Chapter 8 : Lession of the Spinal Cord (3) Flashcards
I-C. Lesion A involves degeneration of the ventral horns bilateral!y at midcervicallevels. resuIting in flaccid paralysis in the upper extremities.
- The result of lesion B is best described as
(A) dYSS¥llergia.of movements–affecting both arms and legs
(B) flaccid paralysis of the upper extremities
(C) impaired two-point tactile discrimination in both arms
(D) spastic paresis affecting primarily the muscles distal to the knee joint
(E) bilateral appallesthesia
2-D. Lesion B involves degeneration of the lateral corticospinal tracts bilaterally. resulting in spastic paresis of the lower extremities and primarily affecting the muscles distal to the knee. Spastic paresis of the upper extremities is masked by flaccid paralysis resulting from lesion A. Apallesthesia is the inability to perceive a vibrating tuning fork.
3-E. Lesions A and B are the result of amyotrophic lateral’ sclerosis (ALS). a pure motor disease.
- Neurologic examination reveals an extensor plantar reflex on the left side. hyperreflexia on the left side. a loss of pain and temperature sensation on the right side. and ptosis and miosis on the left side. A lesion that causes this constellation of deficits would most likely be found in the .
(A) paracentral lobule, left side
(B) crus cerebri. right side
(C) dorsolateral medulla. left side
(D) cervical spinal cord
(E) lumbar spinal cord
4-D. A lesion of the cervical ;pinal cord could result in ipsilateral Homer syndrome. ipsilateral spastic paresis. and contralateral loss of pain and temperature sensation. Horner syndrome is always manifested on the ipsilateral side. This lesion represents a classic Brown-Sequard syndrome
- A 50-yealo-old woman complains of clumsiness in her hands while working in the kitchen; she recently burnt her hands on the stove without experiencing any pain. Neuro¬logic examination reveals bilateral weakness of the shoulder girdles. arms. and hands. as well as a loss of pain and temperature sensa-tion covering the shoulder and upper extremity in a cape-like distribution. Severe atrophy is present in the intrinsic muscles of the hands. The most likely diagnosis is
(A) amyotrophic lateral sclerosis (ALS)
(B) subacute combined degeneration
(C) Werdnig-Hoffmann disease
(D) syringomyelia
(E) tabes dorsah
5-D. Syringomyelia is a cavitation of the spinal cord most commonly seen in the cervicothoracic segments. This condition results in bilateral loss of pain and temperature sensation in a capelike distribution as well as wasting of the intrinsic muscles of the hands. Amyotrophic lateral
sclerosis (ALS) is a pure motor syndrome, subacute combined degeneration includes both sensory and motor deficits, Werdnig.Hoffmann disease is ,a pure motor disease, and tabes dorsalis is a pure sensory syndrome (neurosyphilis).
- A 50-year-old man has a 2-year history of progressive muscle weakness in all extremi¬ties. with severe muscle atrophy and reduced muscle stretch reflexes (MSRs) in both legs. In liis arms. the muscle atrophy is less pronounced and the MSRs are exaggerated Post mortem examination would most likely show which of the following areas of neuronal degeneration?
(A) Loss of Purkinje cells
(B) Loss of neurons from the globus pallid us
(C) Loss of neurons from the paracentral lob¬ule and from the anterior horns of the spinal cord
(D) Demyelination ofaxons in the posterior and lateral columns
(E) Demyelination ofaxons in the posterior limb of the intemal capsule
6-C. Amyotrophic lateral sclerosis (ALS) affects both the upper and lower motor neurons. It is also referred to as motor systems disease. A loss of Purkinje cells as seen in cerebellar cortical atrophy (cerebello-olivary atrophy) results in cerebellar signs. Cell loss in the globus pallid us and putamen is seen in Wilson disease (hepatolenticular degeneration). Demyelination ofaxons in the posterior and lateral columns is seen in subacute combined degeneration. Demyelination of
- All of the following statements concerning syringomyelia are correct EXCEPT
(A) it is a central cavitation of the spinal cord
(B) it usually is found at lumbosacral levels
(C) it usually includes a lower motor neuron (LMN) lesion
(D) it usually results in a bilateral loss ofpain and temperature sensation
(E) it. may result in Horner syndrome
7-B. Syringomyelia is a central cavitation of the cervical spinal cord and is of unknown etiology. Expansion of the syrinx typically affects the ventral white commissure, interrupting the decussating fibers of the spinothalamic tracts and resulting in a bilateral loss of pain and temperature sensation at the level of involvement. Lateral extension involves one or both of the ventral horns
and result!; in a lower motor nellron (LMN) lesion with muscle wasting and flaccid paralysis. Caudal extension to (C8) T1-1’2 may involve the lateral horn (ciliospinal center of Budge) and produce Horner syndrome.
