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Spinal Cord Disorders Flashcards

1
Q

What is the most useful sign to determine longitudinal localization?

A

spinal sensory level

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2
Q

The spinal cord how how many segments? How are they classified?

A

31 Total

8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

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3
Q

What is “around the clock” phenomenon? Why does this happen?

A
  • with cervicomedullary lesions, the pattern of weakness is as follows:
    • ipsilateral arm → ipsilateral leg → contralateral leg → contralateral arm

the pattern of decussation is that upper extremity fibers decussate rostral to lower extremities

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4
Q

What is the clinical presentation of a patient with a cervicomedullary lesion?

A
  • Pattern of weakness: ipsilateral arm → ipsilateral leg → contralateral leg → contralateral arm
  • +/- occipital or neck pain
  • If CSF is obstructed → (+) ICP → downbeat nystagmus & papilledema
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5
Q

Symptoms with a SC lesion at C3 or above?

A

death (w/o ventilation) d/t phrenic nerve disconnect

above C4: “onion skin” pattern facial numbness from spinal trigeminal nucleus involvement

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6
Q

Symptoms with a SC lesion at C4-C5?

A

diaphragmatic weakness

above C4: “onion skin” pattern facial numbness from spinal trigeminal nucleus involvement

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7
Q

Symptoms with a SC lesion at C5-C6?

A

quadripelegia

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8
Q

Symptoms with a SC lesion at C7-T1?

A

proximal arm power spared

hand/leg plegia

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9
Q

Symptoms with a SC lesion at T1-T8?

A

Paraplegia

inability to control trunk/sit independently

bowel/bladder dysfunction

+ T7 & above → autonomic dysreflexia/neurogeneic shock

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10
Q

Symptoms with a SC lesion at T9-T12?

A

paraplegia

bowel/bladder dysfunction

trunk stability is preserved

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11
Q

Symptoms with a SC lesion below L1?

A

Paraplegia

bowel/bladder dysfunction

can sit independently

cauda equina syndrome

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12
Q

Symptoms with a SC lesion below L4?

A

paraplegia

can sit independently

bowel/bladder dysfunction

hip flexors are spared

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13
Q

Symptoms with a sacral SC lesion?

A

must be bilateral to impact bladder, bowel & sexual function

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14
Q

How do SC lesions impact reflexes at the level of the lesion, above the lesion, & below the lesion?

A
  • at lesion: decreased
  • above: normal
  • below: increased
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15
Q

Describe the reflexes you would expect to see in a patient with a lesion in C5-C6?

A

decreased biceps & brachioradialis

increased triceps

L4 & S1 increased

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16
Q

Describe the reflexes you would expect to see in a patient with a lesion in C7?

A

decreased triceps

normal biceps & brachioradialis

L4 & S1 increased

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17
Q

Describe the reflexes you would expect to see in a patient with a lesion in L1?

A

increased patellar & ankle reflexes

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18
Q

Describe the reflexes you would expect to see in a patient with a lesion in L2-L4?

A

decreased patellar reflex

increased ankle reflex

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19
Q

Describe the reflexes you would expect to see in a patient with a lesion in L5?

A

normal patellar

increased ankle

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20
Q

Describe the reflexes you would expect to see in a patient with a lesion in C5-C6?

A

abolished ankle reflexes

normal patellar reflex

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21
Q

What is the clinical picture of a patient with conus medularis syndrome?

A

bilateral “saddle” sensory loss

mild bilateral lumbosacral LMN weakness

flaccid bladder dysfunction (early)

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22
Q

What is the clinical picture of a patient with cauda equina syndrome?

A

radicular pain

asymmetric sensory loss

marked asymmetric lumbosacral LMN weakness

flaccid bladder dysfunction (late)

absent patellar/ankel reflexes

23
Q

What are the common causes of conus medullaris syndrome?

A

lumbar disease, trauma, epidural metastasis/abscess L1 or L2, CMV in AIDS, schistostomiasis, HSV type 2

24
Q

What are the common causes of conus cauda equina?

A

lumbar disc disease, trauma, epidural metastasis/abscess L3 or lower, CMV in AIDS, schistostomiasis, neoplasm

