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Spinal Cord Flashcards

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1
Q

How many spinal nerves are there?

A
  • 31 spinal nerves total
  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 1 coccygeal
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2
Q

Where do nerves C1-C7 exit?

A

Above the corresponding vertebra

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3
Q

Where do all other spinal nerves exit?

A

Below corresponding vertebra

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4
Q

What is Vertebral disc herniation?

A

Nucleus pulposus herniates through anulus fibrosus

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5
Q

Where does disc herniation usually occur?

A

Posterolaterally at L4-L5 or L5-S1

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6
Q

Where does the spinal cord extend to?

A

Lower border of L1-L2 vertebrae

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7
Q

Where does the Subarachnoid space extend to?

A

Lower border of S2 vertebra

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8
Q

Where is a lumbar puncture usually performed?

A

B/w L3-L4 or L4-L5

(level of cauda equina)

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9
Q

What is the goal of a lumbar puncture?

A

Obtain a sample of CSF w/o damaging the SC

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10
Q

What do the Dorsal columns control?

A

Pressure, vibration, touch & proprioception

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11
Q

What are the 2 dorsal columns?

A

Fasciculus cuneatus (UE)

Fasciculus gracilis (LE)

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12
Q

What are the 3 spinal arteries?

A

2 Posterior & 1 Anterior

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13
Q

What do the Lateral spinothalamic tracts control?

A

Pain & temperature sense

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14
Q

What are the Intermediate horn sympathetics?

A

T1-L2/L3

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15
Q

What do the Anterior spinothalamic tracts control?

A

Crude touch & pressure sense

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16
Q

What do the Lateral corticospinal tracts control?

A

Voluntary motor

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17
Q

What is the tract of the Dorsal column?

A

Medial leminiscal pathway

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18
Q

What is the 1st order neuron of the Dorsal column?

A

Sensory nerve ending→ cell body in dorsal root ganglion→ enters SC, ascending ipsilaterally in dorsal column

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19
Q

What is synapse 1 for Dorsal columns?

A

Ipsilateral nucleus cuneatus or gracilis (medulla)

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20
Q

What is the 2nd order neuron of the Dorsal column?

A

Decussates in medulla→ ascends contrallaterally in medial lemniscus

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21
Q

What is synapse 2 for Dorsal columns?

A

VPL (thalamus)

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22
Q

What is the 3rd order neuron for Dorsal columns?

A

Sensory cortex

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23
Q

What is the 1st order neuron of the Spinothalamic tract?

A

Snesory nerve ending (A delta & C fibers) (cell body in dorsal root ganlion)→ enters SC

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24
Q

What is the synapse 1 of the Spinothalamic tract?

A

Ipsilateral gray matter (SC)

