Spinal Cord

Question 1

Tract carrying PAIN TEMPERATURE CRUDE TOUCH AND CRUDE PRESSURE

Answer 1

ST

Lat ST= Temp—> Pressure

Anterior ST= —> Crude touch/pressure

Question 2

Thalamus nucleus of ST and DC

Answer 2

VPL

Question 3

Lemniscus of ST

Answer 3

Spinal

Question 4

Brown sequard at T3 what will be the nature of lesion at ST3 and ST5 DC and CST (umn & lmn)

Answer 4

I/L at ST3

C/L at ST5

I/L DC

I/L T3 CST= LMN
I/L T5 CST = UMN

Question 5

Dorsal column transmits?

VPFJ

Answer 5

Vibration
Proprioception
Fine touch
Joint position sense (x=RHOMBERGS SIGN)

Question 6

Lemniscus of DC

Answer 6

Medial

Question 7

Nucleus of LL in DC

Answer 7

GRACILIS

Question 8

Fasciculus of UL in DC

Answer 8

F. CUNEATUS

Question 9

Crossing of DC is at?

Answer 9

MEDULLA

Question 10

Which lesion in Pb poisoning?

Answer 10

LMN ALWAYS

Question 11

SPINAL SHOCK FEATURES and DURATION

Answer 11

Transient paradoxical LMN below the level of lesion.

Lasts 1-6wk (mc = 48-72 hrs)

All features of LMN except WASTING!!

Arreflexia
Flaccidity
Sensory loss+
Urinary retention+

Question 12

Which is the first reflex to reappear in a spinal shock?

Answer 12

BULBOCAVERNOSUS»Flexor withdrawal

Question 13

Hemiparesis group causes?

As per artery rupture

Answer 13

MCA rupture in CORTEX

MCA rupture in IC (Dense HEMIPARESIS)

In Cerebral Hge in PUTAMEN

Question 14

Test for Hemiparesis

Answer 14

PRONATOR DRIFT TEST

-Hand on weak side will pronate and drift downwards

Question 15

Cause of MONOPARESIS

Answer 15

NEUROPATHIES

Question 16

Cause of PARAPARESIS

Answer 16

MYELOPATHIES (Spinal roots)

- Always check dermatomes to find lesion

Question 17

BEEVOR SIGN?

Answer 17

Tell pt to get up from supine position

• Umbilicus upwards??— Upper muscles normal and lower muscles weak—> lesion at T10 or below
• Umbilicus normal??—Both muscles strong—> Lesion below T12

NO NEED TO DO BEEVOR TEST IF LESION IS ABOVE T10, the patient wont be able to get up only

Question 18

Hemisectional anatomy of tracts and artery supply in spinal cord

Answer 18

DC- S L T C (notice medial LL and lateral UL—Gracillis and Cuneatus accordingly)

ST&CST - C T L S

Posterior= VERTEBRAL ARTERY (DC)
Anterior = ANT SPINAL ARTERY (ST&CST)

Question 19

Features of Intramedullary pathology on tracts (SLTC CTLS CTLS)

Answer 19

Descending Sensory and Motor loss (ST&CST)

C= Shoulder—Elbow—wrist

BURNING PAIN**

SACRAL SPARING***

Question 20

Extramedullary pathology symptoms

Answer 20

Early Sacral loss

Root/Radicular pain (Eg IVD slip)

ASCENDING S&M loss (ST&CST)

CSF PROTEINS+++ **

Question 21

Syringomyelia age/sex and mcs

Answer 21

10-30y
M»F

C5-C8 pressing anteriorly (ST&raquo_space;CST)

• CAPE LIKE SENSORY LOSS***
• Loss of reflexes in the same area (LMN)

Question 22

Syringomyelia pathology

Answer 22

CSF filled cavity (SYRINX) expanding and pushing anteriorly

A/w CHIARI MALFORMATION 1 (>50%)
- Cerebellar tonsillar herniation—pushes central canal anteriorly

Question 23

Etiology if SYRINGOMYELIA

cT3

Answer 23

Congenital

TB

Trauma

Tumor

Question 24

Cf of Syringomyelia

Answer 24

DISSOCIATIVE ANESTHESIA c BURNING SENSATION-painless
(selective loss of pain and temp)