- Hemisection of toe spinal cord at Tl on the it usually results in urinary incontinence left side results in all of the following signs or symptoms EXCEPT
(A) plantar response flexor on the left side
(B) loss of vibration sensa ‘,ion in the left leg
(C) leg dystaxia on the rigl.t side
(D) exaggerated knee jerk reflex on the left side
(E) normal pain and temperature sensation on the left side
8-A. Hemisection of the spinal cord is known as Brown-Sequard syndrome. Transection of the left lateral corticospinal tract would result in an extensor plantar response on the left side (Babinski sign). Leg dystaxia on the right side results from interruption of the crossed ventral spinocerebellar tract.
- Lower motor neuron (LMN) lesions result in all of the following deficits or signs EXCEPT
(A) loss of muscle stretch reflexes (MSRs)
(B) loss of superficial reflexes’
(C) fasciculations
(0) muscle wasting
(E) plantar reflex extensor
9-E. Lower motor neuron (LMN) lesions result from destruction of ventral horn (or cranial nerve) motor neurons or transection of their axons. LMN lesions interrupt the final common pnthwllY to skcletul muscles; they result in flaccid paralysis and atrophy (muscle wasting) and a loss of all reflex action (areflexia). Fasciculations (visible musCle twitching) and fibrillations [seen on an electromyogram (EM G)] are signs of LMN disease. The Babinski sign, an extensor plantar reflex, is not seen in LMN lesions.
- All of the following statements’concerning upper motor neuron (UMN) lesions are correct EXCEPT
(A) they are found above the pyramidal de¬cussation
(B) they result in the presence of the Babin¬ski sign
(C) they result in the absence of the knee jerk reflex
(D) they are commonly caused by cerebrovas¬cular accidents
(E) they frequently involve the internal cap¬sule
10-C. Upper motor neuron (UMN) lesions result from destn~ction of cortical neurons (or their axons) that give rise to the corticospinal and corticobulbar tracts. UMNs are found in the cerebral cortex and in the brainstem. UMN lesions result in spastic paralysis (hyperreflexia, hypertonia, clasp-knife phenomenon, clonus, muscle weakness, and the Babinski sign). UMN lesions are commonly caused by cerebrovascular accidents and frequently damage the internal capsule.
- All of,the following stutel11ents concerning Homer syndrome are correct EXCEPT
(A) it is seen in spinal cord lesions above Tl
(B) it is ipsilateral to the lesion
(C) it results from interruption of descending autonomic pathways
(D) it results in mydriasis and mild ptosis
(E) it results in facial hemianhidrosis
ll-D. Interruption of descending autonomic pathways found in the lateral funiculi of the spinal cord results in Homer syndrome. Horner syndrome is ipsilateral to the lesion and consists of miosis, ptosis, facial hemianhidrosis, and apparent enophthalmos.
- All of the following statements concerning intervertebral disk herniation are correct EXCEPT
(A) it results from prolapse of the nucleus pul¬posus through a defective annulus fibrosus into the vertebral canal
(B) it may involve the cauda equina
(C) it usually involves a single nerve root
(D) it most frequently appears in the L4-L5. interspace
I2-E. Intervertebral disk herniation results from the prolapse of the nucleus pulposus through a defective annulus fibrosus into the vertebral canal. In 90% of cases, it appears at the L4-L5 or the L5-S1 interspace. In 10% of cases, it appears at the cervical region, usually at the C5-C6 or C6-C7 interspace. Intervertebral disk herniation may involve the cauda equina; usually it involves a single nerve root. Urinary incontinence is not seen with unilateral root lesions.
