Last 3 clinical correlations lectures

Question 1

How is a spinal cord injury defined?

Answer 1

Injury or pathology to spinal cord and nerve roots INSIDE neural canal. Does not include peripheral nerves / brachial /lumbosacral plexuses.

Question 2

What is tetraplegia vs paraplegia?

Answer 2

Tetraplegia = quadriplegia, injury to the cervical cord

Paraplegia = injury to thoracic, lumbar, sacral, or cauda equina

Question 3

What gender makes up most of spinal cord injuries?

Answer 3

Males. New cases are around 12,500 per year.

Question 4

Why is a rectal exam part of the required spinal cord exam?

Answer 4

Test of S4/S5, ability to contract (voluntary anal contraction) or feel pressure (deep anal pressure) tells you whether the injury is complete or incomplete

Question 5

What are two elements of the neurological exam which are considered optional?

Answer 5

Testing of proprioception and deep pressure.

Question 6

What is used to test C5?

Answer 6

Elbow flexion - biceps / brachialis

Question 7

What is used to test C6?

Answer 7

Wrist extensors - extensor carpi radialis longus / brevis

Question 8

What is used to test C7?

Answer 8

Elbow extensors - triceps

Question 9

What is used to test C8?

Answer 9

Finger flexors to middle finger - FDP

Question 10

What is used to test T1?

Answer 10

Abduction of pinkie - abductor digiti minimi

Question 11

What is used to test L2?

Answer 11

Hip flexors (iliopsoas)

Question 12

What is used to test L3?

Answer 12

Knee extensors (quadriceps)

Question 13

What is used to test L4?

Answer 13

Ankle dorsiflexors - tibialis anterior - deep fibular nerve (L4-S1)

Question 14

What is used to test L5?

Answer 14

Long toe extensors (extensor hallicus longus) - deep fibular nerve (L4-S1)

Question 15

What is used to test S1?

Answer 15

Ankle plantar flexors - gastrocnemius - tibial nerve

Question 16

What do muscle grades 0 and 1 correspond to?

Answer 16

0 - no contraction

1 - palpable contraction but no joint movement

Question 17

What do muscle grades 2 and 3 correspond to?

Answer 17

2 - full range of motion with gravity eliminated

3 - full range of motion against gravity but no resistance

Question 18

What do muscle grades 4 and 5 correspond to?

Answer 18

4 - full range of motion against gravity + moderate resistance
5 - normal -> resist maximum force

Question 19

What do sensory gradings 0, 1, and 2 correspond to? What is the reference?

Answer 19

0 - absent sensation
1 - impaired (hypo / hyper)
2 - normal

Reference = face sensation

Question 20

What corresponds to a 0 on the pin-prick test?

Answer 20

Complete inability to differentiate between sharp and dull

Question 21

How is motor level scored?

Answer 21

Most caudal key muscle group that is graded as 3/5 or better, with segments above graded as 5/5. If not in the key muscle group range, motor level = sensory level

Question 22

How is sensory level determined?

Answer 22

Most caudal dermatome with normal pinprick and light touch

Question 23

How is the neurological level of injury (NLI) defined?

Answer 23

Most rostral of the sensory and motor levels

Question 24

What does skeletal level mean?

Answer 24

The level with the greatest vertebral damage

Question 25

What is ASIA-A vs ASIA-B?

Answer 25

ASIA - A = complete, no preservation in S4-S5 ASIA - B = sensory incomplete - S4/S5 preserved (LT, PP, or DAP) + no motor function preserved more than 3 levels below the NLI on either side

Question 26

What is ASIA-C vs ASIA-D?

Answer 26

ASIA-C = motor incomplete, including voluntary anal contraction OR is sensory incomlpete but has sparing of motor function more than 3 levels below NLI. Must have less than half of key muscles below NLI > or equal to 3. ASIA-D: At least half of key muscles are > or equal to 3 below the NLI ASIA-E: normal but had prior deficits

Question 27

What is the prognosis for recovery in Brown-sequard?

Answer 27

Good prognosis for walking (ambulation) again, ipsilateral proximal extensors recover before distal flexors

Question 28

What causes autonomic dysreflexia?

Answer 28

Sympathetic hyperactivity when the NLI is T6 and above. Causes SANS overload and an increase in blood pressure as a result. Also sweating, abnormal heartrate, and cyanosis below the level of the injury.

Question 29

How do you relieve autonomic dysreflexia?

Answer 29

Remove the stimulus which is being redirected to cause SANS overload. For instance, often bladder distension will be rerouted to the ILC to cause SANS overload which cannot be cortically relieved in spinal injury. Catheterizing the patient can remove this stimulus.

Question 30

What are some etiopathologic causes of spinal lesions?

Answer 30

1. Infection 2. Inflammation 3. Vascular 4. Deficiency disorder 5. Genetic disorder 6. Trauma 7. Tumor / other

Question 31

What is the order of neurological examination?

Answer 31

1. Higher mental function 2. Cranial nerve function 3. Motor system 4. Sensory system

Question 32

What part of the exam is praxis tested in and what is it?

Answer 32

Higher mental functions - ability to do learned motor activities. Apraxia = absence

Question 33

What's the mneumonic for remembering Horner's syndrome?

Answer 33

Have you met PAM Horner? P = ptosis A = anhydrosis M = miosis

Question 34

How do you test muscle tone?

Answer 34

Try to move a muscle against its primary action

Question 35

What is pronator drift?

Answer 35

Hold arms up and close eyes. In a positive test, arms will favor pronation with arms extended and the arm will drop (relying on proprioception). It indicates an UMN lesion

Question 36

What are the superficial reflexes?

Answer 36

Abdominal reflexes in all 4 quadrants, cremasteric reflex, plantar reflex (Babinski)

Question 37

How does myopathy vs neuropathy differ in presentation?

Answer 37

Myopathy - proximal weakness with no sensory loss, symptoms present early and atrophy is insignificant. Reflexes and atrophy occur only very late Neuropathy - Distal weakness (long way down the nerve), accomplanied by sensory and reflex loss. Atrophy is quick and noticeable

Question 38

How does a neural injury to the neuromuscular junction present?

Answer 38

Fatiguable muscles with a diurnal pattern (better in the morning), as in myasthenia gravis. No atrophy