NSC 4366 1nd Edition Lecture 6 Outline of Last Lecture I Spinal cord anatomy Outline of Current Lecture II Cases Current Lecture Case 1 can t feel pain but can feel vibration She had a tumor coming from the ventral side that continued to grow until she lost dorsal column function leaving her paralyzed didn t have a stroke because her symptoms didn t happen at the same time These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute Case 2 problem JUST with her arms volatile weakness of hands hand muscles shrank so motor neurons must be dying lower motor neuron is dying on both sides areflexic lost reflexes and sensory input brisk lower limb reflexes means she s hyperactive hyperreflexia both upper and motor neuron injuries lesion in cervicospinal cord lost pain and temp sensation spinothalamic tract not the entire spinal cord in the center of the spinal cord central cord syndrome she has a syrinx the ventricle outside of the spinal cord has expanded and it compressed the spinal cord if she had a syrinx in the lumbar she would have weakness of the leg muscles arms would arms wouldn t be hyper reflexive Case 3 Anterior spinal artery infarct when you repair an aortic aneurysm you have to clamp the aorta lesion in anterior front lumbar spinal cord loss of blood in anterior spinal artery anterior spinal artery syndrome Case 4 strength is normal but vibration sense is reduced descending corticospinal pathway has been mildly affected spinothalamic pathway affected Vitamin B12 deficiency can be fixed with vitamin B12 Case 5 dissociated sensory loss pain and temperature on one side vibration on another side Can happen only below the neck He has cross sensory symptoms dissociated sensory loss spinal cord location bc spinal cord is the only place where pain fibers and light touch fibers are second order neurons in the sensory system start in the substantia gelatinous broke his back memorize Brown Sequard hemicore injury half spinal cord has been injured gives you dissociated sensory loss the side that the lesion is on is the MRI of a spinal epidural abscess due to tuberculosis A Sagittal T2 weighted free spin echo MR sequence A hypointense mass replaces the posterior elements of C3 and extends epidurally to compress the spinal cord arrows B Sagittal T1 weighted image after contrast administration reveals a diffuse enhancement of the epidural process arrows with extension into the epidural space Abscess in epidural space crushing the spinal cord Symptoms sensory part of the spinal cord being impaired because of the location of the abscess The dorsal column dorsal part of the spinal cord fascicullus gracillus and fasciculus coneatus If it s mild they give him antibiotics IF legs and arms start to feel heavy surgery is required Symptoms loss of vibration and loss of position sense not weakness because it s just affecting the dorsal part of the spinal cord MRI of syringomyelia associated with a Chiari malformation Sagittal T1 weighted image through the cervical and upper thoracic spine demonstrates descent of the cerebellar tonsils and vermis below the level of the foramen magnum black arrows Within the substance of the cervical and thoracic spinal cord a CSF collection dilates the central canal white arrows Central canal is affected pain and temperature cross over at the central canal loss of bilateral pain and temperature Cape loss trunk means legs are normal Lets are okay because they crossed over Upgoing toes upper motor neuron sign hyperreflexia upgoing toe are first order motor neuron signs in the upper motor neuron Ventral horn hand atrophy both lower and upper motor neuron lesion Case 6 Transverse myelitis tingling in middle of his trunk dorsal column arms normal legs no feeling and no strength lesion in spinal cord between cervical and lumbar Transverse myelitis spinal cord swollen Transverse side to side at T6 T7 myelitis inflammation of spinal cord Treatment is steroids but not always effective Case 7 B12 def dorsal column back of the spine hyperreflexia descending pathway two upper motor neuron signs deep tendon reflexer and toes upping Case 8 descending lateral spinal pathway has been affected because of hyperreflexia he has two spinal cords developmental malformation fo Tethered spinal cord treatment vertebral column surgical release to let the spinal cord rise Case 9 Joan Rivers epidural injection of lidocaine and bupivacaine as an outpatient like joan rivers Vestibulospinal tract affected ruberospinal tractred nucleus affected and dies the patient will die Less than 1 survival rate Lidocaine got into the blood stream and into the heart