• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/192

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

192 Cards in this Set

  • Front
  • Back
DISEASES AFFECTING THE MOTOR SYSTEM
START
What type of GI virus can infect the anterior horn cells?
Poliomyelitis
Where else can polio infect? What is the general rule then?
the nuclei of the medulla so basically the end of any corticomotor tract
So what kind of neurons will polio affect?
lower motor neurons
What disease in infants presents like polio?
progressive infantile muscular atrophy
How do babies get progressive infantile muscular atrophy and is it unilateral or bilateral?
they inherit it and it is bilateral
What is another name for progressive infantile muscular atrophy?
Werding Hoffman disorder
When do the babies start getting symptoms?
before the 1st year of life
What similar disease to progressive infantile muscular atrophy happens in children and adolesents? Alternate name?
Juvenile heriditary lower motor neuron disease or Kugelberg Walenda disease
So what are the three diseases that affect LMN's without affecting sensory or UMN's?
1. Polio
2. Infantile progressive muscular atrophy
3. Juvenile Hereditary LMN disease
Whenever there is the word spastic in a disease, does that mean it is a LMN or UMN disease?
UMN
What kind of inherited disease affects the long UMN axons bilaterally? (hint about the long neurons)
Hereditary Spastic Paraplegia
What is the difference between paraplegia and quadreplegia?
Break down the logic behind the naming of the last disease.
Hereditary- genetic
Spastic- involves UMNs
Paraplegia- lose ability to use both legs (longest motor neurons)
What is the pathophysiology behind Hereditary Spastic Paraplegia?
There is degeneration of these UMN's.
What is the disease where there is a mix of UMN and LMN involvement from anywhere from the cortex to the anterior horn?
Amyotrophic Lateral Sclerosis
Break down the name amyotrophic lateral sclerosis.
Amyotrophic- atrophy from LMN lesion
Lateral- lateral column meaning UMN lesion
Sclerosis - scarring of neural tissue
What kinds of sx would you find in an ALS pt?
different areas of hyperreflexia and a reflexia and different tones and muscle mass.
Would you find any sensory issues with ALS?
NO! It's other name is motor neuron disorder.
So what are the UMN only diseases?
Hereditary Spastic Paraplegia
So what are the UMN and LMN combined diseases?
ALS
DISEASES AFFECTING THE SENSORY SYSTEM
START!
What is usually affected by the demyelinating diseses? Why?
The dorsal column because it is the most heavily myelinated.
What 3 types of info going to the cerebellum help you to keep balance?
1. visual
2. vestibular
3. proprioceptive- spinalcerebellar and dorsal column
What is Romberg's sign?
When a person can stand fine with eyes open, but not with his eyes closed.
Why does ROmberg's sign happen?
Because the person loses dorsal or spinocerebellar proprioceptive input, they rely on visual cues to keep balance.
What normal daily activity would cause a person with spinocerebellar dysfunction to fall over?
washing their face or anything that requires their eyes to be closed.
a
s
s
s
s
s
What disease causes someone to have a positive Romberg's sign by attacking only the dorsal column?
Dorsal column syndrome.
What fibers go through the anterior white commissure? What crosses anterior to that?
the axial anterior motor fibers and the pain and temperature fibers.
the crude touch fibers cross anteriorly.
Do the anterior white commissure fibers end at the same level they come in at?
No, they go one level up.
The crude touch fibers also cross. What level do they end up at?
3-4 levels above.
What happens if you have a lesion of the lateral spinothalamic tract?
loss of contralateral pain and temperature one level below and down from there.
What happens if you have a lesion of the anterior spinothalamic tract?
loss of contralateral crude touch 3-4 levels below and down from there.
What areas do the spinocerebellar tracts gather proprioceptive info from?
the lower limbs (both dorsal and ventral spinocerebellar)Fherp
What happens if you have a lesion of the dorsal vs ventral cerebellar tract?
dorsal- ipsilateral lower leg dystaxxia
ventral- contralateral lower leg dystaxia
Are the two spinocerebellar tracts redundant?
No, they each carry 50% off the proprioceptive information.
What are the two types of lesions you can have?
destructive and irritation lesions
What happens to the activity of a neuron when it is irritated?
It becomes extra sensitive and fires more.
What sx do you get with irritation of a dorsal root?
hyperesthesias and hyperalgesias
Dissect the word analgesic.
loss of pain. "pain killer"
What is hyperalgesia?
increased sensitivity to pain
Dissect the word anesthetic.
Loss of all sensation
What is hyperesthesia?
abnormal increase in sensitivity to stimuli of the sense
What sx do you get with destruction of a dorsal root?
you lose all types of sensation from that dermatone
What happens to your reflexes when a dorsal root is destroyed? Why?
you lose your reflexes because you'll never sense the original stretch/irritation
What disease infects dorsal root ganglion?
herpes zoster virus
What dermatones does this usually affect? Give picture.
