Week 129 - Spinal Cord Compression Flashcards by Victor g

Where does lordosis and kyphosis occur?

Lordosis - cervical and sacral

Kyphosis - thoracic

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Describe the progression of a disc prolapse

1) Disc Bulge
2) Disc Protrusion
3) Disc Extrusion
4) Disc Sequestration

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Where are spinal fractures most commonly seen?

Where mobile areas meet immobile areas (e.g. T12-L1)

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Name stable and unstable fractures and what they involve

Stable - anterior column involved (e.g. wedge fracture)
More Unstable - anterior & middle columns involved (e.g. Burst Fracture)
Unstable - anterior, middle & posterior columns involved (e.g. seat belt fracture)

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What is the function of the Atlanto-occipital joint?

Head nodding

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What is the function of the Atlanto-axial joint?

Rotation

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Where do the vertebral arteries arise from and where do they enter the spinal cord?

Arise from subclavian artery and enter at C6

Travel in transverse foramen of cervical vertebrae

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What type of joints join adjacent vertebrae?

Facet Joints (synovial joints)
Subject to osteoarthritis

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Where does the spinal cord end?

Ends at L1

from there it is known as Cauda equina

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What what level would CSF fluid sample be taken?

L4/L5

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What muscles produce rotation of cervical spine?

Obliquus capitis inferior
Rectus capitis posterior major + minor
Splenius capitis
Contralateral sternocleidomastoid & semispinalis capitis

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What muscles produce side flexion of cervical spine?

Iliocostalis cervicis
Longissimus capitis & cervicis
Splenius capitis & cervicis
Intertransverarii
Scalenes

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What muscles produce flexion of trunk?

Rectus abdominis

Psoas major

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What muscles produce extension of trunk?

Erector spinae multifidus

Semispinalis thoracis

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What does C1 (the atlas lack)?

Vertebral Body (therefore no intervertebral disc between CI and CII

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What is abnormal lateral curvature of vertebral column called?

Scoliosis

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What is the central portion of intervertebral discs called and their function?

Nucleus Pulposus - centre + gelatinous

Absorbs compression forces

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What is the outer ring of fibrocartilage called?

Anulus fibrosus - limits the rotation between vertebrae

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What type of joints are the joints between vertebral arches (zygapophysial joints)?

Synovial Joints

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Name the function and level of decussation of Descending Tracts.

Motor

Pyramidal decussation

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Name the sensory modalities and the level of decussation of the Spinothalamic Tract

Pain, Temperature

Decussation at level of entry

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Name the sensory modalities and the level of decussation of the Dorsal Columns

Proprioception, Soft Touch, Vibration

Crosses over in brain stem region

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What would Brown-Sequard Syndrome at T5 (L) present like?

Left sided block of spinal cord at T5
R leg - Pain, Temp loss
L leg - weak, proprioception loss, hyporeflexia

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What are the consequences of an Anterior Spinal Artery Infarction?

Loss of motor + spinothalamic pathways

Dorsal Columns Spared

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What symptoms would a patient with an Anterior Spinal Artery Infarction (T level) present?

Motor = weak Hyporeflexia Pain, Temp = sensation loss Constipation, bowel + urine problems

What symptoms would a radiculopathy at C6 (nerve root compression) result in? - Ventral root only

Hyporeflexia of brachioradialis reflex

What symptoms would an expanded central canal in cervical region - syringomyelia result in?

