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Nervous System: Unit II > Clinical Evaluation of Spinal Cord > Flashcards

Clinical Evaluation of Spinal Cord Flashcards

1
Q

Myelopathy definition

A

Disorder resulting in spinal cord dysfunction

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2
Q

Nerve root definition

A

Combined sensory and motor rami of the spinal cord (e.g. L5)

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3
Q

Spinal tracts definition

A

Axons that travel in the spinal cord to relay information. (e.g. corticospinal tract).

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4
Q

Dermatome definition

A

Cutaneous area served by an individual sensory root.

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5
Q

Myotome definition

A

Muscles innervated by an individual motor root.

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6
Q

Radiculopathy definition

A

Sensory and/or motor dysfunction due to injury to a nerve root.

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7
Q

Intervertebral foramen definition

A

Opening formed by 2 adjacent vertebral bodies through which the nerve roots travel.

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8
Q

Paresthesia definition

A

An abnormal sensation, can include burning, pricking, tickling, or tingling

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9
Q

Dysesthesia definition

A

Impairment of sensation short of anesthesia

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10
Q

Hyperesthesia definition

A

Abnormal acuteness of sensitivity to touch, pain, or other sensory stimuli

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11
Q

Step-by-step approach to clinical evaluation of the spinal cord

A
  1. sx from hx and PE
  2. define UMN vs. LMN
  3. define tracts involved
  4. define anatomic sites involved
  5. differential dx
  6. workup
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12
Q

Spinothalamic tract: fxn and crossing point

A
  • -Function: Sensory modalities of pain (pinprick) and temperature-cold/hot
  • -Cross: 2-3 segments above root entry level in anterior spinal cord
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13
Q

Posterior/Dorsal Column: fxn and crossing point

A
  • -Function: Sensory modalities of vibration, position, and 2-pt discrim
  • -Cross: medulla (brain stem)
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14
Q

Corticospinal tract: fxn and crossing point

A
  • -Function: Motor function
  • -Cross: Lower medulla (brain stem)
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15
Q

Nerve root levels

A
  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral
  • 1 coccyx
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16
Q

Conus medullaris level/definition

A
  • located @~L1-L2 vertebrae where the spinal cord ends
  • made up of S2-S5 spinal cord segments
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17
Q

Cauda equina definition

A
  • formed by LS roots
  • begins @ ~L1/L2 where the
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18
Q

Exit of nerve roots along spinal column

A
  • -C1, 2, 3, 4, 5, 6, 7 roots exit above same numbered vertebra (e.g. C7 exits above C7).
  • -C8 below C7 and all other roots exit below same numbered vertebra (e.g. T1 exits below T1).
19
Q

Vertebral body vs. underlying cord segment @ cervical spine

A
  • Upper cervical: vertebra # overlies same cord segment # (C2 bone, C2 cord)
  • Lower cervical: vertebra # overlies cord segment # + 1 (C6 bone, C7 cord)
20
Q

Vertebral body vs. underlying cord segment @ thoracic & lumbar spine

A
  • Upper thoracic: vertebra # overlies cord segment # + 2 (T4 bone, T6 cord)
  • Lower thoracic/lumbar: vertebra # overlies cord segment # +2- 3 (T 11bone, L1-2 cord)
  • Lower edge of the L1 vertebral body overlies the cord tip (conus medullaris)
21
Q

UMN injuries

A
  • Corticospinal tract lesions in the spinal cord affect DTRs (deep tendon reflexes), strength, bulk, and tone in muscles AT or BELOW lesion on SAME SIDE of lesion.
  • bulk: normal or disuse atrophy
  • fasciculations: none
  • tone: increased tone/spasticity
  • DTR: hyperreflexia
  • Plantar response: increased; extensor or babinski sign
22
Q

DTRs of the arm and leg

A
  • Arm: Biceps (C5, C6), Brachioradialis (C6, C7), Triceps (C6,C7), Fingers (C8).
  • Leg: Quadriceps (L3, L4), Gastrocnemius (Achilles reflex, S1).
23
Q

LMN injury characteristics

A
  • bulk: decreased; significant atrophy
  • fasciculations: present
  • tone: decreased; flaccid
  • DTRs: decreased or absent
  • plantar response: decreased; flexor
24
Q

Radiculopathy: sx, exam findings, localization

A
  • “spinal root syndrome”
  • Pain:
    • quality is variable: “shooting,” “burning,” “tingling,” “numb.”
    • often radiates into a dermatome or myotome.
  • Exam: possible LMN signs (reduced or absent reflexes +/- weakness).
  • Localization: determine which root the abnormal muscles(s) and dermatome(s) have in common.
25
Q

Radiculopathy: exacerbating and relieving factors, common causes

A
  • Exacerbation by Exam: Neck flexion/extension/rotation, shoulder movements, cough, etc.
  • Relieving Factors: Rest, immobilization, graded therapy, NSAIDS +/- muscle relaxants.
  • Common causes: Compression by degenerative joint disease (causing bony proliferation) or herniated disc near intervertebral foramen.
26
Q

Lherrmitte’s sign

A
  • Neck flexion ==> “electric shock” sensation down the back and/or into arms.
  • Attributed to posterior column disease
    • MS, disc, B12 deficiency, mass
27
Q

Spinal cord pain syndromes

A
  1. Complete Cord Transection
  2. Central Lesions
  3. Posterior Column Syndrome
  4. Combined Anterior Horn Cell-Pyramidal Tract Syndrome
  5. Brown-Sequard (Hemi-Section)
  6. Posterolateral Column Syndrome
  7. Anterior Horn Cell Syndrome
  8. Anterior Spinal Artery Occlusion
  9. Pyramidal Tract Syndrome
  10. Myelpathy w/Radiculopathy
28
Q