LMN PALSY @ Lesion

UMN PALSY below lesion

Question 25

Ixoc Syringomyelia

Answer 25

MRI BRAIN + SPINAL CORD*** | To see total extent if dilatation

Question 26

Rxoc Syringomyelia

Answer 26

Laminectomy and decompression | Poor px

Question 27

Rx Chiari malformation

Answer 27

Sub occipital craniotomy

Question 28

Root values POEM

Answer 28

1-2 Buckle my shoe (AJ -S1S2) 3-4 Kick the door (KJ- L3L4) 5-6 Pick up the sticks (BJ- C5C6) 7-8 Lay them straight (TJ- C7C8) 9,10 Big fat hen (Beevors sign T10)

Question 29

UB higher controls

Answer 29

1) Paracentral Lobule (Frontal lobe) - Social inhibition 2)PONS (Micturition centre) 3)Spinal cord— Symp = T11-L2 (Relax) Parasym= S234 (Contract) Sensory = S234 (Urge)

Question 30

Autonomous bladder | Lesion at s234

Answer 30

LMN lesion Flaccid/ Hypotonic No sensory/ parasymp supply LARGE CAPACITY** OVERFLOW INCONTINENCE **

Question 31

AutonomIc bladder

Answer 31

UMN lesion Spastic bladder Urge incontinence ++ Hypertonic LOW CAPACITY

Question 32

Characteristics of INFANT BLADDER/ CORTICAL BLADDER

Answer 32

Lesion at Pc lobule— disinhibition Cause : ACA infarct

Question 33

Reflex grading

Answer 33

+ hypo ++ normal +++ brisk ++++ clonus

Question 34

Conus Medullaris vs Cauda Equina

Answer 34

``` Inside Outside S1-5 (V= L1,2) S&L 1-5 KJ norm. KJ - Autonomic B. Mixed B Saddle An. - AJ B/L - AJ U/L - Plantar+ Plantar U/L ``` CE- TB tumor trauma

Question 35

Lesion above and below t1 nature?

Answer 35

QUADRIPARESIS PARAPARESIS

Question 36

Phrenic nerve roots

Answer 36

C345

Question 37

Intercoastal nerve roots

Answer 37

C678

Question 38

High cervical lesion features(c1-4)

Answer 38

Phrenic nerve gone IC nerve gone APNOEA

Question 39

Low cervical lesion features

Answer 39

Diaphragmatic breathing++

Question 40

Cervical lesion Features other than respiration

Answer 40

UMN LMN HORNER SYNDROME *** Rectal Sphincter tone DECREASE*** Priapism +++ *** (Dt autonomic transection)

Question 41

What is autonomic dysreflexia and its rx

Answer 41

Upper thoracic lesion—no sympathetic to HEART—Decreased HR—-Increased BP Rx CLONIDINE NIFEDIPINE

Question 42

Types of MNDs

Answer 42

ALS SMA (Spinal Muscular Atrophy)- LMN PLS (Primary Lat Sclerosis)-UMN Adult Tay Sachs-LMN Kennedy syndrome- LMN Multifocal motor neuropathy c Conduction block- LMN FAMILIAL SPASTIC PARAPLEGIA-UMN

Question 43

ALS pathology

Answer 43

SOD dysfunction— High radicles in nerves—Damage to whole nerve—UMN + LMN lesion

Question 44

ALS c/f

Answer 44

Whole CST + AHC gone : No motor fn. (AMYOTROPIC) Fasciculations+ *** (Pathognomonic of AHC LESION) SENSORY SYSTEM AND AUTONOMIC SYSTEM SPARED in all MNDs Bladder EYE** Cognition

Question 45

Rx ALS

Answer 45

RILUZOLE (inhibits glutamate release from adjacent nerve—Ca influx—combines with negative free radicles—No damage) EDAVARONE (Acts like SOD enzyme)

Question 46

Mccd in als

Answer 46

Resp failure

Question 47

Inclusion bodies in ALS

Answer 47

BUNINA BODIES

Question 48

Genetic etiology?

Answer 48

HEXANUCLEOTIDE REPEATS | FTD**

Question 49

SMA pathology

Answer 49

Lesion only in AHC ONLY LMN weakness

Question 50

PLS pathology

Answer 50

Lesion only in CST ONLY UMN weakness

Question 51

Rx SMA

Answer 51

Zolgenesma NUSINERSEN

Question 52

LOu gehrig disease

Answer 52

ALS