T5-T10
T5-T10
Can it affect any dorsal roots? What is it's scope? Give a picture to burn this into my head.
Yes it can and it can also involve cranial ganglion
Yes it can and it can also involve cranial ganglion
What are the symptoms of herpes zoster infection of dorsal roots?
hyperethesia like itching and erupting vesicles on the skin
What disease starts typically with demyelination and segmental degeneration starting with the longest motor neurons and working their way up?
Guillian Barre Syndrome
Is GBS inherited?
No
What starts GBS? What does it attack?
usually you have some sort of infection (like GI) where the microbe antigen mimics the scwann cells, inducing an autoimmune attack.
Why do the lower limbs lose function first?
They have the longest LMN's with the most myelin needed.
What is the worst nerve to lose function in with GBS? What is the tx?
The phrenic nerve to the disphragm. The the pt needs to go on ventilator therapy.
Is GBS symmetrical or asymmetrical? Why?
symmetrical. It is not an infection itself, but rather an immune thing in which the whole body is bathed with the immune cells.
Can you recover from GBS?
yes, it usually resolves on it's own
Do people get recurring episodes of GBS?
Not usually! (Lucky ducks!)
What would you find in the CSF of pt's with GBS? Why?
proteins because the inflammation would reach up to the dorsal root, which is in the subarachnoid space. The increased permeability of the meninges lets in proteins.
Would you see WBC;s in the CSF for GBS? Why?
No because the CNS neurons are not under attack because they do not have schwann cells.
What happens to protein and WBC level in meningitis?
they both go up
What is it called when only protein levels go up in GBS?
albumino-cytological dissociation
What is the most common inherited peripheral neuropathy? Give a pic!
Charcot Marie Tooth disease
Charcot Marie Tooth disease
What types of nerves does Charcot Marie Tooth disease affect? (sensory/UMN/LMN)

What protein is affected? (learned in class)
Both sensory and motor nerves

Connexin 32 in the nervous tissue.
What happens if you irritate the anterior root?
You get spasticity
Which levels of motor roots are most likely to be irritated (for any reason)? Why?
L3,4,5 because they are most likely to be the victims of disc herniation from excessive pressure
Draw and label the structure of an intervetebral disc.
What is the nucleus pulposus like and what is it a remenant of?
It is a jelly-like substance and is the remenant of the notochord.
Draw a transection of what the spinal cord, roots, trunk, and disc look like.
Draw how a disc herniation would affect the nerves
Why would disc herniate?
If you are bending, twisting, and putting a lot of pressure on the spine then there is likely to be a herniation of a weak spot on the annulous fibrosis.
What direction do you herniate into? Why?
posteriolateral because of the posterior spinal ligament being directly in back.
What is the opening that the nerve trunk goes through called?
intervertebral foramina
Show a picture of the intervertebral foramina.
What levels are disc herniations most frequent in? Give the percentages of the top and only 2.
Disc above and below:
L5- 90%
C6- 10%
What are the short term vs long term consequences of disc herniation?
short term- nerve root irritation
long term - degeneration
What would be some sx of nerve root irritation?
spasticity, hypertonia, pain, paresthesias (too much sensation)
What does myelopathy mean?
a pathology with the spinal cord
What is the most common type of myelopathy?
cervical spondylosis leading to myelopathy
What is spondylosis?
osteosrthritis of the spinal joints
Draw out the things that can happen in cervical spondylosis with myelopathy
What are the two pathologies are present in the previous?
osteophytes from bone and parts of discs becoming inappropriately calcified
Why is the cervical region most likely to be involved in this?
Because in the neck, the spinal cord is much closer to the disc so even a little bit of disturbance can cause root compression
What are the main short vs long term sx of cervical spondylosis with myelopathy? Explain them.
Short term- stiff neck (rigid muscles and more vertebbral friction) and arm spasticity and pain (irritated nerve roots)
Long term- arm weakness (degeneration of nerve roots)
What about the pathology of cervical spondylosis with myelopathy is different than disc herniation?
It involves the spinal cord (myelopathy)
So what sx would cervical spondylosis with myelopathy present with? Give them in order of appearance.
root irritation
LMN lesion at that level (closest to anterior horn)
UMN lesion below that level
Draw a picture of the progression of cervical spondylosis with myelopathy.
UPDATE!
What makes bones create disc calcifications, spondylosis, and osteophytes?
irritation of the disc and bones from degeneration and rubbing together
Why is this irritation more likely to happen in the cervical region?
The discs are thinner so they are faster to degenerate to the point of letting friction in.
What other protective mechanism do large discs in the lumbar area give?
They make sire there is lots of space between the bones and spinal cord so even if there are bone spurs, it will be hard for them to reach the nerves.
What happens if you have a lesion of the intermediate at T1/T2? Why?
