Spinal Cord - CNS الجزء الثالث أناتومي الـ

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Questions and Answers

Which of the following accurately describes the vertebral level at which the adult spinal cord typically terminates?

  • Upper border of S1
  • Lower border of L1 (correct)
  • Lower border of L3
  • Upper border of L2

The lumbar cistern is a significant anatomical space created by the dilatation of which specific structure?

  • Epidural space
  • Subdural space
  • Subarachnoid space (correct)
  • Pia mater

Which artery directly supplies the anterior two-thirds of the spinal cord with blood?

  • Vertebral artery
  • Posterior spinal artery
  • Radicular artery
  • Anterior spinal artery (correct)

What is the primary function of the radicular arteries in the context of spinal cord blood supply?

<p>Provide the main blood supply to the lower part of the spinal cord (C)</p> Signup and view all the answers

With respect to the vertebral column, where do the cervical spinal nerves typically emerge?

<p>Above the corresponding vertebrae, except for the eighth cervical nerve (B)</p> Signup and view all the answers

Which structures are contained within the lumbar cistern?

<p>Cerebrospinal fluid and filum terminale (B)</p> Signup and view all the answers

What is the outermost meningeal layer of the spinal cord, and at what vertebral level does it terminate?

<p>Dura mater, S2 (C)</p> Signup and view all the answers

Which of the following is NOT a function associated with the lumbar cistern?

<p>Anchoring the spinal cord to the coccyx (C)</p> Signup and view all the answers

Which spinal cord enlargement corresponds to the origin of the nerves that form the brachial plexus?

<p>Cervical enlargement (D)</p> Signup and view all the answers

The anterior median fissure and posterior median septum divide the spinal cord into what?

<p>Left and right halves (B)</p> Signup and view all the answers

What type of neurons are primarily found in the ventral horn of the spinal cord?

<p>Motor neurons (B)</p> Signup and view all the answers

In which region of the spinal cord is the lateral horn located, and what type of nerve cells does it contain?

<p>Thoraco-lumbar; sympathetic (A)</p> Signup and view all the answers

Which area of the dorsal horn is responsible for mediating pain and temperature sensations?

<p>Substantia gelatinosa (D)</p> Signup and view all the answers

Which of the following is a characteristic of the 'white matter' in the spinal cord?

<p>Organized into ventral, lateral, and dorsal columns (B)</p> Signup and view all the answers

What is the origin and termination of the filum terminale?

<p>From conus medullaris to coccyx (C)</p> Signup and view all the answers

Which of the following is NOT a function of CSF?

<p>Maintaining blood pressure (A)</p> Signup and view all the answers

Where in the spinal cord does the denticulate ligament extend from and to?

<p>Pia to dura (C)</p> Signup and view all the answers

Which of the following arteries is NOT a radicular artery arising from the spinal cord?

<p>Anterior spinal artery (C)</p> Signup and view all the answers

Which of the following is the middle layer of the meniges?

<p>Arachnoid (C)</p> Signup and view all the answers

Which of the spinal cord segments contains the Clark's nucleus?

<p>C8-&gt;L2 (A)</p> Signup and view all the answers

How does the termination point of the spinal cord in newborns differ from its termination point in adults?

<p>In newborns, the spinal cord ends at the level of L3, whereas in adults, it ascends to terminate at the lower border of L1. (D)</p> Signup and view all the answers

A patient undergoing a lumbar puncture experiences referred pain in the lower limb. Which anatomical structure's proximity to the spinal needle is most likely responsible for this phenomenon?

<p>Cauda equina (D)</p> Signup and view all the answers

Following a traumatic injury, a patient exhibits loss of pain and temperature sensation on one side of the body, while motor function and proprioception remain intact. Which spinal cord tract is most likely affected?

<p>Lateral spinothalamic tract (C)</p> Signup and view all the answers

A lesion in the spinal cord affects the anterior spinal artery. Which of the following functional deficits would most likely be observed?

<p>Weakness or paralysis (A)</p> Signup and view all the answers

What is the functional significance of the cervical and lumbar enlargements of the spinal cord?

<p>They correspond to the innervation of the upper and lower limbs, respectively. (D)</p> Signup and view all the answers

A patient presents with an inability to consciously perceive proprioceptive information from their lower limb. Assuming a spinal cord lesion, which of the following structures would most likely be involved?

<p>Clark's nucleus (B)</p> Signup and view all the answers

Following a stab in the back, a patient experiences ipsilateral loss of motor function and proprioception, along with contralateral loss of pain and temperature sensation, all below the level of the injury. This presentation is most consistent with damage to which of the following?

