Spinal Cord Dysfunction

Question 1

What type of lesion is this?

• affects function of a single cord segment
• interfere with neural function only at the level of the lesion

Answer 1

Segmental function

Question 2

What type of lesion is this?

• tracts conveying ascending & descending information
• result in loss of function below the level of the lesion

Answer 2

Vertical tract function

Question 3

Focal lesion involving dorsal or ventral root or a spinal nerve also results in segmental signs due to what?

Answer 3

Interruption of sensory and motor signals to and from a spinal segment

Question 4

This lesion interferes with sensory function in a spinal segment causing abnormal sensation or loss of sensation in a dermatomal distribution

Answer 4

Dorsal root, spinal nerve or dorsal horn in segmental dysfunction

Question 5

This lesion interferes with LMN functions
signs of LMN dsyfunction: flaccid weakness, atrophy, fibrilation, & fasciculation

Answer 5

Ventral root, ventral horn or spinal nerve in segmental dysfunction

Question 6

If LMN signs occur in a mytomal pattern where is the lesion?

Answer 6

Spinal region

Question 7

What sign helps differentiate spinal region from peripheral nerve lesions?

Answer 7

Paraspinal involvment

Question 8

What is absent if sensory or motor fibers contributing to reflex circuit is damaged?

Answer 8

Reflex is absent

Question 9

What are the segmental signs of segmental dysfunction?

Answer 9

• abnormal or lost sensation in dermatome distribution &/or LMN signs in myotome distribution

Question 10

Lesions here result in loss of communication to &/or from spinal levels below the lesion

Answer 10

Vertical Tract Dysfunction

Question 11

What are the ascending tract signs of vertical tract dysfunction?

Answer 11

• ipsilateral if dorsal column is interrupted
• contralateral if spinothalamic tracts are involved

Question 12

What are autonomic tract signs that take place during a vertical tract dysfunction?

Answer 12

problems with regulation of BP, sweating, & bladder and bowel control

Question 13

Lesions that affect UMN in vertical tract dysfunction cause what signs?

Answer 13

• paralysis
• spasticity
• muscle hypertonia

Question 14

What are ascending tract signs of vertical dysfunction?

Answer 14

decrease or loss of somatosensation

Question 15

Is the following peripheral region or spinal region lesion?

Deficits in distribution of peripheral nerve distrbution

Answer 15

Peripheral region

Question 16

What lesion causing the following?

• decrease or loss of muscle power in peripheral nerve distribution
• no vertical tract signs
• decreased or lost phasic stretch reflex

Answer 16

Peripheral nerve lesion

Question 17

Is the following spinal region segmental or vertical tract signs?

spinal segment, nerve root &/or spinal nerve is compressed
- alterted or loss sensation in dermatome
- lost muscle power in myotome
- decreased or lost phasic stretch reflex

Answer 17

Spinal region segmental signs

Question 18

Is the following spinal region segmental or vertical tract signs?

• altered or lost sensation below level of lesion
• altered or lost descending control of BP, pelvic visera & thermoregulation
• UMN signs: decrease or loss of muscle power, spasticity & muscle hypertonia
• Lat corticospinal: positive Babinski’s sign & clonus

Answer 18

Spinal region vertical tract signs

Question 19

What is the following a defintion of?

Collection of signs and symptoms that consistently occur together & do not indicate a specific cause

Answer 19

Syndrome

Question 20

Anterior cord syndrome is caused by what?

Answer 20

Blood flow disruption in anterior spinal artery

Question 21

In anterior cord syndrome ischemai damages anterior 2/3 of the spinal cord affecting what?

Answer 21

• ascending spinothalamic tracts
• descending UMN’s
• cell bodies of LMN’s

Question 22

Anterior cord syndrome interfers with what?

Answer 22

nociceptive & temp. sensation and motor control

Question 23

In the anterior cord syndrome there is what type of loss?

Answer 23

• incomplete to complete loss of motor function (anterior horns & lat. corticospinal tract)
• incomplete to complete loss of pain, temperature, & crude touch (anterolateral system)

Question 24

Why are the DCML tracts not affecting in the anterior cord syndrome?

Answer 24

B/c they are located in the posterior spinal cord

Question 25

Where does the central cord syndrome occur?

Answer 25

cervical level resulting from trauma

Question 26

In the central cord syndrome there is greater weakness in UE than LE due to what?