You get horner's syndrome because the sympathetic nucleus that supplies the eyes is affected.
What is it called when you have a complete transection at C1-C3?
Exitus Lethalus
Why is it called exitus lethalus?
because you cut off the nerves to the diaphragm and you can due
What do you get when you have a complete transection at C4-5?
quadreplegia
What do you get when you have a complete transection below T2? Why?
Spastic paraplegia because the brachial plexus is spared so you will have use f your arms.
What happens to autonomic functions like defecation and urination when you have a coomplete transection?
You lose them except for their reflexive capabilities. All voluntary control is lost.
Draw the anterior and posterior spinal arteries.
Draw what part of the spinal cord each artery serves.
Draw what happens if there is an infarction of the anterior spinal artery. Check the parts that are spared.
Draw out the end of the spinal cord with the cauda equina, conus medullaris, and filum terminale.
Draw out conus medullaris syndrome and what levels it affects.
Draw out epiconus syndrome and what levels it affects.
What kind of lesions is conus medullaris syndrome and epiconus syndrome?
A medial, CNS lesion
Draw out filum terminale syndrome
What happens in filum terminale syndrome?
the filum terminale become thickened and shrinks, pulling on the spinal cord
Draw out cauda equina syndrome.
Now we go into detail about all the lower spinal cord lesions!
ok!
What layer of meninges is the filum terminale made from and what is it's normal function?
It is made from a thickening of pia mater and works to anchor the spinal cord to the outer meninges below it.
What is the main pathology causing filum temrinale syndrome?
undue traction of the lower spinal cord
What does the filum terminale stick to in FT syndrome?
posteriorly to the sacrum
What kinds of functions is the lower spinal cord responsible for?
sphincter control and leg/foot muscles
What are the 3 symptoms of filum terminale syndrome?
1. incontinence from weak sphincters
2. bilateral trouble with gait control
3. bilarteral foot deformities
Why do you have foot deformities?
you would have loss of tone from LMN disturbance and thus deformity
What are three things that can cause conus medullaris syndrome?
Anything that presses against it.
1. Local tumor
2. Metastatic tumor
3. Hemorrhage
What sections of the sacral spinal cord give off PS nerves?
S2, S3, and S4
What organs do the sacral PS nerves control?
lower part of GI tract and the urinary system
What extra sx could males get with caudal equina syndrome?
impotence
Would you still have urinary and bowel reflexes intact? Why?
No, there would be complete paralysis because the LMN's are affected here.
What sensations would you lose in conus medullaris syndrome? What is this pattern called.
Saddle anesthesia- you lose all the ones that come through these roots so around the anus and genital area.
What is the cauda equina exactly? Does it include the spinal cord?
No. It is the collection of nerves that travel down from the end of the spinal cord in order to exit at their spinal levels.
What is the developmental reason for us having cauda equina?
our spinal cord stops lengthening at age 4, but our spinal column keeps on going and drags the spinal roots at the bottom with it.
Which spinal cord segments innervate the lower limb?
L2-S3
What is additionally lost in epiconus syndrome that is spared in conus medullaris syndrome?
loss of function and sensation to the lower legs.
What is spared in epiconus syndrome that is lost in conus medullaris syndrome? Why?
Reflexive control of bowels and bladder because the LMN's in the conus medullaris are spared.
What do the reflexes of the bowel and bladder do?
They empty those spaces when they are full.
What will happen to the tone of the sphincters in epiconus syndrome?
they will be spastic.
What are the two big causes of cauda equina syndrome? Show a pic!
tumor or disc herniation/slip
tumor or disc herniation/slip
So what is the main difference between cauda equina and all the other lower spinal cord disturbances?
It affects only one side whereas the others were all bilateral.
How does cauda equina progress?
Just like any other nerve root disturbance except to the legs.
short term- root irritation (spasticity and hyperesthesia)
long term- degeneration (flacidity and loss of sensation)
Are sphincters affected in unilateral lesions? Why?
No because they are rings that don't control sides separately.
Draw out which body parts are affected by each lower spinal lesion.
What does vitamin B12 do for the nervous system?
Aids in the myelination of spinal axons.
So which tracts would be affected in vitamin B12 deficiency?
the most heavily myelinated ones
1. dorsal column
2. motor tracts
What is the syndrome cause by vitamin B12 called?
Subacute combined degeneration
Why is it called "combined"?
both sensory and motor tracts are affected
Can other things cause subacute combined degeneration?
Yes, but vitamin B12 deficiency is the most common
Draw out and label all the tracts in the transection of the spinal cord.
Which tracts will suffer in subacute combined degeneration?
All of them, but especially the most myelinated (the dorsal column)
Will you have hypereflexia or hyporeflexia in subacute combined degeneration?
hypereflexia because you lose the upper motor neurons
does this kind of B12 deficiency happen gradually or suddenly? WHy?