<p>Hemitransection of the spinal cord (Brown-Séquard syndrome) (A)</p> Signup and view all the answers

What is the primary clinical relevance of understanding the vertebral level at which the spinal cord terminates in adults?

<p>It is essential for performing safe lumbar punctures and avoiding spinal cord injury. (C)</p> Signup and view all the answers

Which of the following accurately compares the filum terminale internum and filum terminale externum?

<p>The filum terminale internum is located within the dural sac, and the filum terminale externum is located outside the dural sac. (C)</p> Signup and view all the answers

If a patient has damage to the posterior intercostal arteries, what is the most likely consequence in relation to the spinal cord's arterial supply?

<p>Compromised blood supply to the posterior one-third of the spinal cord in the thoracic region. (C)</p> Signup and view all the answers

During a surgical procedure near the spinal cord, the dura mater is inadvertently punctured. What is the most immediate risk associated with this complication?

<p>Cerebrospinal fluid leak (A)</p> Signup and view all the answers

A patient is diagnosed with a tumor that is compressing the lateral horn of the spinal cord in the thoracic region. Which of the following symptoms would be most likely to manifest as a result of this compression?

<p>Disruption of sympathetic nervous system function (A)</p> Signup and view all the answers

What is the functional consequence of the unique arrangement of cervical spinal nerves emerging above their corresponding vertebrae (with the exception of C8)?

<p>It minimizes the risk of nerve injury during neck movements and vertebral misalignment. (A)</p> Signup and view all the answers

If a patient demonstrates impaired motor control of the distal musculature of the upper extremity, which specific area of the ventral horn would likely be affected?

<p>Lateral group (A)</p> Signup and view all the answers

A spinal cord injury results in damage to the ascending tracts within the dorsal column. What specific sensory deficits would you expect to observe in the patient?

<p>Loss of fine touch, vibration, and proprioception (B)</p> Signup and view all the answers

A surgeon is performing a procedure that requires access to the spinal cord. To minimize the risk of damage, at which vertebral level should the surgeon aim to perform a laminectomy to access the spinal cord in an adult patient?

<p>Between C1 and C2 (B)</p> Signup and view all the answers

Following a spinal cord injury, a patient exhibits spasticity primarily in the flexor muscles of the lower limb. Which of the following best explains the neurophysiological basis for this phenomenon?

<p>Disinhibition of dorsal nuclei that control flexors (C)</p> Signup and view all the answers

A patient presents with a spinal cord lesion that selectively damages the substantia gelatinosa in the dorsal horn. What specific sensory deficit would you expect to observe?

<p>Attenuation of pain and temperature sensations (A)</p> Signup and view all the answers

Which of the following statements accurately distinguishes the innervation patterns of the medial and lateral groups of the ventral horn?

<p>The medial group innervates axial trunk muscles, while the lateral group innervates limb muscles. (A)</p> Signup and view all the answers

A patient experiences a traumatic injury affecting the vertebral artery. What is the most critical implication of this injury concerning the spinal cord?

<p>Compromised blood supply to the anterior two-thirds of the spinal cord (D)</p> Signup and view all the answers

Flashcards

Spinal Cord Begin

Continuation of the medulla oblongata.

Spinal Cord Location

Upper 2/3 of the spinal cord.

Spinal Cord Length

45 cm in males, 42 cm in females.

Spinal Cord End

Forms the conus medullaris.

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Cervical Enlargement

Gives rise to the brachial plexus (C5-T1).

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Lumbar Enlargement

Gives rise to the lumbo-sacral plexus.

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Dura Mater

Outer layer, ending at S2.

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Arachnoid Mater

Middle layer, ending at S2.

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Pia Mater

Inner layer, forms filum terminale and denticulate ligament.

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Filum Terminale

From conus medullaris to coccyx.

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Denticulate Ligament

From pia to dura mater.

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Lumbar Cistern Definition

Sub-arachnoid space dilatation at level (L2-S2).

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Lumbar Puncture

Done between L3 & L4.

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Lumbar Puncture Function

Drain CSF, inject drugs, measure CSF pressure.

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Anterior Spinal Artery

Supplies anterior 2/3 of spinal cord.

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Posterior Spinal Artery

Supplies posterior 1/3 of spinal cord.

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Radicular Arteries

Main supply to the lower part of spinal cord.

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Spinal Cord Composition

Inner gray matter ('nerve cell body') & outer white matter ('axon of nerve cells').

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Medial Group

Supplies muscles of the trunk.

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Lateral Group

Supplies muscles of the limbs.

