Clinical Syndromes of the Spinal Cord

Question 1

Caused by:

1. fracture/dislocation trauma by MVA, dive in pool, fall off horse, etc, usually in the cervical region, or bullet/knife wound
2. demyelinating disease-MS, post-infectious transverse myelitis
3. compression by tumor or inflammatory mass

Answer 1

Complete Transection

Question 2

An acute syndrome of complete transection elicits

Answer 2

Spinal Shock

Question 3

Can last several weeks, and consists of loss of all sensation, flaccid paralysis, loss of reflexes, and no bowel/bladder function

Answer 3

Spinal Shock

Question 4

Chronically, with complete transection, there will emerge hyper-active reflexes (clonus) and increased tone, which together we term

Answer 4

Spasticity

Question 5

Over time there will be flexor spasms, set off by simple

Answer 5

Cutaneous stimulation

Question 6

If the lesion is sacral, the bladder will distend and overflow causing emptying with

Answer 6

Chronic infection

Question 7

A spinal hemisection, example C4 level, is called

Answer 7

Brown Sequard Syndrome

Question 8

Ipsilateral corticospinal tract-UMN syndrome with weakness of arm and leg, mild atrophy, hyper-reflexia (clonus of ankle), Babinski sign, and loss of abdominal and anal wink

Answer 8

Brown Sequard Syndrome

Question 9

With Brown Sequard syndrome we see loss of Ipsilateral (dorsal) dorsal column

Answer 9

Position and Vibration

Question 10

With Brown Sequard syndrome we see contralateral loss of

Answer 10

Pain (pin) and Temperature

Question 11

With Brown Sequard syndrome we see the autonomic affects of

Answer 11

Horner’s Syndrome (miosis, ptosos, and anhydrosis)

Question 12

With Brown Sequard syndrome at the C4 level, we see complete loss of

Answer 12

Motor and sensory root function

Question 13

C4 level exhibits complete loss of motor and sensory root functions including sensation in dermatomal pattern if

Answer 13

2 roots

Question 14

Partial Compression-Extra-axial, Extra-Medullary=

Answer 14

Pain

Question 15

Pain and paresthesias, loss of pin, temperature, position, and vibration in C6/C7 dermatome; reduced triceps reflex

Answer 15

C6-C7 Dorsal root compression

Question 16

Ipsilateral loss of position and vibration on arm and upper torso

Answer 16

C6-C7 dorsal column compression

Question 17

Ipsilateral UMN signs: increased tone and reflexes in triceps (not biceps), knee, and ankles with Babinski sign

Answer 17

C6-C7 Corticospinal Tract Compression

Question 18

Loss of ipsilateral lower motor neurons: segmental muscle weakness

Answer 18

C6-C7 Ventral Horn COmpression

Question 19

Cavitation near the central canal of the spinal cord

Answer 19

Syringomyelia/Central Cord Syndrome

Question 20

Caused by developmental, vascular (AVM), trauma, infections, astrocytic tumor, congenital malformations

Answer 20

Syringomyelia/Central Cord Syndrome

Question 21

Syringomyelia/Central Cord Syndrome most commonly occurs from

Answer 21

C3 to T4

Question 22

Initially experience a cape (shawl) distribution of lost spinothalamic fibers crossing at the ventral commissure, giving rise to reduced pin and temperature over lateral arms, forearms and fingers

Answer 22

Syringomyelia/Central Cord Syndrome

Question 23

Mechanical compression injury of the spinal cord with white matter injury, edema, and possible neuronal cell loss most commonly in the cervical region

Answer 23

Central Cord Syndrome

Question 24

Has the signs and symptoms of motor impairment, (arms greater than legs), and sensory loss below the level of the injury

Answer 24

Central Cord Syndrome

Question 25

The injury mechanism for central cord syndrome is usually

Answer 25

Age dependent

Question 26

High-energy events that cause fracture dislocations or disc herniation; includes motor vehicle accidents, falls, athletic and diving injury, gunshot wounds, assaults

Answer 26

Central Cord Syndrome in those younger than 45

Question 27

Low-energy hyperextension events that cause buckling of the ligamentum flavum; in the face of varying degrees of cervical spondylosis, cervical stenosis, spinal flexibility

Answer 27

Central Cord Syndrome in those older than 45

Question 28

MRI gradient T2 echo will reveal hyperintense signal in cervical cord and evidence of compression with

Answer 28

Central Cord Syndrome

Question 29

Atrophic weakness of hands/forearms; spasticity of legs; generalized hyperreflexia; a mixed UMN and LMN disorder progressive spread both rostrally and caudally until fatal

Answer 29

Atrophic Lateral Sclerosis (ALS)

Question 30

LMN signs with loss of strength, reduced tone, atrophy and loss of reflexes, all due to muscle denervation

Answer 30

ALS

Question 31

Some of these LMN signs of ALS are apparently reversed by appearance of hyper-reflexia from loss of

Answer 31

UMN Innervation

Question 32

Most common initial symptoms: stiffness/weakness and muscle wasting of hands/fingers, hand cramping, and later twitching of forearms (fasciculations)

Answer 32

ALS

Question 33

With ALS, only upper and lower motor neurons are affects and there is NO

Answer 33

Sensory involvement

Question 34

Due to vitamin B12 deficiency

Answer 34

Subacute combined degeneration

Question 35

Most affected by subacute combined degeneration

Answer 35

Dorsal columns (corticospinal tract is second)

Question 36

Because B12 deficiency also causes peripheral neuropathy, there may be the paradoxical combination of

Answer 36

Extensor plantar reflex (UMN sign) and hypoactive ankle (LMN sign)

Question 37

The great radicular artery of adamkiewicz is located at

Answer 37

T12-L2