Spinal Cord disorders

Question 1

what are LMN signs

Answer 1

focal weakness
severe atrophy 
fasciculations
decreased muscle tone
decreased reflexes

Question 2

What are UMN signs

Answer 2

diffuse, severe weakness
mild atrophy
increased muscle tone (spasticity)
increased reflexes
possible clonus
posible babinski sign

Question 3

when are LMN signs seen

Answer 3

when there is a spinal cord lesion affecting the anterior horn cells that innervate the muscles of the limb

Question 4

when are UMN signs seen

Answer 4

in limbs below a spinal cord lesion that affects the corticospinal tract
•ipsilateral cervical or thoracic spinal cord lesion or
• contralateral brainstem or brain lesion

Question 5

what is radicular (root) pain

Answer 5

lightning, stabbing or shooting electrical pain in the dermatomal distribution of a dorsal root.

Question 6

what does radicular pain indicate

Answer 6

inflammation of the dorsal root

Question 7

what are 2 examples that cause radicular pain

Answer 7

Herpes zoster

compression by an extramedullary lesion

Question 8

what kind of pain does an extramedullary lesion itself cause (not the resulting compression)

Answer 8

constant dull, local pain

Question 9

what kind of pain is caused by an intramedullary lesion

Answer 9

diffuse pain or none at all

Question 10

how can radicular pain be relieved

Answer 10

analgesics, anti-inflammatory medications or nerve block procedures.

chronic root pain - anticonvulsants and antidepressants

Question 11

what are the signs and symptoms of a spinal cord lesion in the spinothalamic tract

Answer 11

pain and temperature deficit in the contralateral body

dermatomal level of loss approximates the level of the lesion

Question 12

what would a suspended patter of pain and temperature loss with sacral sparing indicate

Answer 12

intramedullary lesion

due to disruption of the decussating spinothalamic tract fibers and possibly medial portions of the STT

Question 13

where are sacral fibers located in the STT

Answer 13

laterally

Question 14

what would a sensory deficit for pain and temperature up to a level with sacral involvement indicate

Answer 14

extramedullary lesion (compressing from outside the spinal cord)

Question 15

where would you expect position sense and vibration sense deficits due to a spinal cord lesion

Answer 15

ipsilateral side

lesion would affect the DCP (crosses in the medulla)

Question 16

how would an extramedullary lesion present

Answer 16

radicular pain with sensory loss up to a level including sacral

Question 17

how would an intramedullary lesion present

Answer 17

diffuse or no pain, sensory loss would be suspended with sacral sparing

Question 18

what is a transverse myelopathy

Answer 18

complete lesion of the spinal cord

Question 19

what is a transverse myelitis

Answer 19

a transverse myelopathy that is inflammatory in nature

Question 20

what can be used to approximate the level of a transverse myelopathy (transection)

Answer 20

the dermatomal level of sensory loss and the presence of any lower motor neuron signs

Question 21

what causes spinal or neurogenic shock

Answer 21

trauma

Question 22

what is spinal or neurogenic shock

Answer 22

weakness my be accompanied by decreased muscle tone and muscle stretch reflexes with the expected UMN signs only gradually emerging weeks to months later

Question 23

a lesion at what level could cause respiratory failure

Answer 23

involvement of anterior horn cells at C3, C4, C5 - may impair phrenic nerve function

Question 24

what are some examples of extramedullary lesions that could cause transverse myelopathy

Answer 24

tumors, spinal stenosis, extradural hemorrhage or abscess, severe spinal cord ischemia

Question 25

what are examples of inflammatory causes of a transverse myelopathy

Answer 25

viral infections, autoimmune demyelination (MS)

Question 26

how does a Brown-Sequard lesion present?

