01b: SC lesions

Question 1

Brown-sequard syndrome occurs with (X) injury. What are the classic symptoms?

Answer 1

X = hemisection of SC

Ipislateral paralysis and loss of touch/vibration
Contralateral loss of Pain and T

Question 2

Hemisection of SC at T1. What symptoms seen at the level of injury (T1)?

Answer 2

Loss of all sensory and motor

Question 3

Syringomyelia is classical cause of (X) syndrome. The first symptom is classically loss of (Y) in which distribution pattern?

Answer 3

X = central cord (cavitation of central portion of SC)
Y = pain/T (preserved touch) due to interruption of decussating fibers

Cape-like distribution

Question 4

Syringomyelia begins at which level of SC?

Answer 4

Lower cervical region (then extends upwards and downwards)

Question 5

T/F: Syringomyelia spares motor function.

Answer 5

False - as cavitation extends, damages anterior horn cells (muscle weakness and absent reflexes in arms)

Question 6

Poliomyelitis is (virus/bacteria) with very strong affinity for (X).

Answer 6

Virus

X = LMN (anterior horn cells and lower CN motor neurons)

Question 7

T/F: Sensation is preserved in poliomyelitis.

Answer 7

True

Question 8

ALS affects (sensory/motor) neurons in (SC/brainstem/cortex).

Answer 8

Pure motor neuron disease (UMN and LMN);

All

Question 9

T/F: All ALS cases are familial (AD inheritance).

Answer 9

False - only 10%

Question 10

ALS is due to mutation of (X).

Answer 10

X = superoxide dismutase

Question 11

Most common initial presentation of ALS:

Answer 11

weakness in distal extremities (then spreads proximally)

Question 12

How are DTRs altered in ALS?

Answer 12

Can be either diminished or enhanced

Question 13

T/F: Babinski sign is present in ALS.

Answer 13

True

Question 14

T/F: Sensation is preserved in poliomyelitis.

Answer 14

True

Question 15

T/F: Mental status is preserved in poliomyelitis.

Answer 15

True

Question 16

What’s “combined system disease” aka Subacute Combined Degeneration?

Answer 16

Neuro manifestation of pernicious anemia (vit B12 deficiency)

Question 17

Combined System Disease/Subacute Combined Degeneration usually causes decreased (X) and (diminished/enhanced) reflexes.

Answer 17

X = vibration and joint perception

Diminished

Question 18

T/F: Folate supplementation corrects both pernicious anemia and associated neuro defects (combined system disease).

Answer 18

False - only anemia

Question 19

Tabes dorsalis is a(n) (early/late) manifestation of (X) that damages (Y) portion of (cortex/SC/brainstem).

Answer 19

Late
X = syphilis
Y = dorsal roots/columns
SC

Question 20

What are the symptoms/signs of Tabes Dorsalis?

Answer 20

1. Marked loss of sensation/joint perception
2. Shooting radicular pain
3. Romberg sign

Question 21

All CNs have ipislateral targets except:

Answer 21

CN IV

Question 22

Corticospinal tract crosses in:

Answer 22

Lower medulla (pyramidal decussation)

Question 23

Patient with R side ptosis, midriasis, lateral deviation likely has (R/L) side hemiplegia and a lesion affecting which part of brainstem?

Answer 23

L (contralateral);

Rostral midbrain (affecting both oculomotor nucleus and pyramidal tract)

Question 24

When cranial nerves III and IV are affected on the same eye, the lesion is in (X) part of brainstem and (contralateral/ipsilateral) to the affected eye.

Answer 24

X = outside of brainstem!

Ipsilateral

Question 25

Patient with upper cervical cord lesion has lost (sensation/motor/pain) to the face. Which (nucleus/nerve) has been affected by lesion?

Answer 25

Pain; Nucleus; Descending trigeminal nucleus (pain/T); extends from mid-pons to upper cervical cord (C2-3)

Question 26

Symptoms of CN VI and VII palsy indicates (ventral/dorsal) (X) lesion.

Answer 26

Dorsal | X = pons

Question 27

Symptoms of CN VI palsy and (ipsi/contra)-lateral hemiparesis indicates lesion in which part of brainstem?

Answer 27

Contralateral; | Ventral/anterior pons

Question 28

Patient with R tongue paralysis may have (R/L) hemiparesis due to lesion in (R/L) (X) part of brianstem.

