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APEX-Neuro > NEURO-Spinal cord > Flashcards

NEURO-Spinal cord Flashcards

1
Q

describe the spinal cord circulation

A

Posterior spinal arteries (3)
Anterior spinal artery (1)
Radicular arteries (6 - 8)

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2
Q

What portion of the spinal cord do each of the following perfuse
Posterior spinal aa.
Anterior spinal a.
Radicular aa.

A

Posterior spinal aa. = posterior 1/3 of SC
Anterior spinal a. = anterior 2/3 of SC
Radicular aa. = spinal aa. in thoracolumbar region of SC

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3
Q

From which artery do the anterior and posterior spinal arteries arise

A

Vertebral arteries in the cervical region

Radicular and lumbar arteries below cervical level

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4
Q

Where do the posterior spinal arteries run

A

The length of the spinal cord longitudinally on both sides of midline, in posteriorlateral sulcus

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5
Q

Where does the anterior spinal artery fun

A

The length of the spinal cord, longitudinally along the anterior median fissure

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6
Q

Name of the most important radicular artery

A

Artery of Adamkiewicz aka great radicular artery

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7
Q

What is the importance of the artery of Adamkiewicz

A

It perfuses the anterior spinal cord in the thoracolumbar region

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8
Q

Where does the artery of Adamkiewicz originate

A

Varies, person-to-person
Most commonly on LEFT side between T8 - T12

Rarely, L1 - 2

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9
Q

Why is the anterior spinal cord susceptible to ischemia

A

Because it is highly dependent on radicular artery perfusion, and any interruption of radicular flow can cause ischemia to that portion of spinal cord

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10
Q

How can spinal cord perfusion be affected by aortic x-clamping

A

Aortic x-clamp above the artery of Adamkiewicz can cause ischemia to the lower portion of the anterior spinal cord

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11
Q

What are 4 s/sx of anterior spinal artery syndrome aka Beck’s syndrome

A
  1. Flaccid paralysis of LE
  2. Bowel and bladder dysfunction
  3. Loss of temperature and pain sensation
  4. Preserved touch and proprioception
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12
Q

Which spinal pathways are perfused by the anterior blood supply

A
  1. Corticospinal tract
  2. Spinothalamic tract
  3. Autonomic motor fibers
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13
Q

Why are touch and proprioception preserved in an individual with anterior spinal cord syndrome

A

Because the dorsal column is still being perfused via posterior spinal arteries

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14
Q

How are autonomic motor fibers perfused in the spinal cord

A

Anterior spinal artery

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15
Q

Define ganglion as it pertains to the spinal cord

A

A collection of cell bodies that reside outside of the CNS

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16
Q

What is contained in the grey matter of the spinal cord

A

Neuronal cell bodies

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17
Q

What is the function of grey matter in the spinal cord

A

Center for AFFERENT signals arriving from periphery

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18
Q

Describe the subdivision of grey matter in the SC

A

There are 10 laminae
Laminae 1-6 are in the dorsal grey matter
Laminae 7-9 are in the ventral grey matter
Lamina 10 is around the central canal

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19
Q

Which laminae are sensory and where are they located

A

Laminae 1 - 6

In the dorsal grey matter

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20
Q

Which laminae are motor and where are they located

A

Laminae 7-9

In the ventral grey matter

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21
Q

What is the difference between lamina 10 vs 1 - 9

A

10 is around the central canal

Anterior and posterior commissures comprise lamina 10

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22
Q

Where is the Tract of Lissauer

A

It is immediately before lamina 1 in the dorsal grey matter

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23
Q

How does the grey matter differ in the cervical and lumbar spine?

A

The grey matter is larger
C5-C7 = contains cell bodies for neurons supplying the UE

L3-S2 = contains cell bodies for neurons supplying LE

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24
Q

What structures are contained in the white matter of the SC

A

The axons of the ascending and descending tracts

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25
Q

What are the divisions of white mater in the SC

A

Dorsal
Lateral
Ventral

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26
Q

Define tracts as it pertains to the SC

A

A group of fibers inside the white matter in the CNS

They relay information up or down the SC or to and from the brain

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27
Q

Which 4 spinal tracts are sensory

A
  1. Cuneatus and gracilis in dorsal column
  2. Tract of Lissauer
  3. Lateral spinothalamic tract
  4. Ventral spinothalamic tract
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28
Q