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Sources of Radicular Arteries

The vertebral or ascending cervical artery, posterior intercostal arteries, lumbar arteries and lateral sacral arteries

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Nerve Exit Exception

Cervical nerves emerge above their corresponding vertebrae, except the 8th cervical nerve.

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Ventral Nuclei Function

Control extensors

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Dorsal Nuclei Function

Control flexors

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Lateral Horn

Only found in the thoraco-lumbar region and contains sympathetic nerve cells

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Central Group

Only found at lumbo-sacral segments

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Venous Drainage

The veins correspond to the arteries and they drain into the internal vertebral venous plexus in the epidural space.

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Spinal Cord Divisions

Posterior median fissure and anterior median septum

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Study Notes

  • The study notes detail the spinal cord's external features, lumbar cistern, arterial supply, venous drainage, relation of spinal nerves and vertebrae, and internal structure.

Spinal Cord External Features

  • Originates as a continuation of the medulla oblongata below the foramen magnum.
  • Situated in the upper two-thirds of the spinal cord.
  • Measures 45 cm in length for males and 42 cm for females.
  • Terminates as the conus medullaris.
  • During fetal life, it fills the entire vertebral canal.
  • In newborns, it ends at the L3 level.
  • In adulthood, it ends at the lower border of L1.
  • Cervical enlargement gives rise to the brachial plexus opposite C5-T1.
  • Lumbar enlargement gives rise to the lumbo-sacral plexus opposite the lumbo-sacral region.

Meninges

  • Dura is the outermost layer that ends at the S2 level.
  • Arachnoid is the middle layer that ends at the S2 level.
  • Pia is the innermost layer.
  • The filum terminale extends from the conus medullaris to the coccyx.
  • The denticulate ligament extends from the pia to the dura.

Lumbar Cistern

  • Is defined as the subarachnoid space dilatation at levels L2-S2.
  • Contains CSF, the cauda equina, and the filum terminale.
  • Utilization is for lumbar punctures, typically performed between L3 and L4.
  • Used to drain CSF samples, inject medications/anesthetics, and measure CSF pressure.

Arterial Supply

  • The anterior spinal artery arises from the vertebral artery and supplies the anterior two-thirds of the spinal cord.
  • The posterior spinal artery is derived from the vertebral artery and supplies the posterior one-third of the spinal cord.
  • Radicular arteries provide the main arterial supply to the lower spinal cord, originating from vertebral or ascending cervical arteries in the neck.
  • Radicular arteries originate from posterior intercostal arteries in the thorax.
  • Radicular arteries originate from lumbar arteries in the abdomen.
  • Radicular arteries originate from lateral sacral arteries in the pelvis.

Venous Drainage

  • The veins correspond to the arteries.
  • They drain into the internal vertebral venous plexus located in the epidural space.

Spinal Nerve and Vertebrae Relation

  • Cervical nerves emerge above their corresponding vertebrae.
  • Exception to this rule is the 8th cervical nerve, which passes below the 7th cervical vertebra.
  • All other spinal nerves emerge below their corresponding vertebrae.

Internal Structure of Spinal Cord

  • The anterior median fissure and posterior median septum divide the spinal cord into two halves.
  • Each half contains inner gray matter or nerve cell body, and outer white matter or axon of nerve cells.

White Matter Tracts

  • Ascending tracts include the gracile and cuneate tracts.
  • Lateral column includes the lateral spinothalamic, dorsal spinocerebellar, and ventral spinocerebellar tracts.
  • Ventral column includes the ventral spinothalamic tract.
  • Descending tracts include the rubrospinal and lateral cortico-spinal tracts.
  • Ventral column descending tracts include ventral cortico-spinal, tecto-spinal, vestibule-spinal, and olivo-spinal tracts.

Gray Matter Horns

  • Ventral horn contains motor neurons arranged in medial, lateral, and central groups.
  • Medial group supplies trunk muscles.
  • Lateral group supplies muscles of the limbs.
  • Central group is found only in the lumbo-sacral segments.
  • Ventral nuclei control extensors while dorsal nuclei control flexors.
  • Lateral horn is present only in the thoraco-lumbar region and contains sympathetic nerve cells.
  • Dorsal horn contains the postero-marginal nucleus, substantia gelatinosa, and nucleus proprius.
  • Clark's nucleus is present from C8-L2.

Rexed Laminae and Function

  • Rexed lamina I mediates pain and temperature sensation.
  • Rexed laminae III & IV are involved in simple touch and pressure.
  • Rexed lamina VII mediates unconscious proprioception.

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