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55 Cards in this Set
- Front
- Back
What are the three disturbances associated with spinal cord lesions?
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Sensory
Motor Visceral |
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What are the two critical aspects of clinical signs?
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Longitudinal localization (lesion level)
Transverse location (Cells and tracts affected |
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Define: The cutaneous area innervated by the cells and fibers from a single dorsal root ganglion (DRG).
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Dermatome
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What is the effect of a single dorsal root removal?
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Rarely any detectable sensory loss because of dermatome overlap
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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. |
Multple contiguous dorsal roots
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Do dermatomes overlap?
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Yes
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What is the pattern of degeneration at the level of lesions for a dorsal rhizotomy at the level of lesion?
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Anterograde degeneration: dorsal root fibers, 1 degree sensory fibers within cord collateral to motoneurons, chromatolysis in DRG
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What is the effect of a dorsal root ganglion rhizotomy above the level of the lesion?
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Ascending primary sensory tract fiber bundle degeneration.
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Lower or Upper: Anterior Horn cells (lamina IX)
Axons directly innervate skeletal muscle |
Lower (alpha) MOtor neurons
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Upper/Lower? Project from heihger brain centers to spinal cord to ingluence activity of lower motor neurons
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Upper Motor Neurons
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True/False: Damage to upper and lower motor neurons produce different clinical signs?
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true
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Lesion of upper or lower motor neurons: Patient presents with:
Paralysis (Flaccid) Hypotonia Reduced or absent myotatic reflexes (DTRs) Fasciculations Rapid Muscle atrophy |
Lower Motor Neuron Signs
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Define: Random motor neuron firing sometimes in response to damage.
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Fasciculations
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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) |
Upper motor neuron Clinical sign
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Upper/Lower motor neurons are both damaged what clinical signs would you see?
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Clinical signs for the lower motor neurons
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What type of lesion causes paralysis of lower motor neuron type dorsal or ventral rhizotomy?
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Ventral rhizotomy
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What are the two damages associated with a single ventral root lesion?
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Weakness
Reduced DTRs |
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What are the four effects of multiple ventral roots rhizotomy?
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Flaccid Paralysis
Loss of DTRs Rapid atrophy Autonomic damage |
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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 |
Horner's syndrome
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What levels are affected with a ventral root rhizotomy for the preganglionic sympathetic fibers resulting in Horner's syndrome?
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T1-T4
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Define: Produces immediate, complete loss of all neural activity caudal to the lesion?
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Spinal shock
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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 |
Spinal shock
Babinski Spasticity in flexor muscles Extensor muscle tone predominates |
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Brown-Sequard syndrome is also known as a ______ ________?
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Spinal hemisection
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List the 5 damaged structres of the Brown Sequard syndrome.
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Posterior column
Lateral Cortciospinal tract ALSTS ANterior Horn Anterior White commissure |
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What are the ipsilateral deficits of the Brown Sequard syndrome?
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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) |
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What are the contralateral deficits associated wtih Brown-Sequard Syndrome (spinal hemisection)?
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Loss of pain and thermal sense AT AND BELOW the lesion levle (light touch is usually intact) due to ALSTS damage
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How is poliomyelitis passed?
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Enterovirus (fecal-oral route)
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What does poliomyelitis attack?
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The lower motor neurons of anterior horn
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Is the loss of motor neurons with polio symmetric?
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Rarely symmetrically
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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? |
Amyotrophic Lateral Sclerosis (lou Gehrig's Disease)
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What are the clnical signs of Lou Gehrig's disease?
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Can vary because they can invole both lower and upper motor neurons and can begin in either. Early UMN and lower LMN generally.
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What is the agent responsible for Tabes Dorsalis (locomoter ataxia)?
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CNS form of syphilic (tertiary syphilic)
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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
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Tabes Dorsalis (locomotor ataxia)
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What is ataxia?
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Uncoordinated movements
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Define: when you ask the patient to put their feet togehter and close their eye, they fall over.
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Positive Romberg sign
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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 |
Tabes Dorsalis (locomotor ataxia)
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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.
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Syringomyelia
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Define: Selective loss of pain an dhtermal sense with preseneration of tactile sense.
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Sensory dissociation
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What is central gliosis and cavitation in regions of the spinal cord associated wtih Syringomyelia?
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The central canal becomes bigger
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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 |
Syringomyelia
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What is gliosis?
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Glial scars
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What causes combined system disease?
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Vitamn B12 deficiency
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What causes pernicious anemia?
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Lack of intrinsic factor to absorb B12
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What is another name for combined system disease?
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Subacute combined degeneration
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What is the pathology associated with Combined system disease?
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Bilateral degeneration in the posterior columns (mainly fasciculus gracilis) an din the lateral columns (CST), greatest in lumbosacral segments.
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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 |
Combine System disease
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What are the two tracts involved?
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Posterior columns
Lateral columns |
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What supplies the anterior two thirds of the spinal cord?
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Anterior spinal artery
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What is the pathology of the Anterior spinal artery syndrome?
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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.
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What are the three effects of the anterior spinal artery?
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Bilateral spastic paralysis
Bilateral loss of pain & thermal sense below level of lesion Flaccid paralysis (LMN) at level of lesion |
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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.
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Guillain-Barre
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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. |
Guillain-Barre
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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.
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Guillain-Barre
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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.
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Guillain-Barre syndrome (GBS or acute idiopathic polyneuritis)
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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. |
Guillain-Barre' Syndrome (GBS or aacute idiopathic polyneuritis).
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