Fns Lecture 14: Spinal Cord Lesions And Syndrome

Front 1

What are the three disturbances associated with spinal cord lesions?

Back 1

Sensory
Motor
Visceral

Front 2

What are the two critical aspects of clinical signs?

Back 2

Longitudinal localization (lesion level)
Transverse location (Cells and tracts affected

Front 3

Define: The cutaneous area innervated by the cells and fibers from a single dorsal root ganglion (DRG).

Back 3

Dermatome

Front 4

What is the effect of a single dorsal root removal?

Back 4

Rarely any detectable sensory loss because of dermatome overlap

Front 5

What is the lesion?
1. Somewhat restricted loss of cutaneous sensation
2. Loss of muscle tone (reflex arc interrupted)
3. Loss of stretch (myotatic, deep tendon) reflexes
4. Although there is no paralysis, patient is left with lmited, or no, use of denervated body part.

Back 5

Multple contiguous dorsal roots

Front 6

Do dermatomes overlap?

Back 6

Yes

Front 7

What is the pattern of degeneration at the level of lesions for a dorsal rhizotomy at the level of lesion?

Back 7

Anterograde degeneration: dorsal root fibers, 1 degree sensory fibers within cord collateral to motoneurons, chromatolysis in DRG

Front 8

What is the effect of a dorsal root ganglion rhizotomy above the level of the lesion?

Back 8

Ascending primary sensory tract fiber bundle degeneration.

Front 9

Lower or Upper: Anterior Horn cells (lamina IX)
Axons directly innervate skeletal muscle

Back 9

Lower (alpha) MOtor neurons

Front 10

Upper/Lower? Project from heihger brain centers to spinal cord to ingluence activity of lower motor neurons

Back 10

Upper Motor Neurons

Front 11

True/False: Damage to upper and lower motor neurons produce different clinical signs?

Back 11

true

Front 12

Lesion of upper or lower motor neurons: Patient presents with:
Paralysis (Flaccid)
Hypotonia
Reduced or absent myotatic reflexes (DTRs)
Fasciculations
Rapid Muscle atrophy

Back 12

Lower Motor Neuron Signs

Front 13

Define: Random motor neuron firing sometimes in response to damage.

Back 13

Fasciculations

Front 14

Upper or Lower Motor neuron clinical signs?:
Paralysis (may initially be flaccid but then becomes spastic)
Hypertonia
Hyperactive myotatic reflexes (DTRs)
Increased resistance to passive movement
Babinski sign
Clasp-knife syndrome
Loss of superficial abdominal and cremasteric (male) reflexes below lesion level
Late muscle atrophY (disuse)

Back 14

Upper motor neuron Clinical sign

Front 15

Upper/Lower motor neurons are both damaged what clinical signs would you see?

Back 15

Clinical signs for the lower motor neurons

Front 16

What type of lesion causes paralysis of lower motor neuron type dorsal or ventral rhizotomy?

Back 16

Ventral rhizotomy

Front 17

What are the two damages associated with a single ventral root lesion?

Back 17

Weakness
Reduced DTRs

Front 18

What are the four effects of multiple ventral roots rhizotomy?

Back 18

Flaccid Paralysis
Loss of DTRs
Rapid atrophy
Autonomic damage

Front 19

Definfe: In the T!-T4 region, preganglionic sympathetic fibers to the face are involved. Produces an ipsilateral disease called _____ (PRE-MD.
Pseudoptosis
Redness
Enophthalmus
Miosis
Dryness

Back 19

Horner's syndrome

Front 20

What levels are affected with a ventral root rhizotomy for the preganglionic sympathetic fibers resulting in Horner's syndrome?

Back 20

T1-T4

Front 21

Define: Produces immediate, complete loss of all neural activity caudal to the lesion?

Back 21

Spinal shock

Front 22

Order these stages of spinal activity
Upper motor neuron signs develop gradually
- Babinski sign
-Spasticity begins in
flexor muscles
- Extensor muscle tone predominates
- Lots of bad things
Spinal shock

Back 22

Spinal shock
Babinski
Spasticity in flexor muscles
Extensor muscle tone predominates

Front 23

Brown-Sequard syndrome is also known as a ______ ________?

Back 23

Spinal hemisection

Front 24

List the 5 damaged structres of the Brown Sequard syndrome.

Back 24

Posterior column
Lateral Cortciospinal tract
ALSTS
ANterior Horn
Anterior White commissure

Front 25

What are the ipsilateral deficits of the Brown Sequard syndrome?

Back 25

Posterior Column (Loss of kinesthtetic and vibratory sense and two-point tactile discrmination BELOW the lesion level.
Lateral Corticospinal tract (UMN motor neuron sgins BELOW the lesion level)
Anterio Horn (Lower motor neuron signs only AT the lesion level)
Anterior White Commissure (loss of pain and thermal sense only AT the lesion level)

Front 26

What are the contralateral deficits associated wtih Brown-Sequard Syndrome (spinal hemisection)?

Back 26

Loss of pain and thermal sense AT AND BELOW the lesion levle (light touch is usually intact) due to ALSTS damage

Front 27

How is poliomyelitis passed?

Back 27

Enterovirus (fecal-oral route)

Front 28

What does poliomyelitis attack?

Back 28

The lower motor neurons of anterior horn

Front 29

Is the loss of motor neurons with polio symmetric?

Back 29

Rarely symmetrically

Front 30

Define: Chronic progressive disease of unknown etiology
Most common in males beyond fifth decade characterized by bilateral degeneration in anterior horn cells in spinal cord an dcorticospinal neurons and fibers?

