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Undeleted > Spinal Cord and Brainstem Syndromes > Flashcards

Spinal Cord and Brainstem Syndromes Flashcards

0
Q

Fluorosis

A

Exposure to high levels of flurine or fluroide –> calcification of spinal longitudinal ligaments –> spinal stenosis

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1
Q

Spondylosis

A

arthritic degeneration of vertebrae that narrows intervertebral foramina
New bone formation can grow into spinal canal –> spinal stenosis

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2
Q

Most disk herniations occur in ___ and ___

A

Cervical: C6/7
Lumbar: L4/5 and L5/S1

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3
Q

Herniation in cervical region affects:

A

Nerve emerging from corresponding intervertebral foramina

C6/C7 herniation affect root C7

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4
Q

Herniation of lumbar region affects:

A

Root corresponding to the lowest of the two vertebra forming the point
L5/S1 affects root S1

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5
Q

Extrinsic lesion of cord compressing laterally will affect ____ first
Will cause _____ which will appear to (ascend/descend)

A

Sacral levels
Loss of pain/temp and motor paresis
Ascend

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6
Q

Intrinsic lesion originating within spinal cord will affect ____ first, resulting in ____

A

Upper limb first

Sacral sparing

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7
Q

Brown-Sequard syndrome describes ____

A

motor and sensory signs resulting from a left or right hemisection of the spinal cord

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8
Q

Central cord syndromes result from ____

Characterized by _____

A

Lesion developing within spinal cord itself
Bilateral loss of pain and temp over limited area w/ sacral sparing
Disproportionately greater motor impairment in upper compared to lower extremities

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9
Q

Syringomyelia is _____
Destroys _____
Causes ____

A

Longitudinal cavity that forms in cervical spinal cord
Ventral white commissure
Bilateral loss of pain and temp over shoulder and lateral surface of arm (Cape like sensory loss)
Damage medial (upper limb) portions of lateral corticospinal tract

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10
Q 
Anterior cord (spinal artery) syndrome causes: (2)
Spares:
A
  1. Complete bilateral motor paralysis below lesion
  2. Complete bilateral loss of pain and temp sensation below lesion
    Spares: 2 pt discrimination, vibration sense and kinesthesia
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11
Q

Posterior cord syndrome is characterized by:

A

Loss of 2 pt discrimination, vibration and kinesthesia

Positive Romberg sign (pt falls when eyes are shut)

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12
Q

Most common cause of posterior cord syndrome

Pts will have:

A 
Syphilis --> cell death in DRG 
Gait problems (locomotor ataxia) caused by loss of proprioception and damage to corticospinal system
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13
Q

Cauda equina syndrome leads to _____

Signs: (5)

A

Spinal stenosis affecting dorsal and ventral roots forming cauda equina
Signs:
1. Weakness of leg and foot (LMN signs)
2. Saddle anesthesia: loss of pain/temp, 2 pt, touch over S1-S5 dermatomes
3. Loss of knee and ankle reflexes: damage to ventral roots
4. Urinary retention: Roots S3 and 4
5. Loss of tone in external anal sphincter: Damage to S3-S5

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14
Q

Conus medullaris syndrome signs

A

Bladder, bowel, sexual dysfunction
UMN signs
Sensory loss confined to perianal region (S4,5)

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15
Q

Lesions in autonomic neurons at or above T2 result in (ipsilateral/contralateral) ____

A

ipsilateral

Horner’s syndrome

16
Q

Lesions in sacral autonomic neurons between levels ____ result in ____

A

S2-S4

Bladder and bowel dysfunction

17
Q

Corticospinal tract lesions produce ____ signs

A

Upper motor neuron signs

18
Q

Ventral horn lesions produce ____signs

A

Lower motor neuron signs

19
Q

Blood supply to medulla (4)

A

Anterior spinal artery: paramedian territory of medulla
Posterior spinal artery
Vertebral artery: lateral medulla
Posterior inferior cerebellar artery: dorsal lateral medulla

20
Q

Medial medullary syndrome results from ____

A

occlusion of anterior spinal artery

21
Q

Lateral medullary syndrome results from ____

A

occlusion of vertebral artery or PICA

22
Q

Medial medullary syndrome

Major structures affected and resulting signs: (3)

A
  1. Pyramid: contralateral UMN signs with sparing face
  2. Hypoglossal n./nerve: Ipsilateral LMN sign. Tongue deviates to lesioned side (loss of genioglossus)
  3. Medial lemniscus: Contralateral 2 pt discrimination, vibration sense and kinesthesia of whole body
23
Q

Lateral medullary syndrome (Wallenberg’s syndrome, PICA syndrome)
Major structures affected and resulting signs: (7)

A
  1. Nucleus ambiguus: Dysphagia (difficulty swallowing), Displaced uvula (levator palati), Flaccid vocal fold (near midline)
  2. Spinal n. and tract of V: Ipsilateral loss of pain and temp on face
  3. Spinothalamic tract: Contralateral loss of pain/temp of body
  4. Hypothalamospinal tract: Horner’s syndrome
  5. Inferior cerebellar peduncle: ipsilateral ataxia
  6. Vestibular nuclei: vertigo, nausea
  7. Reticular formation: hiccups
24
Q

Caudal pontine AICA infarct

A

Similar to PICA infarct

25
Q

Caudal pontine basilar paramedian infarct

A
  1. Abducens nucleus: lack of conjugate gaze
  2. Facial paralysis
  3. Medial lemniscus: contralateral tactile sensation from whole body
  4. Pyramid: Contralateral UMN signs
26
Q

Rostral pontine AICA infarct

A
  1. Motor nucleus of 5: mm. of mastication
  2. Spinal tract and nucleus: Main sensory of face
  3. Discriminative touch of face
  4. Spinothalamic tract from body: pain/temp
  5. Lower extremities tactile touch: lateral medial lemniscus
27
Q

Rostral basilar paramedian infarct

A

Upper extremities tactile touch: medial medial lemniscus

Tectospinal tract

28
Q

Pseudobulbar palsy caused by:
Results in:
Symptoms: (3)

A

Bilateral interruption of corticobulbar fibers to cranial nerve motor nuclei
Result is: UMN weakness of muscles supplied by affected cranial n. nuclei
Symptoms: Speech problems, dysphagia, inappropriate outburst of laughter and crying

29
Q

Locked in syndrome results from ____
Damage to _____
Spared ____

A

Large lesions of basal pons
Corticospinal and corticobulbar pathways bilaterally
Somatosensory pathways and reticular formation –> awake and aware of surroundings

30
Q

Vascular supply to midbrain (5)

A

Superior cerabellar a.
Collicular branches of basilar a.
Paramedian branches of basilar a. (caudal)
Posterior choroidal branch of posterior cerebellar a. (rostral)
Branches of post. communicating a. (rostral)

31
Q

Weber’s Syndrome: results from ____

Major structures affected and signs: (3)

A

Lesions involving basal midbrain
CN 3 : ipsilateral down and out
Corticobulbar and corticospinal fibers: contralateral UMN

32
Q

Benedikt’s Syndrome: results from ___

Major structures affected and signs: (6)

A

Lesions involving midbrain tegmentum
CN3: ipsilateral down and out
Cerebellothalamic fibers/red nucleus: course tremor on movement
Subtantia nigra: resting tremor
Medial/Spinal/Tigeminal lemniscus: contralateral tactile, pain/temp of face and body

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