Podcast
Questions and Answers
What is the origin point of the spinal cord?
What is the origin point of the spinal cord?
The white matter tracts of the spinal cord are located centrally.
The white matter tracts of the spinal cord are located centrally.
False
What are the two enlarged regions of the spinal cord called?
What are the two enlarged regions of the spinal cord called?
Cervical and lumbar regions
The spinal cord continues caudally to the ______ at the lumbar level.
The spinal cord continues caudally to the ______ at the lumbar level.
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Match the following spinal cord components with their characteristics:
Match the following spinal cord components with their characteristics:
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What does a positive Babinski’s sign indicate?
What does a positive Babinski’s sign indicate?
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Hyporeflexia or areflexia indicates heightened reflex response.
Hyporeflexia or areflexia indicates heightened reflex response.
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What is the sensory level in relation to spinal cord lesions?
What is the sensory level in relation to spinal cord lesions?
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Spinal shock may last up to ______ weeks following a severe spinal cord injury.
Spinal shock may last up to ______ weeks following a severe spinal cord injury.
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Match the anatomical reference points with their corresponding spinal levels:
Match the anatomical reference points with their corresponding spinal levels:
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Which of the following can cause myelopathy?
Which of the following can cause myelopathy?
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One of the causes of myelopathy is a herniated disc.
One of the causes of myelopathy is a herniated disc.
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What term is used to describe an intramedullary fluid-filled cavity in the spinal cord?
What term is used to describe an intramedullary fluid-filled cavity in the spinal cord?
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Myelopathy can result from autoimmune disorders or other __________.
Myelopathy can result from autoimmune disorders or other __________.
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Match the type of myelopathy with its example:
Match the type of myelopathy with its example:
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Which horn contains sensory neurons?
Which horn contains sensory neurons?
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The dorsal column-medial lemniscus tract carries sensory information from the contralateral side of the body.
The dorsal column-medial lemniscus tract carries sensory information from the contralateral side of the body.
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What type of neurons are found in the ventral horn?
What type of neurons are found in the ventral horn?
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The ___________ tract is responsible for transmitting pain, temperature, and crude touch sensations.
The ___________ tract is responsible for transmitting pain, temperature, and crude touch sensations.
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Match the type of spinal cord lesion with the affected limbs and associated motor neuron type:
Match the type of spinal cord lesion with the affected limbs and associated motor neuron type:
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What is the characteristic tone in Upper Motor Neuron (UMN) lesions?
What is the characteristic tone in Upper Motor Neuron (UMN) lesions?
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A lesion at the spinal cord results in ipsilateral effects from the spinothalamic tract.
A lesion at the spinal cord results in ipsilateral effects from the spinothalamic tract.
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How does the corticospinal tract decussate?
How does the corticospinal tract decussate?
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What is the most common condition associated with syringomyelia?
What is the most common condition associated with syringomyelia?
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Decreased pain and temperature sensation in the cape-like distribution occurs due to disruption of the crossing corticospinal tracts.
Decreased pain and temperature sensation in the cape-like distribution occurs due to disruption of the crossing corticospinal tracts.
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What is the best imaging modality for diagnosing spinal cord disease?
What is the best imaging modality for diagnosing spinal cord disease?
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A common clinical feature of cervicothoracic syringomyelia is a cape-like distribution of decreased pain and temperature sensation in the back, arms, and _____
A common clinical feature of cervicothoracic syringomyelia is a cape-like distribution of decreased pain and temperature sensation in the back, arms, and _____
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Match the following clinical features with their corresponding characteristics:
Match the following clinical features with their corresponding characteristics:
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Which of the following may be preserved in cases of syringomyelia?
Which of the following may be preserved in cases of syringomyelia?
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The dorsal column is affected in patients with cervicothoracic syringomyelia.
The dorsal column is affected in patients with cervicothoracic syringomyelia.
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What type of management is typically warranted in cases with no or only minor symptoms of syringomyelia?
What type of management is typically warranted in cases with no or only minor symptoms of syringomyelia?
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Study Notes
Overview of Spinal Cord Neuroanatomy
- Spinal cord extends from the medulla to the conus medullaris at lumbar levels L1-L2.
- Enlargements occur in cervical and lumbar regions for upper and lower limb innervation.
- White matter contains ascending sensory and descending motor pathways peripherally; grey matter (four-leaf clover shape) contains nerve cell bodies around the central canal.
- Membranes (pia, arachnoid, dura) covering the spinal cord are continuous with those of the brain.
Grey Matter and White Matter Structures
- Dorsal Horn: Contains sensory neurons.
- Ventral Horn: Contains motor neurons (anterior horn cells).
- Lateral Horn: Contains sympathetic neurons.
- Dorsal Funiculus: Dorsal column-medial lemniscus tract, involved in sensory (vibration, proprioception, fine touch) from ipsilateral body side.
- Lateral Funiculus: Lateral corticospinal tract, responsible for motor movements of limbs.
- Ventral Funiculus: Spinothalamic tract, sensory for pain, temperature, and crude touch from the contralateral side.
Spinal Cord Lesion Localization
- Above C5: Causes quadriparesis (upper motor neuron - UMN) and lower motor neuron (LMN) symptoms in upper limbs.
- C5-T1: Quadriparesis with UMN signs in lower limbs.
- T1-L1: Paraparesis with UMN signs.
- Below L1: Paraparesis with LMN signs.
Signs of Upper and Lower Motor Neuron Lesions
- Weakness: UMN affects muscle groups; LMN affects single muscle fibers.
- Atrophy: UMN does not cause atrophy; LMN causes atrophy and fasciculations.
- Tone: UMN shows hypertonia (spasticity); LMN shows hypotonia.
- Reflexes: UMN has hyperreflexia; LMN has hyporeflexia or areflexia (negative Babinski’s sign).
Sensory Levels and Spinal Shock
- Sensory Level: The level below which all sensory modalities are lost. Notable landmarks: Louis Angle (T2), Xiphisternum (T6), Umbilicus (T10), Inguinal ligaments (L1).
- Spinal Shock: Loss of neurological activity below injury level after severe cord injury lasting 2-3 weeks. It presents with lower motor neuron signs.
Causes and Differential Diagnosis of Myelopathy
- Neurosurgical Causes: Trauma, tumors, abscess, herniated disc, cervical spondylosis, syrinx cavity.
- Neurological Causes: Inflammatory (transverse myelitis, MS, NMO), infections (HIV, TB), vitamin B12 deficiency, vascular issues (stroke), hereditary conditions (spastic paraplegia).
Syringomyelia
- Syrinx forms an intramedullary fluid-filled cavity commonly in cervical to midthoracic spine, typically filled with CSF.
- Primary Syringomyelia: Congenital or associated with Chiari type 1 malformation.
- Secondary Syringomyelia: Due to spinal cord tumors or chronic phase post-trauma.
- Clinical features include cape-like distribution of decreased pain/temperature sensation, weakness in arms/legs, and possible Horner syndrome if lateral columns are affected.
Imaging and Treatment
- Best diagnostic tool for spinal cord disease: Magnetic Resonance Imaging (MRI). It visualizes syrinx and associated abnormalities.
- Conservative Treatment: Observation for minor symptoms, neuropathic pain medications for nonoperative management.
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Description
This quiz covers essential aspects of spinal cord disorders, focusing on myelopathy and its localization. It includes an overview of spinal cord neuroanatomy, differential diagnoses, and a clinical approach to various neurological disorders like syringomyelia and transverse myelitis. Test your knowledge on these critical topics in neurology.
