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Neuro II - AJS > Clinical assessment of the spinal cord - Ojemann > Flashcards

Clinical assessment of the spinal cord - Ojemann Flashcards

1
Q

Myelopathy:

A

Disorder resulting in spinal cord dysfunction.

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2
Q

Nerve root:

A

Nerve bundle exiting at a given vertebral level containing both motor and sensory rami

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3
Q

Tracts:

A

Bundles of nerves in the CNS

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4
Q

Dermatome:

A

Cutaneous area served by a given sensory root

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5
Q

Myotome:

A

Muscles innervated by a given motor root

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6
Q

Radiculopathy

A

Sensory or motor dysfunction due to an irritation of a nerve root

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7
Q

Paresthesia

A

An abnormal sensation, can include burning, pricking,

tickling, or tingling. Sometimes characterized as “pins and needles”

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8
Q

Dysthesia

A

Impairment of sensation; less than that of anesthesia

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9
Q

Hyperesthesia

A

Abnormal acuteness of sensitivity to touch, pain, or other

sensory stimuli

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10
Q

C4 vertebral body overlies the ____ spinal cord segment.

A

C4

Upper cervical: Vertebra # overlies same cord segment # (C2 vertebra overlies C2 spinal cord segment)

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11
Q

C7 vertebral body overlies the ____ spinal cord segment.

A

C8

Lower cervical: vertebra # overlies cord segment # + 1 (C6 bone, C7 cord)

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12
Q

T5 vertebral body overlies the ____ spinal cord segment.

A

T7

Upper thoracic: vertebra # overlies cord segment # + 2 (T4 bone, T6 cord)

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13
Q

T11 vertebral body overlies the ____ spinal cord segment.

A

L2

Lower thoracic/lumbar: vertebra # overlies cord segment # +2- 3 (T 11bone, L1-2 cord)

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14
Q

What vertebral body overlies the conus medullaris?

A

L1

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15
Q

C1-7 nerve roots exit ____ the corresponding vertebral secment. C8-S5 exit ___>

A

Above, below

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16
Q

Lesions, such as tumors, that evolve from OUTSIDE of the cord are called _____. They tend to cause early pain and UMN signs, and pain and temperature sensation is likely to evolve in an ascending fashion (affects sacral, then lumbar, then thoracic, cervical fibers progressively).

To what is this due?

A

Extramedullary lesions

Due to the somatotopy of the spinal cord.

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17
Q

Intramedullary lesions, those that arise within the cord, will tend to cause what symptoms, and in what progressin?

A

early bladder dysfunction, with only late development of pain. Loss of pain and temperature may progress in a descending fashion- invlovling cervical and thoracic levels early, then lumbar, then sacral.

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18
Q

Somatotopic organization to the tracts:

Within the Posterior Columns, ___ fibers are medial, fibers from the ____ are lateral.

Within the Corticospinal and Spinothalamic Tracts, __ fibers are medial and fibers from the ___ are lateral.

A

SACRAL; ARMS

ARMS; SACRUM

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19
Q

C5 dermatome

A

back of shoulder, lateral arm

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20
Q

C6 dermatome

A

thumb and index finger

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21
Q

C7 dermatome

A

middle finger

22
Q

T4 dermatome anatomic landmark?

A

nipple line demarcates the bottom of the T4 dermatome

23
Q

What dermatome ends at the umbilicus?

A

T10

24
Q

What dermatome ends at the xyphoid process?

A

T6

25
Q

Where is the L4 dermatome

A

Medial leg, kneecap

26
Q

Where is the L5 dermatome

A

Dorsum of the foot, great toe

27
Q

Where is the S1 dermatome on the foot

A

Small toe, lateral foot, sole of the foot

28
Q

DCML sensation includes (4)

A

Vibration
Light touch
2 touch discrimination
Joint position sense

29
Q

AMS sensation includes (2)

A

Pain

Temperature

30
Q

What is babinski’s sign?

A

+ extension of big toe, flexion of others

  • flexion of all toes

Signifies UMN injury.

31
Q

What is Hoffmans sign

A

+ flexion of thumb DIP when middle fingernail flicked

  • no flexion

This is the upper limb equivalent of babinskis sign. positive indicates UMN

32
Q

For injury of nerve root C5, which muscles, dermatomes, and reflex should be impaired.

What is the disc bulge that causes this injury? With what frequency does it occur?

A

Muscles: Deltoid, Infraspinatus, Biceps

Dermatomes: shoulder, upper lateral arm

Reflex: bicipetal

Usually involves C4-5, 10% of UE radic.

33
Q

For injury of nerve root C6, which muscles, dermatomes, and reflex should be impaired.

What is the disc bulge that causes this injury? With what frequency does it occur?

