Neuro shelf - spinal cord

  1. anterior horn of grey matter
    contains alpha motor neurons and motor fibers innervating skeletal muscles
  2. path of corticospinal tract
    descends from the cortex and crosses midline in the medulla, then synapses on alpha motor neurons in anterior horm. Runs laterally in cord.
  3. path of dorsal columns
    ipsilateral to origin, then crosses in brainstem
  4. path of anterolateral spinothalamic tracts
    begins in peripheral nerves (pain and temp), enters cord and synapses within 2 levels, then crosses and ascends contralaterally
  5. which spinal nerve contains no sensory fibers
  6. spinal cord ends at
  7. transection above C3-C5...
    respiratory insufficiency
  8. abdominal reflexes lost with lesions...
    above T6
  9. brown-sequard syndrome
    weakness and hyperreflexia ipsilateral to and below the lesion (corticospinal tract), impaired position sense below the lesion, loss of pain and temp perception below level of lesion but contralateral to lesion
  10. lesioins in central spinal cord
    affects spinothalamic tract fibers crossing at level of lesion

    deficits in pain and temp sensation bilaterally over several segments (cape-like). pain and temp affected byt NOT touch or position

    ex: syringomyelia - expansion of potential fluid space in center of spinal cord. May be associated with posterior skull and brain malformations such as Chiari malformations
  11. syphilis affects
    posterior columns (tabes dorsalis). B12 targets posterior columns also
  12. Cauda equina lesions
    wasing, weakness, and fasciculations in appropriately innervated muscles lumbrosacral region with pain. Sacral root dysfunction can cause bowel, bladder, and sexual dysfunction
  13. conus medullaris lesions
    upper motor neuron findings, radicular pain, bowel, bladder, and sexual dusfunction. If lesions are below the lumbar cord, may leave leg strength and reflexes intact while severely affecting bowel, bladder, and sexual function
  14. blood supply to the anterior 2/3 of cord
    anterior spinal artery
  15. caudal arterial supply to anterior spinal artery
    artery of adamkiewicz, entering the spinal cnal around L2
  16. dorsal columns supplied arterieally by
    plexus fed by segmental arteries from the aorta
  17. anterior spinal artery syndrome
    weakness below lesion, intense radicular pain, sphincter dysfunction, sensory loss but not position loss, thoracic cord is lease well perfused and most vulnerable. Systemic hypotension can lead ot watershed infarct affecting this area.
  18. to treat traumatic spinal cord compression
    high doses of steroids
  19. ALS
    due to mutation in the superoxide dismutase enzyme, leading to exitotoxin damage

    involve alpha motor neurons (lower motor) of anterior horm of spinal cord, leading weakness, faciculations, and wasting. Also involves lateral corticospinal tracts leading to weakness, spasticity, hyperreflexia, and Babinski signs

    No sensory deficits, eye movements unaffected.

    Tx: riluzole slows deterioration.

    Things that mimic ALS: stenosis of spinal canal (EMG testing), hereditary spastic paraparesis (HTLV-1 testing), severe nutritional deficiency.

    Things that affect alpha motor neurons but w/o spasticity or sensory deficits - spinal muscular atrophies
  20. Werdnig-Hoffmann disease
    SMA presenting in infancy - atrophy of anterior horn cells
  21. Chiari malformation
    downward protursion of the medulla, with or without cerebellum, through the foramen magnum
  22. Tethered cord syndrome
    hypertrophy of the filum terminale - pain and dysfunction of cord, especially at lower levels
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Neuro shelf - spinal cord