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Neuro III > Classification and syndromes > Flashcards

Classification and syndromes Flashcards

1
Q

non-traumatic injuries

A

infections (polio), vascular lesions or inflammatory disorders, diseases or degeneration (MS, DDD), congenital anomalies, psychological causes (hysterical paralysis), neoplasms, CVA in spinal cord

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2
Q

Transverse Myelitis

A

common inflammatory disorder
F to M 4:1
progresses over period of 48 hr- weeks
50% have paralysis, all have neurogenic bladder, 80-95% have sensory problems
prognosis: 1/3 recover, 1/3 have paraplegia, 1/3 have some neuro deficits

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3
Q

Traumatic SCI stats

A

12,000 new US per year
average age 33 but mainly 16-30 yo
caucasian>AA>hispanic
Less SCI are complete today vs incomplete
Many d/c home and life expectancy is shortened

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4
Q

Spinal cord segments

A

31 pairs
C1-7 above corresponding vertebra
C8 down exit below corresponding vertebra
8C, 12T, 5L, 5S, 1Coccygeal

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5
Q

spinal cord cross section

A

dorsal nerve root= sensory, anterior= motor
gray matter= cell bodies
white= axons, tracts

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6
Q

conus medullaris

A

termination of SC at L1-2 vertebra

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7
Q

filum terminale

A

attaches SC to coccyx

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8
Q

cauda equina

A

get more LMN injury or peripheral N injury

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9
Q

Vertebra bone

A

Know location of vertebral canal, spinous process, transverse process, lamina, pedicle, facet joint

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10
Q

Ligaments

A

Know ALA lig and transverse ligament of atlas

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11
Q

blood supply

A

1 anterior spinal artery and 2 posterior spinal arteries

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12
Q

corticospinal tract

A

descending; voluntary mvt ms, 90% crosses in medulla; 10% doesn’t cross

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13
Q

vestibulospinal tract

A

descends ipsilaterally; posture and head stability

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14
Q

reticulospinal tract

A

descending; RAS in brainstem; ventral ipsilateral extension mvt; lateral ipsi and contralateral ms tone

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15
Q

rubrospinal tract

A

descending; facilitates flexion UE

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16
Q

tectospinal tract

A

descending; reflex posture, mvt head, coordinates head/eye mvt

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17
Q

spinothalamic tract

A

ascending; lateral pain/temp, ascends 2-4 levels then crosses

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18
Q

spinocerebellar tract

A

ascending; unconscious proprioception, some contra and ipsilateral

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19
Q

dorsal columns tract

A

ascending; cross at medulla, kinesthesia, vibration, 2 pt discrimination, stereognosis

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20
Q

SCI mechanism of injury

A

usually indirect trauma–> violent mvt of head or trunk
magnitude/direction determines pattern and severity of injury
extent and location of bony and ligamentous damage determines spine’s stability
Single or limited # vertebra

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21
Q

SCIWORA

A

SCI without radiographic abnormality; force with pre-existing abnormality

22
Q

Cervical cord innervations

A 
C3-5= diaphragm, chief ms of inspiration via phrenic nerve
C4-7= SH and arm ms
C6-8= FA ext and flexors
C8-T1= hand ms
23
Q

Cervical injuries

A

most vulnerable; usually damage to lower levels of cervical

24
Q

Thoracic cord

A

spinal roots form intercostal nerves along inferior rib margin; main ms of expiration; innervate heart and abdominal organs

25
Thoracic injuries
most stable, more likely to be complete, T12-L1 junction most common site
26
Lumbosacral cord innervations
L1-2= sympathetic pelvic and abdominal organs L2-3= hip flexion L3-4= knee ext L4-5= ankle DF and hip ext L5-S1= knee flex S1-2= ankle PF Sacral also innervate parasympathetic pelvic and abdominal organs
27
Lumbar injuries
usually inomplete | cauda equina less sensitive to trauma than spinal cord
28
Associated injuries
fx, pneumothorax, hemothorax, head injury, brachial plexus, peripheral nerve injury
29
Pathological changes
damage spreads out, rostrally and caudally primary damage= neuronal damage secondary damge= ischemia, inflammation, disruption of ion concentration, apoptosis
30
spinal shock
transient; absent or depressed caudal to lesion: motor/sensory, reflexes, autonomic function
31
return to function
return if brain and spinal cord remain connected; if no return, will still have reflexes at each individual level
32
mechanism of return
remyelination of surviving neurons | resolution of secondary problems: edema, hemorrhage, vasoconstriction
33
predictors of motor return
incomplete vs complete, preserved motor or pin prick sensation, early vs late return, age
34
neurological level
most caudal spinal cord section with intact sensory and motor function bilaterally; if motor/sensory different, can still document but should document both separately too
35
motor level
most caudal or lowest level with normal function bilaterally (>3/5) and level above must be 5/5
36
sensory level
most caudal section spinal cord with normal sensory bilaterally
37
complete vs incomplete SCI
complete means no motor or sensory at S4 or S5
38
zone of partial preservation
sensory and/or motor below neuro level, but nothing at S4 or S5; must be complete injury or ASIA A
39
ASIA Impairment scale A
complete; no motor or sensory function is preserved in sacral segments S4 or S5
40
ASIA Impairment scale B
incomplete; sensory but not motor function is preserved below neuro level and includes sacral segments S4 or S5
41
ASIA Impairment scale C
incomplete; motor function is preserved below neuro level and more than half key muscles below neuro level have muscle grade <3/5
42
ASIA Impairment scale D
incomplete; motor function is preserved below neuro level and at least half key muscles below neuro level have muscle grade of 3 or more
43
ASIA Impairment scale E
normal: motor and sensory function are normal; had SCI and improved to this point
44
UE Key muscles for ASIA
``` C5 elbow flexion C6 wrist ext C7 elbow ext C8 finger flex T1 finger ABD tested in supine ```
45
LE Key muscles for ASIA
``` L2 hip flex L3 knee ext L4 ankle DF L5 long toe ext S1 ankle PF tested in supine ```
46
Brown Sequard Syndrome
ipsilateral loss of position sense/vibration and motor along with spasticity below LOL contralateral loss of pain/temp below LOL Flaccid paralysis at LOL good prognosis
47
Anterior Cord Syndrome
motor: anterior horn cells B sides LMN at LOL, UMN below Sensory: bilateral pain/temp loss at LOL and below preservation of dorsal column (prop/vibration) Poor prognosis
48
Central cord syndrome
motor loss UE>LE Sensory loss variable, may be sacral sparing S4-S5 ok Prognosis
49
Conus medullaris syndrome
vertebral level T12-L2 contains motor neuron for B&B sacral sparing
50
sacral sparing
refers to incomplete lesion- have perianal sensation and external sphincter control
51
Cauda Equina syndrome
LMN incomplete injury behaves like a PN injury- flaccid paralysis B&B function full recovery not typical

Neuro III (5 decks)

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