Spinal Cord Disorders

Question 1

LMN lesion

Answer 1

• focal weakness
• severe focal atrophy
• fasciculations may be present
• decreased muscle tone and dec MSR

Question 2

UMN lesion

Answer 2

• diffuse weakness
• mild atrophy
• no fasciculations
• INC muscle tone (spasticity)
• INC MSR
• clonus
• pathological reflexes (Babinski sign)

Question 3

C5,C6

Answer 3

deltoids, biceps

Question 4

C7,C8

Answer 4

triceps

Question 5

C8,T1

Answer 5

interossei, flexor digitorum (finger flexors)

Question 6

L2,3,4

Answer 6

iliopsoas (hip flexor), quadriceps

Question 7

L4,5

Answer 7

tibialis anterior (foot dorsiflexor)

Question 8

S!,2

Answer 8

gastrocnemius (foot plantar flexor)

Question 9

radicular (root) pain

Answer 9

lightening, stabbing, shooting electrical pain in the dermal distribution of a dorsal root

Question 10

what does radicular (root) pain indicate?

Answer 10

-dorsal root inflammation which occurs in shingles from Herpes zoster
OR
-compression by an extramedullary lesion with arises outside the spinal cord

Question 11

extramedullary vs intramedullary pain

Answer 11

• extra (herniated intervertebral disc or vertebral tumor) may also produce a more constant dull local pain
• intra arises inside sc, creates diffuse or no pain

Question 12

what indicates intramedullary lesion within the spinal cord itself

Answer 12

a suspended pattern of deficit with sacral sparing (since sacral is at the very edge; order: c.t.l.s)

Question 13

what indicates an extramedullary lesion arising from outside the spinal cord

Answer 13

a sensory deficit for pain and temp up to a level with sacral involvement

Question 14

what would a severe fracture and displacement of the T12 vertebral body approximately affect

Answer 14

the L3 level of the spinal cord itself

Question 15

transection of transverse myelopathy

Answer 15

complete (or nearly complete) lesion encompassing cross-sectional extent of the sc at one or a few adjacent levels

Question 16

transverse myelitis

Answer 16

when lesion is inflammatory or infectious in nature

Question 17

C8 transverse myelopathy

Answer 17

• severely atrophic, weak hand muscles with fasciculations
• spastic, hyper-reflexic, weak lower limbs with Babinski signs
• bladder and bowel dysfunction may occur from impairment of descending motor tracts which control the sacral anterior horn cells that innervate the sphincter muscles

Question 18

what happens when the transection is due to severe, acute TRAUMA

Answer 18

• the setting of spinal or neurogenic shock may initially be present
• UMN aign emerge weeks or months later

Question 19

involvement of what may impair phrenic nerve function and cause respiratory failure

Answer 19

extensive involvement of anterior horn cells at levels C3,C4,C5 (keeps the diaphragm alive)

Question 20

What are some causes of transverse myelopathy

Answer 20

• tumors (especially vertebral mets)
• spinal stenosis (sc compression from degen of bony spinal column and herniated intervertebral discs)
• extradural hemorrhage or abscess

Question 21

what causes transverse myelitis

Answer 21

• viral infections
• rxn to vaccines
• ai demyelination of the sc (eg from MS)

Question 22

role of corticosteroids

Answer 22

rapidly help reduce sc edema from tumors or myelitis and improve recovery of those with severe sc trauma

Question 23

Brown-Sequard syndrome (sc hemisection)

Answer 23

• contra deficit to pain and temp sensation
• ipsi deficit of vibe and position sense
• ipsi weakness

Question 24

what are common causes of hemisection

Answer 24

• trauma
• extramedullary tumors
• herniated discs with regenerative disease of the bony spine

Question 25

syringomyelia

Answer 25

- spinal cord lesions from a syrinx, or cavity, within or near the center of the sc - an intramedullary lesion, primarily affects gray matter

Question 26

where does a syrinx usually occur

Answer 26

in the cervical or thoracic spinal cord, may extend over several segments or levels in a longitudinal or r-c direction enlarging slowly over time

Question 27

syringomyelia cp

Answer 27

- suspended sensory level with sacral sparing, shawl/cape - preservation of the vibration and position sense - may be a late residual of severe sc injury

Question 28

causes of syringomyelia

Answer 28

- traumatic cervical sc hemorrhage will resorb if pt survives leaving a cavity/syrinx in its place - intramedullary sc tumors - impaired CSF flow (Chiari malformation)

Question 29

anterior spinal artery

Answer 29

- supplied by several radicular branches of the aorta and has a midline longitudinal orientation - supplies anterior/ventral 2/3 of the spinal cord (sc stroke would occur if it were blocked or occluded)

Question 30

anterior spinal artery occlusion 1/2

Answer 30

- usually occurs in lower thoracic or upper lumbar spinal cord - involvement of the corticospinal tracts there=paraplegia with UMN signs in lower limbs and a thoracic level of sensory loss, without sacral sparing, to pain and temp - vibe and position sense are nml

Question 31

anterior spinal artery occlusion 2/2

Answer 31

- back pain or radicular pain are common initial s/s | - occurs suddenly and progresses over hours (like a stroke)

Question 32

posterolateral syndrome/subacute combined degeneration

Answer 32

- classically due to vit b12 deficiency - in the sc demyelination and degeneration of the white matter takes place at thoracic levels - vibe and position sense are reduced/lost in lower limbs - spastic paresis from involvement of the corticospinal tract - pain and temp are not affected - may also be caused by copper deficiency or HIV

Question 33

ALS

Answer 33

- diffuse motor neuron lesions: cerebral cortex, brain stem, spinal cord - sensory pathways are not affected - bowel and bladder function remain nml - radicular pain is not present - fasciculations are prominent

Question 34

when would you suspect a cervical myelopathy

Answer 34

if LMN signs developed in the upper limbs and UMN signs were found in the lower limbs

Question 35

tabes dorsalis

Answer 35

-neurosyphilis affecting the spinal cord

Question 36

tabes dorsalis path

Answer 36

1. lumbosacral dorsal roots become infected and inflamed producing severe radicular lightening pains in the lower limbs 2. dorsal and posterior columns degenerate=impairment of vibe and position sense 3. loss of sensation in lower limbs where reflexes are lost (afferent reflex arcs are disrupted) - strength remains intact since motor neurons and corticospinal tract are spared