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25
What is the 2nd order neuron of the Spinothalamic tract?
Decussates at anterior white commissure→ ascends contralaterally
26
What is the synapse 2 for the Spinothalamic tract?
VPL (thalamus)
27
What is the 3rd order neuron for the Spinothalamic tract?
Sensory cortex
28
What is the 1st order neuron of the Lateral corticospinal tract?
UMN: cell body in 1° motor cortex→ descends ipsilaterally (through internal capsule) until decussating at cuadal medullar (pyrimdal decussation)→ descends contralaterally
29
What is the synapse 1 for the Lateral corticospinal tract?
Cell body of anterior horn (SC)
30
What is the 2nd order neuron for the Lateral corticospinal tract?
LMN: leaves SC
31
What is the synapse 2 for the lateral corticospinal tract?
NMJ
32
What happens in a Lower motor neuron lesion?
* Everything lowered * Less muscle mass * Dec muscle tone * Dec reflexes * Downgoing toes
33
What happens in an Upper motor neuron lesion?
Everything up (tone, DTR, toes)
34
What is Fasiculation?
Muscle twitching
35
When is a + Babinski sign considered normal?
In infants
36
What are the signs in an UMN lesion?
* Weakness * Inc reflexes * Inc tone * Babinski * Spastic paralysis * Clasp knife spasticity
37
What are the signs in an LMN lesion?
* Weakness * Atrophy * Fasiculations * Dec reflexes * Dec Tone * Flaccid paralysis
38
What are the characteristics of Poliomyelitis & Werding-Hoffman dz?
* LMN lesions only * Due to destruction of anterior horns * Flaccid paralysis
39
What are the characteristics of Multiple sclerosis?
* Scanning speech * Intention tremor * Nystagmus
40
What region of the SC does Mutliple sclerosis effect?
* Mostly white matter of cervical region * Random & asymmetric lesions
41
What are the characteristics of Amyotrophic lateral sclerosis (ALS)?
Combined UMN & LMN deficits w/ no sensory, cognitiev or oculomotor deficits
42
What can cause ALS?
Defect in superoxide dismutase 1
43
How does ALS present?
Fasiculations w/ eventual atrophy progressive & fatal
44
What is the tx for ALS?
Riluzole tx modestly inc survival by dec presynaptic glutamate release
45
What is ALS also know as?
Lou Gehring's dz
46
What are the characteristics of Complete occlusion of anterior spinal artery?
* Spares dorsal columns & Lissauer's tract * Upper throracic ASA territory is a whatershed area, as artery of Adamkiewiez supplies ASA below ~T8
47
What causes Tabes dorsalis?
3° syphilis
48
What does Tabes dorsalis result from?
Demyelination of dorsal columns & roots→ impaired sensation & proprioception & progressive sensory ataxia (inability to sense or feel legs)
49
What is Tabes dorsalis assoc w/?
* Charcot's joints * Shooting pain * Argyll Robertson pupils
50
What are Argyll Robertsons pupils?
Small bilateral pupils that further constrict to accommodation but not to light
51
What will Tabes dorsalis demonstrate on PE?
Absence of DTR's & + Romberg
52
What are the characteristics of Syringomyelia?
Syrinx expands & damages anterior white commissure of spinothalamic tract (2nd order neurons)→ bilateral loss of pain & temp sensation (us. C8-T1) Can expand & affect other tracts
53
What can Syringomyelia be seen w/?
Chiari I malformations
54
What are the characteristics of Vit B12 or Vit E def?
Subacute combined degeneration--demyelinations of dorsal columns, lateral corticospinal tracts & spinocerebellar tracts; ataxic gait, paresthesia, impaired position & vibration sense
55
What causes Poliomyelitis?
Poliovirus
56
How does poliovirus infect the body?
Fecal-oral transmission
57
Where does poliovirus replicate?
Oropharynx & SI before spreading via the BS to the CNS
58
What does poliovirus infection cause?
Destruction of cells in anterior horn of SC (LMN death) Poliomyelitis
59
What are the LMN lesions signs in Poliomyelitis?
* Weakness * Hypotonia * Flaccid paralysis * Atrophy * Fasciculations * Hyporeflexia * Muscle atrophy
60
What are the signs of infection in Poliomyelitis?
* Malaise * Headache * Fever * Nausea
61
What are the findings in Poliomyelitis?
CSF w/ inc WBCs w/ slight elevation of protein (w/ no change in CSF glucose)
62
Where can the poliovirus be recovered?
Stool or throat
63
What is Werding-Hoffman dz?
Cogenital degeneration of anterior horns of SC→ LMN lesion. "Floppy baby" w/ marked hypotonia & tongue fasciculations
64
What is the infantile type of Werdnig-Hoffman dz?
Median age of death of 7 months AR inheritance
65
What causes Friedreich's ataxia?
AR trinucelotide repeat disorder (GAA) in gene that encodes frataxin. Leads to impairment in mito functioning
66
What are the characteristics of Friedreich's ataxia?
* Staggering gait * Frequent falling * Nystagmus * Dysarthria * Pes Cavus * Hammer toes
67
How does Friedreich's ataxia present?
In childhood w/ kyphoscoliosis
68
What is the COD in Friedreich's ataxia?
Hypertrophic cardiomyopathy
69
What is Brown-Séquard synd?
Hemisection of SC
70
What are the findings in Brown-Séquard synd?
* Ipsi UMN signs BELOW level of lesion * Ipsi loss of tactile, vibration, proprioception sense BELOW * Contra pain & temp loss BELOW * Ipsi loss of all sensation AT level of lesion * Ipsi LMN signs AT level
71
What happens if the lesion in Brown-Séquard is above T1?
Pt may present w/ Horner's synd d/t damage of sympathetic ganglion
72
What is Horner's syndrome?
Sympathetctomy of face: Ptosis, Anhidrosis (& flushing of affected side of face) & miosis
73
What is Ptosis?
Slight drooping of eyelid: superior tarsal muscle
74
What is Anhidrosis?
Absence of sweating
75
What is rubor?
Flushing
76
What is Horner's synd assoc w/?
Lesion of SC above T1 (Pancoast tumor, Brown-Séquard synd, late-stage syringomyelia)
77
Where does the 3 neuron oculosympathetic pathway project?
Hypothalamus→ intermediolateral column of the SC→ superior cervical ganglion→ pupil, sm of the eyelids & sweat glands of the foreheard & face
78
What is the landmark of the C2 dermatome?
Posterior half of a skull "cap"
79
What is the landmark of the C3 dermatome?
High turtleneck shirt
80
What is the landmark of the C4 dermatome?
Low-collar shirt
81
What is the landmark of the T4 dermatome?
At the nipple
82
What is the landmark of the T10 dermatome?
At the umbilicus (important for early appendicitis pain referral)
83
What is the landmark of the L1 dermatome?
At the inguinal ligament
84
What is the landmark of the L4 dermatome?
Includes the kneecaps
85
What are the landmarks of the S2, S3, S4 dermatomes?
Erection & sensation of penile & anal zones
86
What is the clinical reflex of the Biceps?
C5 nerve root
87
What is the clinical reflex of the Triceps?
C7
88
What is the clinical reflex of the Patella?
L4 nerve root
89
What is the clinical reflex of the Achilles?
S1 nerve root
90
What is the clinical reflex of the Babinski?
* Dorsiflexion of the big toe & fannin of other toes * Sign of UMN lesion * Normal reflex in 1st year of life
91
What are Primitive reflexes?
CNS reflexes that are present in a healthy infant, but are absent in a neurologically intact adult
92
When do primitive reflexes disappear?
1st year of life
93
What are primitive reflexes inhibited by?
Mature/developing frontal lobe
94
When will primitive reemerge in adults?
Following frontal lobe lesions→ loss of inhibition of these reflexes
95
What is the Moro reflex?
"Hang on for life" reflex Abduct/extend limbs when startld & then draw together
96
What is the Rooting reflex?
Movement of head toward one side if cheek or mouth is stroked (nipple seeking)
97
What is the Sucking reflex?
Sucking response when roof of mouth is touched
98
What is the Palmar reflex?
Curling of fingers if palm is stroked
99
What is the plantar reflex?
Dorsiflexion of large toe & fanning of other toes w/ plantar stim (Babinski sign)
100
What is the Galant reflex?
Stroking along one side of the spine while newborn is in vental supension (face down) causes lateral flexion of lower body toward stim side

Neurology (9 decks)

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