Answer 28

L; R X = medial (ventral) medulla

Question 29

Superior rectus and inferior rectus turn eye up/down when eye is turned (in/out).

Answer 29

Out; | superior/inferior obliques work when eye is turned in

Question 30

T/F: Superior oblique turns eye downward when it's facing in (toward nose).

Answer 30

True

Question 31

You turn your eyes to the R. Your (R/L) (X) nucleus activates both (med/lat) rectus muscle and (R/L) (Y) nucleus via (Z) fasciculus to activate (med/lat) rectus.

Answer 31

``` R X = abducens Lateral; L Y = oculomotor Z = medial longitudinal Medial (of L eye) ```

Question 32

Internuclear ophthalmoplegia (INO) refers to lesion affecting (X).

Answer 32

X = medial longitudinal fasciculus

Question 33

Patient with R INO can't move R eye (inward/outward) when asked to look (R/L). What does the L eye do?

Answer 33

Inward L Nystagmus

Question 34

Interomediolateral SC column contains (X) and fibers exist as (Y). This occurs only at which levels of the spinal cord?

Answer 34

``` X = SNS pre-ganglionic cell bodies Y = white rami communicantes (sympathetic pre-ganglion is fibers) ``` T1-L2

Question 35

Bilateral INO is pathognomonic of:

Answer 35

MS

Question 36

Artery of Adamkiewicz arises (directly/indirectly) from aorta and supplies (upper/lower) (X)% of SC via (Y) branch.

Answer 36

Indirectly; Upper X = 67 (2/3) Y = anterior spinal artery

Question 37

Anterior spinal artery syndrome: which main tracts affected?

Answer 37

Corticospinal and spinothalamic

Question 38

Anterior spinal artery syndrome: which main tracts spared?

Answer 38

Dorsal column (DCML)

Question 39

Parasympathetic presynaptic neuron cell bodies located in (X) of SC at which levels?

Answer 39

X = intermediolateral cell column CN nuclei and S2-4

Question 40

Gray rami communicantes exit at (X) levels of SC and carry (Y) fibers.

Answer 40

``` X = every Y = post-ganglionic sympathetic nerve (From paravertebral ganglia) ```

Question 41

White rami communicantes exit at (X) levels of SC and carry (Y) fibers.

Answer 41

``` X = T1-L2 Y = sympathetic pre-ganglionic (from SC to paravertebral ganglia) ```

Question 42

Damage to (X) will cause ipsilateral Horner's Syndrome due to loss of (symp/parasymp) fibers.

Answer 42

X = superior cervical ganglion | Sympathetic

Question 43

Horner's Syndrome triad:

Answer 43

Ptosis, miosis, anhidrosis

Question 44

T/F: LMNs arise from brainstem and SC.

Answer 44

True

Question 45

UMN connection with LMN is (direct/indirect).

Answer 45

Both direct and indirect (via Renshaw cells)

Question 46

Atrophy of muscle is seen in (UMN/LMN) lesion.

Answer 46

LMN

Question 47

Flaccid weakness of muscle is seen in (UMN/LMN) lesion.

Answer 47

LMN mainly, but also seen initially in acute UMN lesion (followed by spastic weakness)

Question 48

Fasciculations of muscle is seen in (UMN/LMN) lesion.

Answer 48

LMN

Question 49

Hyperreflexia seen in (UMN/LMN) lesion.

Answer 49

UMN (LMN has depressed/absent DTRs)

Question 50

Sensory deficit/pain seen in (UMN/LMN) lesion.

Answer 50

Neither

Question 51

Disc herniation at C8: (UMN/LMN) deficits above C8, (UMN/LMN) deficits at C8, and (UMN/LMN) deficits below C8.

Answer 51

No deficits above; LMN at C8 (disc compressing motor fibers as they leave cord); UMN below C8 (disc compressing SC)

Question 52

Patient presenting with balance/walking issues. If you see PHx of gastric surgery/weight loss, what neuro issue immediately comes to mind?

Answer 52

Subacute Combined Degeneration (due to long-standing Vit B12 deficiency)

Question 53

Subacute Combined Degeneration: which tracts are degenerating? Why?

Answer 53

1. Dorsal column 2. Lateral and anterior corticospinal Two of the most heavily myelinated tracks in SC and B12 plays role in myelin production