25
lumbar _disc_ disease, trauma, epidural metastasis/abscess **L3 or lower**, CMV in AIDS, schistostomiasis, **neoplasm**
26
The posterior columns of the spinal cord mediate what senses?
proprioception vibration discriminative touch (fine touch)
27
The spinothalamic tracts of the spinal cord mediate what senses?
pain temperature non-discriminative touch (crude touch) pressure
28
The corticospinal tracts of the spinal cord mediate what senses?
_lateral corticospinal_: contralateral muscles _anterior corticospinal_: contralateral axial & girdle muscles
29
What are the symptoms seen in a complete cord transection? If the transection is S4/S5?
* sensory loss to all modalities _1-2 segments below the level of inquiry_ * flaccid paralysis w/ autonomic dysfunction * spasticity, hyperreflexia below the lesion w/ time * S4/S5 * inability to contract anal sphincter voluntarily or feel pinprick/touch aroudn anus
30
What is likely the cause of acute onset complete cord transection?
trauma
31
What is likely the cause of onset within hours of complete cord transection?
transverse myelitis (MS, neuromyelitis optica, Lupus, Sjogren's neurosarcoidosis, etc.)
32
What is likely the cause of onset within days to weeks of complete cord transection?
transverse myelitis, paraneoplastic necrotizing myelopathy (anti-Hu, CRMP-5, anti-amphiphysin)
33
What is likely the cause of late onset of complete cord transection?
radiation-induced myelopathy
34
What is the major difference between spinal shock & neurogenic shock?
spinal shock: acute onset neurogenic shock: delayed onset (hours-days)
35
What is the cause & presentation of a patient with spinal shock?
* d/t acute cervical spinal cord injury - acute onset * below level of injury * deceased/absent reflexes * loss of sensation * flaccid paralysis below injury * transiend \<48 hrs * look for loss of bulbocavernous reflex & anal wink
36
What is the cause & presentation of a patient with neurogenic shock?
* d/t injury T6 & above * delayed on set (hours - days) * distributive d/t sympathectomy unopposed vagal function * hypotension - vasodilation * bradycardia * hypothermia - unable to regulate temperature * lasts 1-3 weeks
37
What is the bulbocavernous reflex?
pressure to glans penis or clitoris → anal contraction
38
Autonomic dysreflexia can be cause by lesions above what spinal level? Symptoms?
Above T6 increase sympathetics → increase vasoconstriction → increase blood pressure; relay inhibition via carotid & aortic baroreceptors is disrupted by trauma * \>20% increase in HR * flushing * piloerection * headache * visual changes * at risk for malignant _hypertension_
39
What are the possible triggers for autonomic dysreflexia?
bladder distension & fecal impaction
40
What deficits are seen in patients with hemicord syndrome?
* Posterior columns * ipsilateral vibration & position sensation below level * Corticospinal tract * ipsilateral UPM weakness below the level * if anterior horn → LMN weakness _at_ level of lesion * Spinothalamic * contralateral pain & temp 1-2 segments below the lesion * damage to descending autonomic fibers * ipsilateral Horner (if C8-T1) * loss of sweat below the lesion * NO bladder dysfuncyion
41
Most common causes hemicord syndrome?
penetrating trauma knife, gunshot, metastases
42
What deficits are seen in patients with central cord syndrome?
* Spinothalamic tract * bilateral loss pain & temp - cape/vest pattern * may involve anterior horn cells → LMN weakness * may involve corticospinal tract & anterolatera tracts → UMN weakness + descending loss temp & sensation below lesion
43
What is syringomyelia?
enlargement of central canal of spinal cord
44
Cervical hyperextension injury may involve formation of fluid in the central spinal canal called what?
syrinx
45
What is “man in a barrel syndrome”?
acute tramua → swelling w/ quadriplegia → as swelling decreases have proximal weakness of arms & legs also, in cases cerebral hypoperfusion d/t watershed stroke
46
What are the symptoms in a patient with extramedullary compression?
ascending contralateral pain/temp & sensory loss UMN signs usually occur early
47
What are the common causes of extramedullary compression?
* Spinal Stenosis * mild (effacement CSF) * moderate (contact/displacement of spinal cord) * severs (compression of neural structures) * vere severe (compression spinal cord / myelomalacia) * tuberculosis * spinal tumors * breast, lung, melanoma, lymphoma
48
What deficits are seen in patients with posterior cord syndrome?
* impaired vibration & proprioception → sensory ataxia w/ “stomping gait" * dorsal root involvement * reflexes absent (esp legs) * strength preserved * may see Lhermitte sign: electric shock sensation on passive neck flexion
49
What are the major causes of posterior cord syndrome?
cervical spondylotic myelopathy, neurosyphilis, radiation
50
Repeated trauma to the feet can result in what condition?
Charcot arthropathy osteoclastic resorption leading to neuropathic joints
51
What is the acronym associated with posterior cord syndrome?
* D - dorsal column degeneration * O - orthopedic pain (charcot joints) * R - reflexes decreased/absent * S - shooting pain * A - Argyll-Robertson pupils (accommodate but do not react) * L - locomotor ataxia * I - impaired proprioception * S - syphilis (tertiary)
52
What deficits are seen in patients with posterolateral cord syndrome?
* impaired vibration, proprioception, UMN * spastic/ataxic gain; reflexes may be increased or decreased * may have bladder spasticity from descending autonomic involvement * temp/pain generally spared
53
What are the main causes of posteolateral syndrome?
**vitamin B12** or copper deficiency, HIV, NO / zinc toxicity, vertebral disease
54
What is the other name for posterolateral cord syndrome?
subacute combined degeneration

Neuro II (30 decks)

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