Back 30

Amyotrophic Lateral Sclerosis (lou Gehrig's Disease)

Front 31

What are the clnical signs of Lou Gehrig's disease?

Back 31

Can vary because they can invole both lower and upper motor neurons and can begin in either. Early UMN and lower LMN generally.

Front 32

What is the agent responsible for Tabes Dorsalis (locomoter ataxia)?

Back 32

CNS form of syphilic (tertiary syphilic)

Front 33

Describe this disease: Mianly in DRG of lumbosacral region, Severe degeneration of fibers in fasciculus gracilis characterized by snesory and motor disturbances including ataxic gait and a positive romberg sign

Back 33

Tabes Dorsalis (locomotor ataxia)

Front 34

What is ataxia?

Back 34

Uncoordinated movements

Front 35

Define: when you ask the patient to put their feet togehter and close their eye, they fall over.

Back 35

Positive Romberg sign

Front 36

Hypotonia and loss of deep tendon reflexes = lower limbs
Insensitiviy to pain - lower limbs
Positive Romber sign
Ataxic gait
Loss of Kinesthetic and vibratory sense

Back 36

Tabes Dorsalis (locomotor ataxia)

Front 37

Name the disease: characterized by central gliosis and cavitation in regions of the spinal cord including anterior white commissure with onset in 3rd or 4th decade of life. Hallmark of disease is bilateral symmetrical selective loss of pain and thermal sense with preservation of tactile sense.

Back 37

Syringomyelia

Front 38

Define: Selective loss of pain an dhtermal sense with preseneration of tactile sense.

Back 38

Sensory dissociation

Front 39

What is central gliosis and cavitation in regions of the spinal cord associated wtih Syringomyelia?

Back 39

The central canal becomes bigger

Front 40

What is the disease?
Bilateral & symmetrical loss of pain and thermal sense at level of lesion
Ipsilateral lower motor neuron syndrome
Ataxia
Horner's Syndrome

Back 40

Syringomyelia

Front 41

What is gliosis?

Back 41

Glial scars

Front 42

What causes combined system disease?

Back 42

Vitamn B12 deficiency

Front 43

What causes pernicious anemia?

Back 43

Lack of intrinsic factor to absorb B12

Front 44

What is another name for combined system disease?

Back 44

Subacute combined degeneration

Front 45

What is the pathology associated with Combined system disease?

Back 45

Bilateral degeneration in the posterior columns (mainly fasciculus gracilis) an din the lateral columns (CST), greatest in lumbosacral segments.

Front 46

NAme the disease:
Sensory disturbances
-loss of kinesthetic and vibratory sense in lower limbs
Positive Romberg sign
Pins and needles sensation in feet & legs (parethesias)
numness and coldness in feet
Motor distrurbances
weakness (UMN type)
Spasticity lower extremities
Babinski signs
Hyperactive myotatic reflexes lower limbs
UMN sings may convert to LMN due to peripheral neuropathy

Back 46

Combine System disease

Front 47

What are the two tracts involved?

Back 47

Posterior columns
Lateral columns

Front 48

What supplies the anterior two thirds of the spinal cord?

Back 48

Anterior spinal artery

Front 49

What is the pathology of the Anterior spinal artery syndrome?

Back 49

Occlusion of the anterior spinal artery or more commonly the radicular vessels feeding into it, results in infacrtion of CST, ALSTS, Anterior horns over one or more spinal segments.

Front 50

What are the three effects of the anterior spinal artery?

Back 50

Bilateral spastic paralysis
Bilateral loss of pain & thermal sense below level of lesion
Flaccid paralysis (LMN) at level of lesion

Front 51

What is an actue idiopathic polyneuritis and is a rapidly progressing disease often preceded by mild respiratory or GI viral infections, vaccination, surgery or lympahtic cnacer. Characterized by scattered inflmmaotry demyelination and Wallerian degeneration in spinal cord ventral roots, dorsal roots and along the entire lenght of peripheral nerves.

Back 51

Guillain-Barre

Front 52

Name the disease:
Sever, bilateral motor weakness starts in limb muscles, then spread to trunk, neck and finally head muscles
Hypotonia and reduced myotatic reflexes in affected muscles
Pain occurs in one-third of cases
May produce death due ot paralysis of respiratory muscles
If repsiration is supported during acute phase, most patients recover spontaneously and completely over a period of several weeks or months, although residual paralysis may persist for some time.

Back 52

Guillain-Barre

Front 53

What is an actue idiopathic polyneuritis and is a rapidly progressing disease often preceded by mild respiratory or GI viral infections, vaccination, surgery or lympahtic cnacer. Characterized by scattered inflmmaotry demyelination and Wallerian degeneration in spinal cord ventral roots, dorsal roots and along the entire lenght of peripheral nerves.

Back 53

Guillain-Barre

Front 54

Name the disease: Scattered inflammatory demyelination and Wallerian degeneration in spinal cord ventral roots, dorsal roots and along the entire lenght of peripheral nerves. Cranial nerves are also affected.

Back 54

Guillain-Barre syndrome (GBS or acute idiopathic polyneuritis)

Front 55

Name the disease: Clinical signs
-Major manifestation is severe, bilateral motor weakness (lower motor neuron symptoms); starts in limb muscles, then spread sto trunk, neck and finally, head muscles.
- hyptonia and reduced myotatic reflexes in affected muscles
- pain occurs in one-third of cases
-may produce death due to paralysis of repsiratory msucles
-If repsiration is supported druing acute phase, most patients recover spontaneiously and completely over a period of several weeks or months, although residual paralysis may persist for some time.

Back 55

Guillain-Barre' Syndrome (GBS or aacute idiopathic polyneuritis).