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39 Cards in this Set

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Main difference in how spinal cord lesions affect loss of
-Tactile/discriminative sense
-Pain/temp sense
-Dorsal column lesions cause loss AT the lesion or just below
-Anterolateral lesions cause loss 2-3 segments below
What will result from lesion of one entire SIDE (1/2) of the spinal cord?
-Loss of ipsilateral dorsal columns JUST BELOW the cut
-Loss of contralateral anterolateral columns 2-3 segments BELOW the cut
-Loss of SOME contralateral crude touch
If a patient has ALTERNATING sensory loss (fine touch on one side, pain/temp on the other) what should you think?
Unilateral lesion
What do lesions in the brainstem above the caudal medulla result in?
Contralateral loss of BOTH pain/temp and fine touch.
What is dorsal rhizotomy?
Cutting of the dorsal nerve ROOTS
What does dorsal rhizotomy result in?
Anesthesia of all sensation from the same side of body, in the dermatome of the level cut.
Does cutting one spinal cord segment remove all sensation from a dermatome?
No; there is overlap
To relieve pain in the T7 dermatome where would you cut?
T6-T8
Cordotomy is what?
Cutting the anterolateral tracts to remove pain/temp sensation from the opposite side, 2-3 segments below the cut.
Where should you make the cut when doing a cordotomy?
2-3 levels above where you want pain/temp loss.
Is cordotomy usually unilateral or bilateral?
Bilateral
What is the result of dorsal rhizotomy and cordotomy?
Pain often recurs in both.
What is loss of pain/temp and discrimination in only PARTS of limbs indicative of?
Peripheral nerve lesions
3 common causes of peripheral nerve lesions:
-Diabetes
-Neuropathy
-Trauma
Complete cord transection results in:
Complete loss of all sensation on both sides of the body + loss of motor control
2 Diseases that can cause complete cord transection:
-Tumor
-Multiple sclerosis
What is the most typical cause of cord transection?
Penetrating trauma - knife wounds or bullets.
What is anterior cord syndrome?
A lesion of the anterolateral tracts
2 Typical causes of anterior cord syndrome:
1. Fractured vertebrae
2. Infarct from a blood clot
Deficit in anterior cord syndrome:
Bilateral loss of anterolateral info
If anterior cord syndrome is caused by a blood clot, what artery would this be in?
The anterior spinal artery
What is posterior cord syndrome?
Lesion of the dorsal columns
What is the most common cause of posterior cord syndrome?
2ndary syphilis - tabes dorsalis
Central cord syndrome will affect:
Pain/temp from both sides, only at the dermatome where the lesion is.
3 causes of central cord syndrome:
-syringomyelia
-gliosis
-hyperextension of the spine
What spinal levels most often will develop central cord syndrome?
-Lower Cervical (most)
-Upper thoracic
What is the typical general sensory loss patients with central cord syndrome that is just a SMALL lesion will present with?
Capelike loss of pain/temp in the upper arms and shoulders.
How is central cord syndrome with a LARGE lesion different from a small lesion?
Can affect the dorsal columns as well as anterolateral and motor.
Who had large lesion central cord syndrome and what caused it?
Christopher reeve; hyperextension caused a fluid-filled cyst in the cord.
What is Brown-Sequard syndrome?
Hemisection of the spine - loss of 1/2 of cord. Ipsilateral dorsals, contralateral anterolaterals
Unilateral lesion of Rostral Medulla loses:
Contralateral everything from body
Unilateral lesion of VPL loses:
Contralateral everything from BODY only.
Result of unilateral lesion of VPM:
Contralateral loss of fine touch and pain/temp from face/head
Result of unilateral lesion in Primary cortex S1:
Contralateral loss of everything in body and/or face (depending on if lesion is more medial or lateral)
Where in the medulla does a lesion have to be to affect FACE as well as anterolateral tracts?
LATERAL
What deficit will result from lesion of the medulla in its lateral portion?
Contralateral anterolateral loss
Ipsilateral facial loss of ONLY pain/temp (descending afferents haven't crossed yet)
Why isn't fine touch of the face affected by a lateral medulla lesion?
Because these enter the spinal cord at the pons, and most immediately cross over to the trigeminal lemniscus to ascend.
So unilateral lesion of lateral medulla will result in loss of:
-Ipsilateral facial pain/temp
-Contralateral body pain/temp
most likely site of an infarct:
VPL