Which 2 spinal tracts are motor

A
  1. Lateral corticospinal tract

2. Ventral corticospinal tract

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29
Q

Identify the corresponding tracts for each function
Fine touch and proprioception=
Pain and temperature=
Crude touch and pressure

A

Fine touch and proprioception= dorsal column: cuneatus and gracilis
Pain and temperature= tract of Lissauer and lateral spinothalamic tract
Crude touch and pressure= ventral spinothalamic tract

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30
Q

Identify the corresponding tract for each function
Limb motor=
Posture motor=

A

Limb motor= lateral corticospinal tract

Posture motor= ventral corticospinal tract

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31
Q 
Identify the corresponding function for each tract
Ventral spinothalamic tract=
Lateral spinothalamic tract=
Dorsal column cuneatus gracilis=
Tract of Lissauer=
A

Ventral spinothalamic tract= crude touch and pressure

Lateral spinothalamic tract= pain and temperature

Dorsal column cuneatus gracilis= fine touch and proprioception

Tract of Lissauer= pain and temperature

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32
Q

Identify the corresponding function for each tract
Ventral corticospinal tract =
Lateral corticospinal tract =

A

Ventral corticospinal tract = posture motor

Lateral corticospinal tract = limb motor

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33
Q

What is the function of the dorsal column-medial lemniscal system

A

Transmits mechanoreceptive sensations:

  • fine touch
  • proprioception
  • vibration
  • pressure

Ability to determine two-point discrimination

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34
Q

What types of nerve fibers are contained in the dorsal column-medial lemniscal system

A

Large, myelinated, rapidly conducting fibers

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35
Q

How is the speed of conduction in the dorsal column compared to the anterolateral system

A

Dorsal column transmits sensory information faster than the anterolateral system

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36
Q

Where does the dorsal column-MLS synapse with the 2nd order neuron

A

Medulla (cuneate and gracile nuclei)

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37
Q

Where does the dorsal column-MLS cross-over to contralateral side of the SC

A

In the medulla

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38
Q

Where does the dorsal column third order neuron arise

A

The thalamus in the ventrobasal complex

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39
Q

What types of peripheral nerves make up the first-order neuron of the dorsal column-MLS

A

A-beta nerves

Some A-alpha nerves

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40
Q

How do dorsal column-MLS first-order neurons enter the spinal cord

A

via the dorsal root ganglion

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41
Q

On which side of the SC does the dorsal column-MLS ascend

A

Ipsilateral side

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42
Q

What is the final destination of the third-order neuron of the dorsal column-MLS

A

Via the internal capsule to the somatosensory cortex in the postcentral gyrus in parietal lobe

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43
Q

What 5 sensations are transmitted via the anterolateral system via the spinothalamic tract

A
  1. pain
  2. temperature
  3. itch
  4. tickle
  5. crude touch
  6. sexual sensation
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44
Q

What type of neurons are contained the anterolateral spinothalamic tract

A

Smaller, myelinated AND nonmyelinated, slower conducting fibers

45
Q

How does the speed of conduction for the anterolateral spinothalamic tract compare to the dorsal column-MLS

A

The anterolateral spinothalamic tract is 1/2 to 1/3 as fast as the dorsal column

46
Q

What nerve fiber types are contained in the anterolateral spinothalamic tracts and their functions

A

A-delta = “fast” pain, mechanoreceptor

C-fibers = “slow” pain, polymodal receptors

47
Q

Where is the cell body for the anterolateral-STT located

A

Dorsal root ganglion

48
Q

How do anterolateral-STT first-order neurons ascend

A

They may ascend or descend 1-3 levels on the ipsilateral side in the Lissauer tract then synapse

49
Q

Where do first-order neurons of the anterolateral-STT synapse with the second-order neuron

A

In the tract of Lissauer 1 - 3 levels above or below where they entered the SC

50
Q

Which lamina contains the substantia gelatinosa

A

Rexed’s lamina 2

51
Q

Where do pain neurons of the anterolateral-STT synapse with 2nd-order neurons

A

In the substantia gelatinosa of Rexed’s lamina 2

52
Q

Where can primary pain neurons of the anterolateral-STT synapse with 2nd-order neurons