L + R arm = Pain + Temp sensation loss

Name 3 causes of spinal cord compression

``` Disc & vertebral lesions Trauma Spinal Cord Tumours (extramedullary tumours or mets) TB Abscess/Haemorrhage ```

What can vitamin B12 deficiency cause, and abuse of what substance may precipitate functional B12 deficiency?

Degeneration of the cord | NO

What do Muscle Spindles do?

Detect changes in muscle length | Stretching generates an action potential

What do Golgi Tendon Organs do?

Detects muscle stretch | Can inhibit muscle -> prevent damage

What is a myotactic reflex?

Aka stretch reflex

What is the function of the Renshaw cell?

Makes reflex transient Releases glycine onto α-motor neurone - inhibiting it Negative feedback

What toxin prevents glycine release?

TTX

What is the function of γ-motor neurones?

Keep the muscle spindles taut By causing their contraction Allow them to continue detecting changes

What control does the corticospinal tract provide?

Motor Control

Where does the corticospinal tract originate? (parts of the cortex)

Primary Motor - 30% Primary Somatosensory - 40% Premotor Supplementary Motor Area

What is Apraxia?

Inability to produce a specific motor act even though sensory and motor pathways remain intact

Name the two type of Apraxia

Ideomotor apraxia - cannot execute movement upon request | Ideational apraxia - cannot conceptualize movement required

What is the function of the Reticulospinal tract?

Modulation of spinal extensor reflexes (motor control)

What is the function of the Vestibulospinal tract?

Posture and balance (motor control)

Name three ascending tracts

Spinothalamic (Pain, Temp, Pressure) Spinocerebellar (Proprioception) Dorsal Columns (Joint position, fine discriminatory touch)

Where do Lower Motor Neurones arise and what do they release?

Arise in Brainstem and Spinal Cord Alpha and Gamma Release ACh

Where do Upper Motor Neurones arise and what do they release?

Arise in brain | Glutamatergic

What are the signs and symptoms of a Lower Motor Neurone Lesion?

``` Hyporeflexia Fasciculations Muscle Atrophy Denervation These are not present in UMN lesions ```

What are the signs and symptoms of an Upper Motor Neurone Lesion?

Paralysis/Weakness Hyperreflexia Immediately after lesion: flaccid paralysis, hypotonia, loss of reflexes BUT afterwards: hypertonia, spasticity, babinski reflex

What is Lhermitte's sign?

"electric shock" kinda feeling

What is Cervical Spondylotic Myelopathy?

Narrowing of spinal canal due to "aging" | Compression leads to pain, weakness, and numbness

Name some causes of weakness

Damage to motor pathway NMJ disease Muscle Disease Arthritis, endocrine disorders, systemic disease, fatigue

What does paresis mean?

Weakness

What is plegia?

Paralysis

What is paraplegia?

Paralysis of both legs

What is monoparesis?

One limb weakness

What does Myelo- mean?

Relating to spinal cord

What does Radiculo- mean?

Pertaining to nerve root

What does Myo- mean?

Pertaining to muscle

Where does the initiation of movement take place?

Frontal lobes & the basal ganglia

What is the general pattern of weakness in arms and legs in UMN lesions?

extensors weaker than FLEXORS in ARMS flexors weaker than EXTENSORS in LEGS Giving a person that looks like had a stroke

What is the pattern of weakness in muscle disease?

Tends to affect proximal muscles (pt. will waddle) | Affected muscles may be wasted OR hypertrophied (fat deposition)

What conditions can result in proximal weakness?

Muscle Disease (e.g. Myasthenia Gravis)

What conditions can cause distal weakness?

Polyneuropathy, Peripheral Neuropathy

What conditions can cause paraparesis?

LMN lesion, spinal cord disease

What conditions can cause hemiparesis?

UMN lesion

What is dysarthria?

Poor articulation of speech

What are the signs of pseudo bulbar palsy?

Dysarthric Slow tongue movements Brisk Jaw Jerk due to damage to lower cranial nerves

What is Amyotrophic Lateral Sclerosis (ALS)?

Degenerative disease of motor pathway Degeneration of both UMN and LMN 5% get frontpotemporal demetia

How is diagnosis of ALS made?

History + Examination Moderately elevated creatine kinase Electromyography

What is myositis?

Inflammation of muscles

What are the symptoms of Polymyositis?

Proximal muscle weakness

What are the symptoms of Dermatomyositis?

Proximal muscle weakness Rash over hands + face Associated with malignancy

What are the symptoms of Inclusion Body Myositis?

Proximal leg muscles and long finger flexors | Elderly

What are the symptoms of Cauda equina syndrome?

Weakness of ankle and plantar flexion (foot drop) ?Bilateral sciatica Bilateral loss of ankle reflexes Loss of anal tone Patchy sensatory loss over the perineum and genitals

What symptoms would anterior spinal artery infarction present with?

``` Paraparesis Upgoing plantars Brisk reflexes Temp + Pain sensation lost Proprioception spared ```

What are the possible causes of quadraplegia?

Trauma - Spinal Shock | Acute onset - Guillain-Barré Syndrome

What are the features of spastic hemiparesis?

Elbow flexed Arm + fingers flexed across chest Leg = extended +circumducts to prevent toe scuffing

What artery supplies dorsal columns of spinal cord?

Posterior spinal artery