infection may compromise the ___ fibers, thereby causing inhibition of the SG cells, and an increased sensitivity to pain

Answer 2

Nonnociceptive (A) fibers

-Decrease in A type fibers “opens” the gate

Question 3

__ is a unilateral transverse lesion or hemisection of the SC usually due to a knife or bullet wound, or a tumor such as a meningioma pressing upon the cord. It is a relatively common trauma.

Answer 3

Brown-Sequard syndrome

Question 4

In Brown-Sequard syndrome, ipsilateral loss of proprioception and vibratory sensations from the body below the level of the lesion is due to interruption of the ___

Answer 4

Posterior columns

Question 5

In Brown-Sequard syndrome, ipsilateral spastic paralysis below the level of the lesion is due to destruction of the ___

Answer 5

Descending motor tracts

Question 6

In Brown-Sequard syndrome, contralateral loss of pain and temperature sensation from the body 2 sensory dermatomal segments below the level of the lesion is due to destruction of the ___

Answer 6

LSTT

Question 7

Syringomyelia is a gross cavitation and gliosis of the central canal usually occuring the __ regions of the SC. As the syrinx enlarges, the neurological deficits progressively worsen over a period of months or years.

Answer 7

Cervical

Question 8

Enlargement of the syrinx in syringomyelia results in destruction of the __ with a bilateral loss of pain and temperature sensations to the UE’s (“yoke-like” anesthesia)

Answer 8

AWC

Question 9

Enlargement of the syrinx in syringomyelia results in asymmetrical (unilateral or bilateral) destruction of the __ that leads to spastic paralysis, hyperreflexia, and hypertonia of the LE

Answer 9

LCST (UMN)

Question 10

Enlargement of the syrinx in syringomyelia results in the __ being destroyed that leads to a LMN paralysis [flaccid paralysis, atrophy, areflexia, and atonia] of the associated upper limb musculature

Answer 10

Anterior horns (LMN)

Question 11

Enlargement of the syrinx in syringomyelia results in some part of the ___ being affected, which leads to an ipsilateral anesthesia (proprioceptive and 2-pt tactile sensation) below the level of the lesion

Answer 11

Posterior columns

Question 12

A pt presents with numbness and tingling in the fingers and toes (“glove and stocking” anesthesia), bilateral loss of proprioception and vibratory sensations, and UMN signs such as spastic paralysis, paresis, hyperreflexia, and Babinkis sign. What is the most likely diagnosis?

Answer 12

Subacute combined degeneration

Question 13

This vitamin deficiency is associated with subacute combined degeneration and pernicious anemia and causes neurological disorders.

Answer 13

B12

Question 14

This condition results in macrocytic anemia and degeneration of the posterior columns and the pyramidal tracts, along with a polyneuropathy.

Answer 14

Subacute combined degeneration and pernicious anemia

Question 15

The most common form of ALS involves a combo of LMNs and UMNs. List LMN components that are affected in ALS:

Answer 15

• anterior horn cells
• hypoglossal nucleus
• nucleus ambiguus
• facial motor nucleus

Question 16

The most common form of ALS involves a combo of LMNs and UMNs. List UMN components that are affected in ALS:

Answer 16

Chronic, progressive degeneration of the corticospinal tracts

Question 17

___ leads to LMN paresis and atrophy of the intrinsic muscles of the hands follwed later by the arms and shoulder musculature. Patients may develop dysarthria, dysphagia, and paresis of the tongue. There are NO SENSORY DEFICITS.

Answer 17

ALS

Question 18

Tabes dorsalis usually occurs during the tertiary (late) stage of syphilis and results in bilateral ischemic necrosis of the ___

Answer 18

Posterior columns and the dorsal roots at this level

Question 19

In tabes dorsalis, involvement of the dorsal roots in the sacral region results in __

Answer 19

Atonic bladder and painless retention of urine

Question 20

Congenital absence of nociceptive __ fibers results in disinhibition of the SG cell and an insensitivity to pain.

Answer 20

C type

Decrease in C type fibers “closes” the gate