A

In the dorsal horn lamina 1, 4, 5, and 6

53
Q

Where does the anterolateral-STT cross-ver

A

in the spinal cord as the 2nd-order neuron

54
Q

Where do cell bodies for the second-order neurons of the anterolateral-STT reside

A

The dorsal horn of the SC

55
Q

The 2nd-order neuron of the anterolateral-STT contains which 2 pathways

A

Anterior spinothalamic tract (crude touch, pressure)

Lateral spinothalamic tract (pain and temp)

56
Q

Where do 2nd-order neurons of the anterolateral-STT synapse with 3rd-order neurons

A

In the reticular activating system and thalamus

57
Q

Where do pain fibers from the anterolateral-STT synapse with 3rd order neurons

A

In the reticular activating system

58
Q

Where do tactile signals from the anterolateral-STT terminate

A

Via the internal capsule to somatosensory cortex in the postcentral gyrus of the parietal lobe

59
Q

Nociceptive neurons primarily synapse with second-order neurons where

A

Substantia gelatinosa of dorsal horn (lamina 2)

They may also synapse in laminae 1, 4, 5, or 6

60
Q

Where do motor neuron signals originate

A

Precentral gyrus of frontal lobe

61
Q

How do motor neuron signals travel to the spinal cord

A

they exit the precentral gyrus, pass through the internal capsule, then travel inferiorly through the pyramids of the medulla

62
Q

Where does the lateral corticospinal tract crossover to the contralateral side

A

In the medulla

63
Q

Where do nerve fibers in the ventral corticospinal tract crossover to the contralateral side

A

In the spinal cord either when they reach the cervical or upper thoracic area

64
Q

Where do the upper motor neurons of the corticospinal tract synapse with lower motor neurons

A

In the ventral horn of the SC

65
Q

Where are the cell bodies for the upper motor neuron located

A

In the cerebral cortex

66
Q

How does upper motor neuron injury in the corticospinal tract present

A

Contralateral spastic paralysis + hyperreflexia

67
Q

Why does spastic paralysis occur with injury to upper motor neurons

A

Normally, inhibitory neurons of CST influence lower motor neurons, preventing lower neurons from firing too frequently.
When upper motor neurons are injured, the inhibitory impulses from the brain are blocked at the level of the injury

68
Q

What are 2 examples of upper motor neuron injury

A

Cerebral palsy

Amyotrophic lateral sclerosis

69
Q

What is the Babinksi test assessing

A

The integrity of the corticospinal tract

70
Q

What does a positive or negative Babinksi test indicate

A

Negative = CST is intact. Toes curl downward

Positive = damage to CST. Toes flex outward

71
Q

Where do lower motor neurons of the CST begin and end

A 
Begin =  In the ventral horn
End = NMJ
72
Q

Where are the cell bodies of the lower motor neurons located

A

In the ventral horn

73
Q

What is the function of the lower motor neuron

A

To send signal from spinal cord to muscles

74
Q

How does injury to the lower motor neuron of the CST present

A

Ipsilateral flaccid paralysis

Impaired reflexes

75
Q

What is another name for the corticospinal tract

A

Pyramidal tract

76
Q

What does a positive Babinski test indicate

A

Toes fan outward

Indicates injury to corticospinal tract

77
Q

Where does the upper motor neuron of the CST begin and end

A 
Begins = precentral gyrus of frontal cortex
End = ventral horn of spinal cord
78
Q

How does sympathectomy manifest below the level of a spinal cord injury

A

Bradycardia
Hypotension
Hypothermia

79
Q

What spinal level are the cardioacceslerator fibers

A

T1-T4

80
Q

What is the consequence of impaired cardioaccelerator fibers

A
  1. Unopposed cardiac vagal tone

2. Bradycardia and reduced inotropy

81
Q

What are 3 consequences of decreased SNS as a result of SCI

A
  1. Vasodilation
  2. Venous pooling
  3. Decreased CO/BP
82
Q

What are 2 consequences of impaired sympathetic pathways following SCI

A
  1. Inability to vasoconstrict or shiver

2. Hypothermia

83
Q

Why does hypothermia occur following SCI

A

It’s a result of the inability of cutaneous vasculature to vasoconstrict causing redistribution of BF towards periphery allowing for more heat to escape the body

84
Q

What are 2 differences between neurogenic vs hypovolemic shock

A

Neurogenic shock includes bradycardia and warm extremities along with hypotension
Hypovolemic shock includes tachycardia with cool, clammy extremities