The response options for items 13-18 are the same. You will be required to select one answer for each item in the set.
(A) Amyotrophic lateral sclerosis (ALS)
(B) Cauda equina syndrome
(C) Cervical spondylosis
(D) Friedreich ataxia
(E) Guillain-Barre syndrome
(F) Multiple sclerosis
(G) Subacute combined degeneration
(H) Tabes dorsalis
(I) Werdnig-Hoffmann disease
Match each statement below with the syn¬drome that corresponds best to it.
- A pure lower motor neuron disease
13-1. Werdnig-Hoffmann disease is heredofamilial degenerative disease of infants that affects only lower motor neurons (LMNs).
The response options for items 13-18 are the same. You will be required to select one answer for each item in the set.
(A) Amyotrophic lateral sclerosis (ALS)
(B) Cauda equina syndrome
(C) Cervical spondylosis
(D) Friedreich ataxia
(E) Guillain-Barre syndrome
(F) Multiple sclerosis
(G) Subacute combined degeneration
(H) Tabes dorsalis
(I) Werdnig-Hoffmann disease
Match each statement below with the syndrome that corresponds best to it.
- Elevated cerebrospinal fluid (CSF) protein with a normal CSF cell count
I4-E. Guillain-Barre syndrome is characterized by an elevated cerebrospinal fluid (CSF) protein with normal CSF cell count (albuminocytologic dissociation).
The response options for items 13-18 are the same. You will be required to select one answer for each item in the set.
(A) Amyotrophic lateral sclerosis (ALS)
(B) Cauda equina syndrome
(C) Cervical spondylosis
(D) Friedreich ataxia
(E) Guillain-Barre syndrome
(F) Multiple sclerosis
(G) Subacute combined degeneration
(H) Tabes dorsalis
(I) Werdnig-Hoffmann disease
Match each statement below with the syndrome that corresponds best to it.
- Characterized by asymmetric lesions found in the white matter of cervical segments
I5-F. Multiple sclerosis is characterized by asymmetric lesions frequently found in the white matter of cervical segments.
19-C. A neurologic manifestation of vitamin B12 deficiency is subacute combined degeneration. There is no involvement of LMNs.
20-A. Lesion A shows the territory of infarction resulting from occlusion of the ventral (anterior) spinal artery.
21-D. A spinal cord hemisection (Brown-Sequard syndrome) on the right side results in a loss of vibration sensation on the right side and a loss of pain and temperature sensation on the left side (dissociated sensory loss).
22-A. Total occlusion of the ventral spinal artery, involving five cervical segments, results in infarction of the ventral two-thirds of the spinal cord and interrupts both lateral spinothalamic tracts. The patient would have a loss of pain and temperature sensation caudal to the lesiori.
23-B. Lesion B shows a cervical syringomyelic lesion involving the ventral white commissure, both ventral horns, and the right corticospinal tract. The patient would have a bilateral loss of pain and temperature sensation in the hands, muscle wasting in both hands, and a spastic paresis on the right side.
24-A. In lesion A, both lateral and ventral funiculi have been infarcted by arterial occlusion. Bilateral destruction of the lateral corticospinal tracts at upper cervical leveis results in quadriplegia (spastic paresis in upper and lower extremities).Bilateral destruction of theventrolateral
quadrants results in urinary and fecal incontinence.
25-C. In lesion C, subacute combined degeneration, there is no involvement oflower motor neurons (LMNs), hence no flaccid paralysis, muscle atrophy, or fasciculations
26-C. In lesion C, subacllte combined degeneration, there is symmetric degeneration of the white matter, both in the dorsal columns (fasciculi gracilis) and in the lateral funiculi (corticospinal tracts). In this degenerative disease, both the myelin sheaths and the axis cylinders are involved. Subacute combined degeneration is classified under nutritional diseases (in this case a
vitamin B12 neuropathy). In true demyelinative diseases (e.g., multiple sclerosis), the myelin sheaths are involved but the axis cylinders and nerve cells are relatively spared.