A

Muscles: Wrist extensors, biceps

Dermatomes: thumb, index

Reflex: biceps, brachioradialis

Usually involves C5-6, 20% of UE radic.

34
Q

For injury of nerve root C7, which muscles, dermatomes, and reflex should be impaired.

What is the disc bulge that causes this injury? With what frequency does it occur?

A

Muscles: Triceps

Dermatome: 3rd digit (middle finger)

Reflex: triceps

Usually involves C6-7, 40-50% UE radic

35
Q

For injury of nerve root L4, which muscles, dermatomes, and reflex should be impaired.

What is the disc bulge that causes this injury? With what frequency does it occur?

A

Muscles: Psoas, Quads

Dermatome: Knee, medial leg

Reflex: patellar

Usually involves L3-4, 10% LE radic

36
Q

For injury of nerve root L5, which muscles, dermatomes, and reflex should be impaired.

What is the disc bulge that causes this injury? With what frequency does it occur?

A

Muscles: Foot dorsiflexion, toe extensors, eversion and inversion

Dermatome: dorsum of foot, great toe

Reflex: none

Usually involves L4-5, 40% of LE radic.

37
Q

For injury of nerve root S1, which muscles, dermatomes, and reflex should be impaired.

What is the disc bulge that causes this injury? With what frequency does it occur?

A

Muscles: foot plantarflexion

Dermatome: lateral foot, sole of foot, small toe

Reflex: achilles

Usually involves L5-S1, 45% of LE radic.

38
Q

Complete spinal cord transection (deficit, signs)

A

Loss of all sensory and motor below site, may have root signs at site.

Spinal shock, then UMN.

39
Q

Central spinal cord lesion (deficit, eg.)

A

Pain and temp loss at level of lesion, sparing of proprioception.

Syringomyelia, ependymomas, cord contusion

40
Q

Posterior column syndrome (deficit)

A

Loss of proprioception below lesion, bilaterally.

41
Q

Loss of anterior horn and lateral CS tracts. (example, deficit)

A

ALS (loss of CS tract and LMN cells in anterior horn)

Loss of bilateral strength. Fasciculations, atrophy, DTR increased or decreased, normal sensation

42
Q

Describe Brown-sequard (again)

A

Hemisection of the cord results in:
IL loss of movement
IL loss of proprioception
CL loss of pain/temp

43
Q

Posterolateral Column syndrome (example, signs)

A

B12 deficiency

Bilateral motor deficit
Bilateral position sense deficit

(CS tracts and posterior column missing)

44
Q

Anterior horn cell syndrome (signs, examples)

A

Polio, spinal muscular atrophy.

LMN symptoms (low tone, low DTR) with sparing of all bladder and sensory tracts.

45
Q

Anterior spinal artery occlusion (Tracts, signs, examples)

A

Tracts: spinothalamic and CS (all but posterior column)

Signs: loss of bilateral motor, pain/temp

Eg: anterior spinal artery occlusion

46
Q

Pyramidal tract syndrome (eg, signs)

A

Primary lateral sclerosis

UMN symptoms bilaterally, sparing of sensory/bladder

47
Q

Myelopathy with Radiculopathy (tracts affected, signs, examples)

A

Tracts: all and any (CS, particularly)

Signs: UMN bilaterally, may have bladder dysfunction

Examples: cervical spinal stenosis

48
Q

What are the features of Cauda Equina syndrome?

A

1) EARLY root pain radiating to legs
2) Leg weakness, diminished DTR
3) patchy, asymmetric “saddle” anesthesia
4) Late bladder dysfunction
5) Late bowel/sexual dysfunction

49
Q

What are the features of Conus Medullaris syndrome?

A

1) Late pain in thighs/buttocks
2) Pelvic floor muscle weakness
3) SYMMETRIC “saddle” anesthesia
4) EARLY bladder dysfunction
5) EARLY sexual/bowel dysfunction

50
Q

Lhermitte’s Sign:

A

Neck flexion results in “electric shock” sensation down the back and/or into arms.
Attributed to posterior column disease (MS, disc, B12 def, mass).

51
Q

Summarize each of the four phases of spinal shock. (Duration, symptoms)

A

Phase 1: Lasts for 1 day. Loss of all sensory/motor function including DTR.

Phase 2: Days 2-3 (2 days). Monosynaptic reflexes re-appear (bulbocavernosus reflex).

Phase 3: Weeks 1-4. DTR hyperreflexia

Phase 4: (Week 1 and beyond) Chronic spacticity.

52
Q

What is neurogenic shock?

A 
Low HR (loss of sympathetic tone [unopposed vagal tone])
Low BP (loss of sympathetic tone [low TPR])

Neuro II - AJS (19 decks)

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