85
Q

Which vasopressor is a good choice during acute neurogenic shock following SCI

A

Levophed, to restore SVR and inotropy

86
Q

What are the major causes of morbidity and mortality in patients with cervical and upper thoracic SCI

A

Ineffective alveolar ventilation and the inability to clear pulmonary secretions

87
Q

When is succinylcholine safe to give to a patient with a severe SCI

A

Within the first 24 hrs, although this may worsen the SCI

88
Q

What type of paralysis is associated with a severe C7 SCI 6 weeks after the acute phase

A

Spastic paralysis

89
Q

After the spinal shock phase ends, the body has a return of what type of reflexes.
Above or below the injury

A

Spinal sympathetic reflexes below the level of injury

90
Q

Why does autonomic hyperreflexia occur in high-level SCI

A

Spinal sympathetic reflexes have returned below the level of the injury

Without inhibitory influences that normally come from ABOVE the level of injury, the sympathetic reflexes below the level of injury exist in an overactive state

91
Q

What are 6 common events that cause autonomic hyperreflexia

A
  1. Stimulation of hollow organs (bowel, bladder, uterus)
  2. Bladder cath
  3. Surgery (esp cystoscopy or colonoscopy)
  4. Bowel movement
  5. Cutaneous stimulation
  6. Childbirth
92
Q

What are the common hemodynamic changes with autonomic hyperreflexia

A

HTN

Bradycardia

93
Q

What is the process of autonomic hyperreflexia when stimulation occurs below the level of SCI

A
  1. sympathetic nerves are activated
  2. Vasoconstriction below level of injury
  3. HTN
  4. Baroreceptor reflex at carotid sinus
  5. Bradycardia
  6. Inhibitory signals from brain for vasodilation don’t transmit below level of SCI
94
Q

What happens to vessels above the level of SCI during an incidence of autonomic hyperreflexia

A

Vasodilation from baroreceptor reflex stimulation (this does not transmit below the level of SCI

95
Q

What s/sx may occur in conjunction with autonomic hyperreflexia

A
  1. Nasal stuffiness
  2. HA
  3. Blurred vision
  4. Stroke
  5. SZ
  6. LV failure
  7. Dysrhythmias
  8. Pulmonary edema
  9. MI
96
Q

Best anesthetic choices for patients with high-level SCI

A

GA

Spinal anesthesia

97
Q

What are 3 treatments for HTN in patients with autonomic hyperreflexia

A
  1. Remove stimulus
  2. Deepen anesthetic
  3. Rapid-acting vasodilator (nitroprusside)
98
Q

Which agents best treat bradycardia during autonomic hyperreflexia

A

Anticholinergics (atropine or glycopyrrolate)

99
Q

Which medication can worsen HTN in patients with autonomic hyperreflexia and bradycardia

A

Giving a positive chronotrope with vasoconstrictive properties (ephedrine)

100
Q

What is the result of amyotrophic lateral sclerosis

A

Progressive degeneration of motor neurons in the corticospinal tract

101
Q

What type of cells replace affected motor neurons in ALS

A

Astrocytic gliosis

102
Q

What upper motor neuron s/sx present with ALS

A
  1. Spasticity
  2. Hyperreflexia
  3. Loss of coordination
103
Q

What lower motor neuron s/sx present with ALS

A
  1. Muscle weakness
  2. Fasciculations
  3. Atrophy
104
Q

What symptoms of autonomic dysfunction present with ALS

A
  1. Orthostatic HoTN

2. Resting tachycardia

105
Q

What type of drug is the only medication that can reduce mortality in patients with ALS

A

Riluzole which is an NMDA receptor antagonist

106
Q

What type of response to patients with ALS have to nondepolarizing NMBD

A

Increased sensitivity

107
Q

What are 3 pulmonary anesthetic considerations in patients with ALS

A
  1. Bulbar muscle dysfunction increases risk of aspiration
  2. Chest weakness reduces VC and maximal Vm
  3. Postop mechanical ventilation may be necessary
108
Q

Which type of mechanoreceptor allows a patient with blindness to read braille

A

Meissner’s corpuscles

109
Q

The tract of Lissauer is a component of which spinal pathway

A

Spinothalamic tract

APEX-Neuro (3 decks)

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