Gradually because it is a nutritional deficit so sx get progressively worse
What other disease is subacute combined deficiency usually associated with?
pernicious anemia
Fredreich's Ataxia
Why does this manifest in ataxia rather than dystaxia?
because all cerebellar communication with the legs is cut off. (different than when just one cerebellar path is disrupted)
How does one usually get Fredreich's ataxia?
it is inherited
What is the pattern of inheritance of Freidreich's ataxia?
autosomal recessive
What gene is affected in Friedrich's ataxia?
frataxin: we're not really sure what it does though!
What is the inherited mutation in the frataxin gene?
Way too many GAA repeats in the gene
What is significant about the prevalence of Fredrich's ataxia?
It is the most common type of inherited ataxia.
What does not having the frataxin protein do to the cerebellar tracts?
it reduces their lifespan
What disease does expansion of the central canal usually cause?
syringomyelia
Breakdown syringo-myelia.
syringo- anything that has a cavity (like a syringe)
myelia- spinal cord

a problem with the cavity of the spinal cord (central canal)
Draw the first thing to be hit by syringomyelia.
What is the pathological cause of syringomyelia?
There is a cyst or dilation of the central canal
What level of the spinal cord is most often affected with syringomyelia?
The cervical region
What sensations are lost from which body parts in early syringomyelia?
pain and temperature from the upper limbs
What are the early clinical symptoms of someone with syringomyelia?
lack of pain in arms and also burns on fingers from not being able to feel high temperatures.
After affecting the anterior white commissure, show where will the central canal expand next.
What sx will develop when the central canal expands into the anterior horn?
flacidity of upper limbs
After affecting the anterior horns, show where will the central canal expand next.
What sx will develop when the central canal expands into the lateral columns?
UMN type disturbances below that level (lower limb)
So what are some classic sx of the three stages of progression of syringomyelia?
1. burns in fingers/loss of pain in "shawl area"
2. weakness in arms in shawl area
3. spasticity of lower limbs
What is the symptom if syringomyelia happens at T1?
You can get horner's syndrome bilaterally
What stage of the progression would the horner's syndrome come in? Why?
before the lower leg spasticity because the lateral horn cells for the S neurons is more medial than the motor columns.
What does the disease become if it ascends up into the brainstem? What nerves are affected now?
syringobulbia affecting the cranial nerves.
What brain malformation is associated with syringomyelia? Why?
Arnold Chiari malformation, which is a herniation of the cerebellum that cuts off CSF drainage from the ventricles, causing accumulation in the central canal.
Show a picture of arnold-chiari malformation
What are the three types of pathologies that result in LMN disorder at the cervical region and UMN disorder below?
1. trauma
2. cervical spondylosis
3. syringomyelia
How can you clinically tell syringomyelia apart from the others? Why is this?
there is no pain because it originates from the inside and doesn't irritate the roots.
What is the most common type of central demyelinating disease in youth?
multiple sclerosis
What is a geographical risk factor for MS?
living or moving further away from the equator
Why do we think that moving farther from the equator increases risk of MS?
Your immune system may be working harder in the cold weather.
What age group is most at risk for MS? Why?
ages 20-50 because they have the strongest immune systems.
What is the cause of the sclerosis in MS?
inflammation of the CNS that heal over to scar and demyelinate
What is the temporal profile of MS?
It can happen anytime and keep producing new patches
Which part of the CNS is affected?
Any part of the brain or spinal cord that is white matter.
Is MS always attacking the CNS?
No, it recurrs forever though so you will get worse in spurts.
What is dissociative anesthesia?
when you have one loss of sensation in one part of the body and another type in another part of the body.
What is the classic disease that causes dissociative anesthesia?
brown sequard syndrome
Do we normally carry treponema pallidum?
Yes, but it is non pathogenic
Where is treponema pallidum normally in our bodies?
In our gums
When is treponema pallidum pathogenic?
When it is sexually transmitted
What is primary syphilus like clinically?
there is an ulcer at the site of infection as well as enlargement of the lymph nodes there because that's where the bacteria travels
What is secondary syphilus like pathologically?
the pathogen goes into the blood
What is secondary syphilus like clinically?
You get lesions in the hands and feet.
Flu-like symptoms
When does tertiary syphilis crop up?
after years
What does tertiary syphilis do to the nervous system? Where does it start and where does it migrate?
starts infecting the dorsal root which can migrate to the dorsal horns and dorsal column. Then it can affect the spinocerebellar tracts.
What is this nervous infection from tertiary syphilis from called?
Tabes Dorsalis
How does Tabes Dorsalis present in short term and long term?
pain in short term
loss of sensation in long term
What does the root spondyl- mean?
A joint of the backbone; a vertebra
Show a picture of Tabes Dorsalis as a spinal cord transection.