Central Vs peripheral lesions

Question 1

Central Lesions

Answer 1

• occur in the brain and spinal cord

Question 2

Thalamic syndrome

Answer 2

• ascending pathways are interrupted
• controlateral pain and temperature affected
• thalamic pain syndrome is rare/unprovoked

Question 3

Locked in syndrome

Answer 3

• occurs in the pons ventrally
• motor loss bilaterally
• lateral corticospinal tracts
• everything paralyzed but the eyes
• nothing is affecting that CN

Question 4

Spinal cord lesions

segmental signs

Answer 4

• altered/lost sensation in dermatome
• decreased/lost muscle power in myotome
• decreased or lost phasic stretch reflex

Question 5

Spinal cord lesions

vertical tract signs

Answer 5

• lost sensation below level of lesion
• lost descending control of blood pressure, pelvic visera, thermoregulation
• UMNS signs

Question 6

Spinal cord sydromes

Central cord syndrome

where/how it occurs, and what is lost

Answer 6

• usually occurs at the cervical level as a result of trauma
• typically falling with head getting hyperextended
• if the lesion is small loss of nocicpetive and temperature information occurs at the level of the lesion due to spinothalamic fibers crossing midline
• larger lesions also impair LCSTs impairing UE function and it occurs in C/S region

Where the compression is and where the fibers are running

Question 7

Central cord syndrome presentation

Answer 7

• cap like fashion
• analgesia and loss of discriminitive temperature sensation

Question 8

Spinal cord sydromes

Anterior cord syndrome

what is affected and what causes it

Answer 8

• sensation is ok (DCML)
• loss of pain and temperture below level of lesion
• loss of motor function
• touch in tact
• interrupts ascending spinothalamic tracts and descending motor tracts and damges Somas of LMN
• usually due to aortic insufficiency

Question 9

Anterior cord sydrome presentation

Answer 9

• Loss of pain and temperature at and below level of lesion
• loss of motor at and below level of lesion
• touch intact

Question 10

Spinal cord sydromes

Dorsal column lesion

Answer 10

• motor control will be okay
• pain and temperture will be okay
• loss of touch, proprioception vibration
• loss of touch below lesion and at lesion level
• caused by demylination secondary to untreated syphilis or interruption of posterior spinal artery

Question 11

Spinal cord sydromes

Brown Sequard syndrome

Answer 11

• hemisection of spinal cord
• caused by trauma such as gun shot wound, accidental stabbing (trauma)
• 1/2 spinal cord is interrupted
• incomplete lesion
• loss of touch = ips
• loss of motor = ips
• loss of pain/temp = contralateral

Question 12

Brown Se quard syndrome presentation

Answer 12

• paralysis combined with loss of all sensory information
• analgesia and loss of discriminative temperature sensation
• paraylsis and discrimintive touch and conscious proprioception loss
• due to redundency = pain temp may be lost at a level or two below the lesion

Question 13

Cauda Equina syndrome

Answer 13

• compression or irritation of nerve roots below L2 (herinated disc, tumor, narrowing of vertebral canal)
• decreased senation in saddle area
• retension or incontinence/impotence
• LE paresis or paralysis
• effects nerve roots not spinal cord directly

Question 14

cauda equina syndrome presenation

Answer 14

• pain
• all sensations impaired
• muscle weakness
• altered bladder and bowl control

Question 15

Transverse myelitis

Answer 15

• damageinflammation to limited part of cord
• vertical tract damage = UMN signs, somatosensory loss, bladder/bowel/sexual dysfunction
• rare immune disorder
• spreads across width of the cord
• effects spinal segments
• signals going up and down the cord are blocked
• bilateral syptoms

Question 16

Transverse myelitis

presentation

Answer 16

• begins with acute back pain and a band like area of tightness around chest and abdomen
• weakness, tingling, numbness in feet that moves up
• can be MS, mutlisystem diseases

Question 17

Multiple sclerosis

Answer 17

• demyelination in CNS
• motor and sensory signs
• Lhermitte signs
• asymmetric weakness frequent = plaques interfere with descending tracts
• asymmetric ataxia = interruption of dorsal columns
• no pattern

Question 18

Lhermitte’s sign

Answer 18

electrical shock down back or limbs elicited by neck flexion done to them

Question 19

Vertebral canal stenosis

What is it, what does it affect, and what causes it

Answer 19

• narrowing of the vertebral canal
• compression of neural and vascular structures
• degenerative: caused by bone growth, facet hypertrophy, bulging discs, hypertrophy of ligamentum flavum

Question 20

Cervical spondylosis

Answer 20

• narrowing central canal compresses spinal cord
• segmental and vertical signs
• degneration of C/S vertebrae and discs = narrowing of canal and intervertebral forearmn
• the narrowing causes increased shear/stretch forces on S.C and nerve roots damaging neurons and glia
• gray matter is most susceptible
• when symptoms are vertical = more concerning

Question 21

Peripheral lesions

Answer 21

• peripheral nerve distribution
• altered or lost sensation
• decrease or loss of muscle power
• no vertical tract signs

Question 22

Peripheral lesions

polyneuropathy

Answer 22

• widespread peripheral nerve disease
• degeneration of axons and myelin
• sensation affected first in diabeteic polyneuropathy

Question 23

Peripheral lesions

Guillian Barre

Answer 23

• inflammation and demyleination of nerves
• antibodies attack schwanna cells
• axonal damage

Question 24

Amyotrophic Lateral sclerosis (ALS)

What is it, What can be involved, Etiology, PT role

Answer 24

• disease of voluntary motor tracts and motor neurons in spinal cord
• possible cranial nerve involvement
• emotional lability
• causes unknown in appro. 90% of cases
• gene for familial type has been ID’s
• results in upper (tract) and lower motor neuron problems
• PT roles: maintain function and treat symptoms