Spinal Cord Disorders

Question 1

C5, C6

Answer 1

deltoid, biceps

Question 2

C7, C8

Answer 2

Triceps

Question 3

C8, T1

Answer 3

Interossei, flexor digitorum

Question 4

L2,3,4

Answer 4

Iliopsoas(hip flexor), quadriceps

Question 5

L4,5

Answer 5

tibialis anterior (foot dorsiflexor)

Question 6

S1, S2

Answer 6

Gastrocnemius (foot plantar flexor)

Question 7

Upper motor neuron signs

Answer 7

1. severe weakness with mild atrophy
2. no fasciculations
3. increased spasticity
4. increased reflexes
5. clonus may be present
6. babinski may be present

Question 8

Lower motor neuron signs

Answer 8

1. severe atrophy with milder weakness
2. fasciculations may be present
3. decreased muscle tone
4. decreased reflexes
5. clonus never present
6. no babinski

Question 9

Radicular pain

Answer 9

lightning, stabbing, shooting or electric pain in the dermatomal distribution of a dorsal root

• Herpes zoster
• compression by an extramedullary lesion

Question 10

Which lesion has radicular pain extramedullary or intramedullary?

Answer 10

extramedullary

-intramedullary creates a more diffuse pain or none at all

Question 11

What does a suspended pattern of deficit with sacral sparing indicate?

Answer 11

intramedullary lesion within the spinal cord
-a lesion near the center of the cord will disrupt decussating spinothalamic fibers and perhaps the medial portions of the spinothalamic tract (sacral fibers are most lateral)

Question 12

What does a sensory deficit for pain and temp up to a level with sacral involvment indicate?

Answer 12

extramedullary lesion arising from outside the spinal cord and compressing it
(usually a tumor)

Question 13

Intramedullary lesion vs extramedullary lesion?

Answer 13

Intramedullary

• diffuse or no pain
• suspended sensory loss (crossing fibers)
• sacral sparing

Extramedullary

• radicular pain
• to a level or sacral
• absent sacral sparing

Question 14

What is transverse myelopathy?

What suggests what spinal cord level is involved?

Answer 14

complete or nearly complete lesion encompassing the cross-sectional extent of the spinal cord at one or a few adjacent levels

-spinal cord level involved is suggested by the dermatomal level of sensory loss and the presence of any lower motor neuron signs
(dermatome, lower motor neuron sign at level)
-upper motor neuron signs may be present in limbs innervated by lower motor neurons below the level of the cord lesion
(upper motor neuron sign, below level) –>in trauma upper motor neuron signs may not come until later (neurogenic shock)

Question 15

What are some causes of transverse myelopathy?

Answer 15

1. trauma
2. tumor (extramedullary lesion)
3. spinal stenosis(spinal cord compression)
4. viral infections
5. autoimmune demyelination- multiple sclerosis
6. transverse myelitis

Question 16

Brown-sequard syndrome

Answer 16

spinal cord hemisection

• contralateral deficit to pain and temperature
• ipsilateral deficit of vibration and position sense
• ipsilateral weakness (lower motor signs with destruction of anterior horn cells, and upper motor signs with corticospinal tract)

Question 17

what are causes of Brown-sequard syndrome?

Answer 17

1. trauma
2. extramedullary tumors
3. herniated discs with degenerative disease of the bony spine

Question 18

Syringomyelia

Answer 18

spinal cord lesion from a syrinx within the center of the spinal cord

• intramedullary lesion-primarily affects gray matter there
• usually cervical or thoracic spinal cord
• interrupts the decussating spinothalamic fibers there creating a pain and temperature deficit over those dermatomes but sparing sacral dermatomes
• suspended sensory level with sacral sparing (no matter how far it expands)
• shall
• if expanded:
  1. weakness if anterior horn cells or corticospinal tract are involved

Question 19

What are some causes of syringomyelia?

Answer 19

1. late residual of severe spinal cord injury
   - traumatic cervical spine hemorrhage reabsorbed leaving a syrinx in its place
2. intramedullary spinal cord tumors
3. impaired cerebrospinal flow-Chiari malformation (posterior fossa)

Question 20

Anterior spinal artery occlusion

Answer 20

lower thoracic or upper spinal cord usually
1. paraplegia with UMN signs in the lower limbs
2. thoracic level of sensory loss without sacral sparing to pain and temp
Normal vibration and position sense

• back pain or radicular pain are common initial symptoms
• occurs suddenly and progresses over hours

Question 21

Posterolateral syndrome or subacute combined degeneration

Answer 21

-Vitamin B 12 deficiency (HIV or Copper deficiency)
-demyelination and degeneration of the white matter usually at thoracic levels
-posterior and lateral columns
1. vibration and position sense are reduced or lost in lower limbs
—>unsteadiness when patient walks in dark or with eyes closed
2. spastic paraparesis from involvment of the corticospinal tract
(pain and temperature are not affected)

Question 22

ALS

Answer 22

motor neuron lesions in the cerebral cortex, brainstem and spinal cord
LMN developed in the upper limbs
UMN developed in lower limbs
Fasiculations-limbs, tongue, neck, trunk
Weakness focally with impaired speech or swallowing or asymmetrically as in one shoulder
-Sensory pathways are not affected, bowel and bladder remains normal, no radicular pain

Question 23

Tabes dorsalis

Answer 23

syphilis

1. lumbosacral dorsal roots become infected and inflamed–>severe radicular pains
2. degenerate–> impairment of vibration and position sense in the lower limbs
   - loss of all sensation in lower limbs where reflexes are lost ?-

strength remains intact-motor neurons and corticospinal tract spared