Answer 26

* contralateral pain and temperature deficit * ipsilateral deficit of vicration and position sense * ipsilateral weakness with LMN and UMN signs

Question 27

what are common causes of Brown-Sequard hemisection lesions

Answer 27

trauma, extramedullary tumors and herniated discs with degenerative disease of the bony spine

Question 28

when would you see a Horner's syndrome with a Brown-Sequard lesion

Answer 28

if it was above T1

Question 29

what is a syringomyelia

Answer 29

spinal cord lesion from a syrix or cavity within or near the center of the spinal cord (primarily affects the grey matter there) - intermedullary lesion

Question 30

what are the most common locations for a syrinx

Answer 30

the cervical or thoracic spinal cord and may extend over several segments or levels - enlarging slowly over time

Question 31

what tracts/fibers are interrupted by a syrinx

Answer 31

selectively interupts the decussating fibers of the STT

Question 32

what symptoms does syringomyelia cause

Answer 32

defitic of pain and temperature ofver the dermatomes involved but sparing of the sacral dermatomes = suspended sensory level with sacral sparing (cape-like pattern) may expand causing weakness later on preservation of vibration and position sense bc DCP is spared

Question 33

what causes syringomyelia

Answer 33

later residual of severe spinal cord injury i.e. a traumatic cervical spinal cord hemorrhage will resob if the patient survives leaving a cavity or cyrix in its place other causes- intramedullary spinal cord tumors or impaired CSF flow from a congenital abnormality of the posterior fossa (Chiari malformation)

Question 34

what is a congenital malformation that may cause a syringomyelia

Answer 34

Chiari malformation - abnormality in the posterior fossa that prevents the flow of CSF

Question 35

what does the anterior spinal artery supply

Answer 35

the anterior 2/3 of the spinal cord

Question 36

what happens if the anterior spinal artery is blocked

Answer 36

a "spinal cord stroke" occurs

Question 37

what causes occulsion of the anterior spinal artery

Answer 37

atherosclerotic disease of the aorta, or a complication of surgery for an aortic aneurysm, or an aortic dissection in a hypertensive patient

Question 38

what is the most common location of an anterior spinal artery occulsion

Answer 38

lower thoracic or upper lumbar spinal cord

Question 39

what are the symptoms of an anterior spinal artery occulsion

Answer 39

paraplegia with UMN signs in the lower limbs and a thoracic level of sensory loss, without sacral sparing to pain and temperature. vibration and position sense remain normal (posterior dorsal columns are preserved) back or radicular pain are common initial symptoms. Symptoms occur suddenly and progress over hours

Question 40

what causes posterolateral syndrome or combined degeneration

Answer 40

Vitamin B12 deficiency | rarely copper deficiency of HIV

Question 41

is posterolateral syndrome or combined degeneration reversible

Answer 41

yes if caught early

Question 42

what other problems may accompany posterolateral syndrome or combined degeneration

Answer 42

polyneuropathy, optic neuropathy and dementia - all can be caused by vit B12 deficiencies

Question 43

what happens in posterolateral syndrome or combined degeneration and where does it take place

Answer 43

demyelination and degeneration of the white matter usually at thoracic levels

Question 44

what does "combined degeneration" refer to

Answer 44

involvement of the posterior and lateral columns

Question 45

what are the symptoms/signs of posterolateral syndrome or combined degeneration

Answer 45

vibration and position sense are reduced or lost in the lower limbs (unsteadiness and falling if the patient walks in the dark or with eyes closed) spastic paraparesis from involvement of the corticospinal tract pain and temperature are not affected

Question 46

what is ALS

Answer 46

degenerative disease affecting UMN and LMN, lesions occur diffusely

Question 47

What important features of ALS helps distinguish it from a spinal cord lesion

Answer 47

it does not affect the sensory pathways, bowel and bladder functions remain normal, and radicular pain is not present

Question 48

what is tabes dorsalis

Answer 48

nervous system involvement by infection with syphilis

Question 49

where is the lesion in tabes dorsalis

Answer 49

lesion of the dorsal roots and dorsal spinal cord

Question 50

what are the symptoms of tabes dorsalis

Answer 50

first - severe radicular pains in the lower limbs then impairment of vibration and position sense in the lower limbs, eventually all sensation in the lower limbs is lost, and loss of reflexes strength remains in tact