Complete Cord Transection: tracts & deficits

A
  • Tracts: All ascending sensory & descending motor/autonomic tracts.
  • Deficit: Sensory + motor levels below lesion; may also have root signs at site.
  • Note: Spinal shock followed by UMN signs.
29
Q

Central Lesions: tracts & deficits

A
  • Tracts: Initially involve crossing ST
  • E.g.s: Syringomyelia (fluid-filled cavity in cord), ependymomas, cord contusion.
  • Deficit: PP/Temp loss at level of lesion, with sparing of position sensation.
  • Note: Cape-like distribution if in C-spine.
30
Q

Posterior Column Syndrome: tracts, e.g., deficits

A
  • Tracts: PC
  • E.g.s. Tabes dorsalis (form of neurosyphilis)
  • Deficit: Bilateral loss of position & vibration sensation.
31
Q

Combined Anterior Horn Cell-Pyramidal Tract Syndrome: tracts, e.g., deficits

A
  • Tracts: CS and LMN cells in cord.
  • E.g.s: Amyotrophic lateral sclerosis
  • Deficit: Loss of bilateral strength.
  • Note: Fasciculations, atrophy, increased or decreased DTR, normal sensation.
32
Q

Brown-Sequard (hemi-section): tracts, e.g., deficits

A
  • Tracts: Crossed ST + uncrossed PC + crossed CS
  • E.g.: Compression by herniated discs, tumor, extramedullary abscess, etc.
  • Deficit: Below lesion, loss of:
    • CL PP/Temp
    • IL Position
    • IL strength.
33
Q

Posterolateral Column Syndrome: tracts, e.g., deficits

A
  • Tracts: PC + CS
  • E.g.: B12 deficiency (aka subacute combined degeneration)
  • Deficit: Bilateral loss of position & vibration, and strength.
34
Q

Anterior Horn Cell Syndrome: tracts, e.g., deficits

A
  • Tracts: None - lower motor neuron (cell).
  • E.g.: Spinal muscular atrophy, polio virus
  • Deficit: Bilateral loss of strength.
  • Note: Fasciculations, decreased tone + decreased DTRs with sparing of all sensory tracts and bladder functions.
35
Q

Anterior Spinal Artery Occlusion: tracts, e.g., deficits

A
  • Tracts: ST + CS
  • E.g.: Anterior spinal artery occlusion.
  • Deficit: Bilateral loss of strength + PP/Temp, with sparing position sense.
36
Q

Pyramidal Tract Syndrome: tracts, e.g., deficits

A
  • Tracts: CS
  • E.g.: Primary lateral sclerosis.
  • Deficit: Bilateral UMN weakness with spastic gait, increased DTRs, but complete sparing of all sensory tracts and bladder function.
37
Q

Myelopathy with Radicolpathy: tracts, e.g., deficits

A
  • Tracts: Any or all 3 tracts (esp. CS)
  • E.g.s: Cervical spinal stenosis, may be congenital or degenerative.
  • Deficit: Bilateral UMN syndrome with spastic gait, increased DTRs + IL or CL root signs + possible bladder dysfunction.
38
Q

Signs/sx of conus medullaris (S2-S5) syndrome

A
  • -Late pain in thighs & buttocks
  • -Pelvic floor muscle weakness
  • -SYMMETRIC “saddle” anesthesia
  • -EARLY bladder dysfunction
  • -EARLY bowel & sexual dysfunction
39
Q

Signs/sx of cauda equina (L1-L5 roots) syndrome

A
  • -EARLY root pain radiating to legs
  • -Leg weakness & decreased DTRs (LMN)
  • -Patchy, asymmetric “saddle” numb.
  • -Late bladder dysfunction
  • -Late bowel & sexual dysfunction
40
Q

Neuronal control of micturition

A
  • most micturition related axons run in or along the LCST
  • brain/brainstem send axons through spinal cord ==> preganglionic parasympathetic neurons @ S2, S3, S4
  • pregang parasym axons ==> ventral roots of S2, S3, S4 ==> postganglionic parasympathetic neruons @ ganglia near bladder
  • postgang parasym innervate detrussor
  • pregang sympathetic neurons @ T11-L1 => contraction of internal urethral sphincter
  • external sphincter = voluntary
    • frontal cortex ==> descending inputs
    • alpha motorneurons @ anterior horn from S3-S4
41
Q

Spinal lesion impact on micturition

A
  • @ sacral level:
    • if sensory is intact ==> urgency w/out good detrussor contraction
    • ==> ~LMN sx = weakness, atrophy, hyporeflexia
  • above sacral level:
    • bladder fxn is only affected w/bilateral lesion
    • ~UMN sx = initially flaccid bladder ==> spastic bladder
42
Q

Dematome @ nipple line, xyphoid, umbilicus

A
  • T4 = nipple line
  • T6 = xyphoid
  • T10 = umbilicus
43
Q

Sensory territory of C5, C6, C7

A
  • C5 = @ level of clavicles; extends lateral and ventral along arms
  • C6 = most lateral portion of arms
  • C7 = middle of dorsal aspect of arms + middle palm and fingers 2,3
44
Q

Sensory territories of L4, L5, S1

A
  • L4/L5/S1 = foot
    • most of ventral lower leg + lateral part of upper leg

Nervous System: Unit II (19 decks)

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