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Finals Neurology > Tracts & Lesions (inc Cauda equina) > Flashcards

Tracts & Lesions (inc Cauda equina) Flashcards

1
Q

Draw the 3 spinal tracts

A
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2
Q

Outline the clinical findings in COMPLETE SPINAL CORD INJURY

A
  • Loss of ALL motor & sensory below the level of the lesion
  • At the level = LMN lesion signs
  • Below the level = UMN lesion signs
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3
Q

Outline the first clinical findings in INCOMPLETE SPINAL CORD INJURY

What are the types?

A
  • Initially loss of all, then some functions may return
  1. Sacral dermatomes/ myosomes first [sacral sparing]
    • Positive bulbocavernosus reflex
    • Toe flex
    • Anal spinchter muscle
    • You feel your butt
  • Types
    • ​Anterior syndrome
    • Central syndrome
    • brown-Sequard syndrome [hemisection]
    • Posterior syndrome
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4
Q

Outline the clinical findings in HEMISECTION OF THE SPINAL CORD

aka Brown-Squard syndrome

A
  • Ipsilateral
    • Loss of proprioception & fine touch [Dorsal column]
    • Upper motor neurone signs [Corticospinal]
  • Contralateral
    • Loss of pain & temperature sensation [Spinothalamic]
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5
Q

Outline the clinical findings in SPINAL NERVE ROOT LESIONS

Which conditions can cause this?

A
  • Sensory loss in a dermatomal pattern
  • Muscle weakness & wasting in a radicular pattern

Causes

  • Spondylosis [vertebral degenerative osteoarthritis]
  • Spondylitis [vertebral inflammation]
  • Invertebral disk prolapse
    • Cervical or lumbar (sciatica) cause pain
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6
Q

Outline the clinical findings in UPPER CERVICAL CORD LESION

A
  • Signs of UMN throghout body NIDIB
    • Muscle bulk - Normal
    • Muscle tone - Incr
    • Muscle power - Decr
    • Reflexes - Incr (brisk)
    • Plantar Responce - Babinski’s sign (extension)
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7
Q

Outline the clinical findings in LOWER CERVICAL CORD LESION

A

At the lesion, the upper & lower motor neurones are cut. So below it will be UMN lesion signs, and the upper limbs/ same level will be LMN lesion signs [as the LMN are cut there].

Upper limbs - At/above the lesion

  • Lower motor neurone signs [DDDD]
    • Muscle bulk - Decr
    • Muscle tone - Decr
    • Muscle power - Decr
    • Reflexes - Deminished/ Absent​

Lower limbs - Below the lesion

  • Upper motor neurone signs [NIDIB]
    • Muscle bulk - Normal
    • Muscle tone - Incr
    • Muscle power - Decr
    • Reflexes - Incr (brisk)
    • Plantar Responce - Babinski’s sign (extension)
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8
Q

Outline the clinical findings in THORACIC CORD LESION

A

UMN lesion below the lesion (legs)

  • Muscle bulk - Normal
  • Muscle tone - Incr
  • Muscle power - Decr
  • Reflexes - Incr (brisk)
  • Plantar Responce - Babinski’s sign (extension)
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9
Q

Outline the clinical findings in LUMBAR CORD LESION

A

LMN lesion signs of lower limb [DDDDA]

  • Muscle bulk - Decr
  • Muscle tone - Decr
  • Muscle power - Decr
  • Reflexes - Diminished/ absent
  • Plantar Responce - Absent
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10
Q

Outline the clinical findings in CENTRAL CORD SYNDROME

What can cause this?

A
  • Lower limbs [below] - UMN lesion signs
  • Upper limbs [at the level] - LMN lesion signs

Hyperextension injury can cause this

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11
Q

Outline the clinical findings in ANTERIOR CORD SYNDROME

What can cause this?