Answer 26

Somatotopic organization of nerve fibers within tract & proximity to central portion of the cord

Question 27

# Is the following small or large lesion in central cord syndrome? Loss of nociceptive & temperature information at the level of the lesion b/c spinothalmic fibers crossing midline are interrupted

Answer 27

Small lesion

Question 28

# Is the following small or large lesion in central cord syndrome? impaired upper limb motor function due to medial location of upper limb fibers in the lat. corticospinal tract & loss of nociceptive & temp information at the level of the lesion

Answer 28

Large lesion

Question 28

What is the Brown-sequard syndrome caused by?

Answer 28

Hemisection of the spinal cord

Question 29

In the brown-sequard syndrome segmental losses are what? and include what type of loss?

Answer 29

- ipsilateral - loss of LMN's & all sensations & ipsilatral flaccid paralysis (ant. horn) & ipsilateral loss of all sensation (dorsal root and post. horn)

Question 30

In brown-sequard syndrome below the level of lesion there is ipsilateral loss of what?

Answer 30

- voluntary motor control (lat. corticospinal tract), conscious proprioception & light touch (dorsal column)

Question 31

In brown-sequard syndrome below the level of lesion there is contralateral loss of what?

Answer 31

loss of nocicpetive, temperature, & crude touch sensation (anteroloateral system: spinothalamic tract)

Question 32

What causes cauda equina syndrome?

Answer 32

compression &/or irritation of spinal nerve roots below L2 vertebral level

Question 33

What are common causes of cauda equina syndrome?

Answer 33

- herniated disks - vertebral fracture - tumor

Question 34

In cauda equina syndrome the 'saddle area' is usually affected. What is this innervated by?

Answer 34

S2-5

Question 35

What are the signs of cauda equina syndrome? (3 signs)

Answer 35

- urine &/or stool retention or incontincence - paresis or paralysis - impariment of nerver roots cause decrase or loss of reflexes

Question 36

What is the tethered cord syndrome caused by?

Answer 36

spinal cord becomes attached to surrounding structures during early development

Question 37

What are some causes that lead to tethered cord syndrome?

Answer 37

- scar tissue - lipoma - abnormal development - stretch injury damages &/or cauda equina

Question 38

When do signs and symptoms of tethered cord syndrome appear?

Answer 38

Growth spurt of children

Question 39

What are the symptoms of tethered cord syndrome? (6)

Answer 39

- LB and lower limb pain - difficulty walking - excessive lordosis - scoliosis - problems with bowel/bladder control - foot deformities

Question 40

In tethered cord syndrome LMN (weakness, flaccidity) signs occur if what is stretched?

Answer 40

Ant. cauda equina is stretched

Question 41

In tethered cord syndrome UMN signs (abnormal reflexes, paresis, skeletal muscle changes) occur if what is stretched?

Answer 41

Spinal cord is stretched

Question 42

Signs that tethered cord is associated with spina bifida, spina bifida myelomeningocele occur at what levels?

Answer 42

L4, L5, & S1

Question 43

What damages the reflexive bladder emptying circuit?

Answer 43

complete lesions involving S2-4 levels or assoicated roots in cauda equina damage

Question 44

Reflexive bladder control results in what?

Answer 44

Flaccid paralyzed bladder

Question 45

What results in hypertonic, hyperreflexia bladder with reduced capacity?

Answer 45

complete lesions above sacral spinal cord interrupts descending axons

Question 46

# What type of neurogenic bladder symptoms are the following? intermittent bladder contractions result in urine leakage sphincter spasm during voiding can prevent complete emptying of bladder

Answer 46

Hypertonic or reflexive bladder

Question 47

# What type of neurogenic bladder symptoms are the following? overflow incontinence results in involuntary release due to overly full bladder

Answer 47

Flaccid bladder

Question 48

Person with lesion above sacral cord is unaware of what?

Answer 48

- rectal stretch - no voluntary control of sphincters

Question 49

What can rectal stretch elicit?

Answer 49

reflexive emptying of lower bowel b/c reflexive lower bowel emptying circuit is intact

Question 50

# Where is this lesion for male sexual function? - loss of psychogenic erection; genital sensation absent - reflexive erection possible - if lumbosacral cord intact --> reflexive ejaculation possible

Answer 50

Above T12 with intact sacral reflex circuits

Question 51

# Where is this lesion for male sexual function? - most likely has normal sexual function - genital sensation is absent

Answer 51

Between L1 and S2 with intact sacral reflex circuits

Question 52

# Where is this lesion for male sexual function? - impotence - genital sensation absent

Answer 52

lesion of S2-4 reflex circuit