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Year 1 Medicine > Week 129 - Spinal Cord Compression > Flashcards

Week 129 - Spinal Cord Compression Flashcards

1
Q

Where does lordosis and kyphosis occur?

A

Lordosis - cervical and sacral

Kyphosis - thoracic

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2
Q

Describe the progression of a disc prolapse

A

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

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3
Q

Where are spinal fractures most commonly seen?

A

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

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4
Q

Name stable and unstable fractures and what they involve

A

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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5
Q

What is the function of the Atlanto-occipital joint?

A

Head nodding

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6
Q

What is the function of the Atlanto-axial joint?

A

Rotation

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7
Q

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

A

Arise from subclavian artery and enter at C6

Travel in transverse foramen of cervical vertebrae

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8
Q

What type of joints join adjacent vertebrae?

A 
Facet Joints (synovial joints)
Subject to osteoarthritis
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9
Q

Where does the spinal cord end?

A

Ends at L1

from there it is known as Cauda equina

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10
Q

What what level would CSF fluid sample be taken?

A

L4/L5

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11
Q

What muscles produce rotation of cervical spine?

A

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

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12
Q

What muscles produce side flexion of cervical spine?

A 
Iliocostalis cervicis
Longissimus capitis & cervicis
Splenius capitis & cervicis
Intertransverarii
Scalenes
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13
Q

What muscles produce flexion of trunk?

A

Rectus abdominis

Psoas major

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14
Q

What muscles produce extension of trunk?

A

Erector spinae multifidus

Semispinalis thoracis

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15
Q

What does C1 (the atlas lack)?

A

Vertebral Body (therefore no intervertebral disc between CI and CII

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16
Q

What is abnormal lateral curvature of vertebral column called?

A

Scoliosis

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17
Q

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

A

Nucleus Pulposus - centre + gelatinous

Absorbs compression forces

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18
Q

What is the outer ring of fibrocartilage called?

A

Anulus fibrosus - limits the rotation between vertebrae

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19
Q

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

A

Synovial Joints

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20
Q

Name the function and level of decussation of Descending Tracts.

A

Motor

Pyramidal decussation

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21
Q

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

A

Pain, Temperature

Decussation at level of entry

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22
Q

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

A

Proprioception, Soft Touch, Vibration

Crosses over in brain stem region

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23
Q

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

A

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

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24
Q

What are the consequences of an Anterior Spinal Artery Infarction?

A

Loss of motor + spinothalamic pathways

Dorsal Columns Spared

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25
Q

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

A

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

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26
Q

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

A

Hyporeflexia of brachioradialis reflex

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27
Q

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

A

L + R arm = Pain + Temp sensation loss

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28
Q

Name 3 causes of spinal cord compression

A 
Disc & vertebral lesions
Trauma
Spinal Cord Tumours (extramedullary tumours or mets)
TB
Abscess/Haemorrhage
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29
Q

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

A

Degeneration of the cord

NO

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30
Q

What do Muscle Spindles do?

A

Detect changes in muscle length

Stretching generates an action potential

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31
Q

What do Golgi Tendon Organs do?

A

Detects muscle stretch

Can inhibit muscle -> prevent damage

32
Q

What is a myotactic reflex?

A

Aka stretch reflex

33
Q

What is the function of the Renshaw cell?

A

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

34
Q

What toxin prevents glycine release?

A

TTX

35
Q

What is the function of γ-motor neurones?

A

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

36
Q

What control does the corticospinal tract provide?

A

Motor Control

37
Q

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

A

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

38
Q

What is Apraxia?

A

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

39
Q

Name the two type of Apraxia

A

Ideomotor apraxia - cannot execute movement upon request

Ideational apraxia - cannot conceptualize movement required

40
Q

What is the function of the Reticulospinal tract?

A

Modulation of spinal extensor reflexes (motor control)

41
Q

What is the function of the Vestibulospinal tract?

A

Posture and balance (motor control)

42
Q

Name three ascending tracts

A

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

43
Q

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

A

Arise in Brainstem and Spinal Cord
Alpha and Gamma
Release ACh

44
Q

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

A

Arise in brain

Glutamatergic

45
Q

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

A 
Hyporeflexia
Fasciculations
Muscle Atrophy
Denervation
These are not present in UMN lesions
46
Q

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

A

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

47
Q

What is Lhermitte’s sign?

A

“electric shock” kinda feeling

48
Q

What is Cervical Spondylotic Myelopathy?

A

Narrowing of spinal canal due to “aging”

Compression leads to pain, weakness, and numbness

49
Q

Name some causes of weakness

A

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

50
Q

What does paresis mean?

A

Weakness

51
Q

What is plegia?

A

Paralysis

52
Q

What is paraplegia?

A

Paralysis of both legs

53
Q

What is monoparesis?

A

One limb weakness

54
Q

What does Myelo- mean?

A

Relating to spinal cord

55
Q

What does Radiculo- mean?

A

Pertaining to nerve root

56
Q

What does Myo- mean?

A

Pertaining to muscle

57
Q

Where does the initiation of movement take place?

A

Frontal lobes & the basal ganglia

58
Q

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

A

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

59
Q

What is the pattern of weakness in muscle disease?

A

Tends to affect proximal muscles (pt. will waddle)

Affected muscles may be wasted OR hypertrophied (fat deposition)

60
Q

What conditions can result in proximal weakness?

A

Muscle Disease (e.g. Myasthenia Gravis)

61
Q

What conditions can cause distal weakness?

A

Polyneuropathy, Peripheral Neuropathy

62
Q

What conditions can cause paraparesis?

A

LMN lesion, spinal cord disease

63
Q

What conditions can cause hemiparesis?

A

UMN lesion

64
Q

What is dysarthria?

A

Poor articulation of speech

65
Q

What are the signs of pseudo bulbar palsy?

A

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

66
Q

What is Amyotrophic Lateral Sclerosis (ALS)?

A

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

67
Q

How is diagnosis of ALS made?

A

History + Examination
Moderately elevated creatine kinase
Electromyography

68
Q

What is myositis?

A

Inflammation of muscles

69
Q

What are the symptoms of Polymyositis?

A

Proximal muscle weakness

70
Q

What are the symptoms of Dermatomyositis?

A

Proximal muscle weakness
Rash over hands + face
Associated with malignancy

71
Q

What are the symptoms of Inclusion Body Myositis?

A

Proximal leg muscles and long finger flexors

Elderly

72
Q

What are the symptoms of Cauda equina syndrome?

A

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

73
Q

What symptoms would anterior spinal artery infarction present with?

A 
Paraparesis
Upgoing plantars
Brisk reflexes
Temp + Pain sensation lost
Proprioception spared
74
Q

What are the possible causes of quadraplegia?

A

Trauma - Spinal Shock

Acute onset - Guillain-Barré Syndrome

75
Q

What are the features of spastic hemiparesis?

A

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

76
Q

What artery supplies dorsal columns of spinal cord?

A

Posterior spinal artery

Year 1 Medicine (12 decks)

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