A
  • Complete motor paralysis [corticospinal anterior horn nuclei cut]
  • Sensory impairment [spinothalamic]

Caused by vascular insufficiency or mechanical compression

Posterior collumn spared - propriocepton & fine touch

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12
Q

Outline the clinical findings in POSTERIOR CORD SYNDROME

A

Only loss of;

  • Proprioception & fine touch/ vibration [dorsal collumns]
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13
Q

Outline the clinical findings in MIDBRAIN BASAL LESION

A

Midbrain (aka Weber’s syndrome) - Posterior Cerebral Artery

  • Oculomotor palsy (Ipsilaterally)
    • Eye muslces
      • ​I, S & M Rectus & I Oblique stop working
      • L Rectus & S Oblique unopposed - eye goes down & out
    • Light accomodation
      • Motor part [Edinger-Westphal nucleus to cilliary ganglion] stop working
      • Large pupil UNREACTIVE to light
    • Upper eyelid [levator palpebae superioris]
      • Droopy eyelid
  • Crus Cerebri [corticospinal] CUT
    • ​Corticospinal goes down & crosses in pyramids
    • Contralateral loss of motor control
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14
Q

Outline the clinical findings in PONS BASAL INFARCTION

Medial Pontine Syndrome?

Draw a diagram

A

CN 6 Nuclei, Medial leminiscus & Corticospinal;

  • Abducens palsy
    • L Rectus stops working
      • Eye cant go outward on ipsilateral side
  • Medial leminiscus
    • ​Contralateral proprioception & fine touch loss
  • Corticospinal tract
    • ​Corticospinal goes down & crosses in pyramids
    • Contralateral loss of motor control

Facial nerve may be affected?

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15
Q

Outline the clinical findings in MEDULLARY MEDIAL & LATERAL SYNDROME

Draw a diagram detailing;

  • Caudal medulla
  • Structures & respective symptoms
  • Blood supply
A

Laterally (aka Wallenberg) - PICA

  • Inf. peduncle - ipsi ataxia
  • Vestibular nuclei - vertigo, nausea
  • CN 5 nuclei (spinal) - ipsi [pain & temp]
  • Sympathetic - ipsi [Horner’s synd]
  • Ambiguus nuclei (CN 9 & 10) - ispi [dysphagia/arthria]
  • Spinothalamic - contra [pain, temp, crude touch]

Medially - Ant. Spinal Artery

  • Hypoglossal nuclei/ nerve - ipsi tongue deviation
  • Medial leminiscus - contra proprioception & light touch [dorsal columns]
  • Corticospinal pyramids - contra weakness
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16
Q

Outline Syrigomyella

Explain its clinical presentation

A

Central canal becomes enlarged due to cyst or cavity & compresses ventral white commisure

  • Spinothalamic crosses here
    • Loss of pain, temp & course touch!
    • Known as dissociated sensory loss [as proprioception & fine touch intact]
17
Q

Outline Tabes dorsalis

Explain its clinical presentation

A

Demyelination of nerves in Dorsal column [secondary to untreat Syphilis infection]

  • Loss of proprioception & fine touch
    • Lower limb
18
Q

Outline Spondylitis

Explain its clinical presentation

A

Inflammation of the vertebra ⇒ Compresseion of spinal nerve ROOTS

  • Sensory loss in a dermatomal pattern
  • Muscle weakness & wasting in a radicular pattern
19
Q

Outline Anterior spinal artery ischaemia

Explain its clinical presentation

A

Anterior Cord Syndrome

  • Complete motor paralysis [corticospinal anterior horn nuclei cut]
  • Sensory impairment [spinothalamic]

Also caused by mechanical compression

Posterior collumn spared - propriocepton & fine touch

20
Q

Outline Posterior spinal artery ischaemia

Explain its clinical presentation

A

Posterior cord syndrome

Only loss of;

  • Proprioception & fine touch/ vibration [dorsal collumns]
21
Q

Draw a diagram showing the structure in the Caudal medulla

A
22
Q
A
23
Q

Draw the Balal ganglia (direct & indirect pathway

Label the lesions for Hungington’s & Parkinson’s disease

A

Finals Neurology (40 decks)

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