Case 3: Anterior spinal artery infarctwhen you repair an aortic aneurysm you have to clamp the aortalesion in anterior (front) lumbar spinal cord - loss of blood in anterior spinal artery (anterior spinal artery syndrome)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 spaceAbscess 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 overUpgoing toes - upper motor neuron sign (hyperreflexia, upgoing toe are first order motor neuron signs in the upper motor neuron)Ventral horn - hand atrophyboth lower and upper motor neuron lesionCase 6: Transverse myelitistingling in middle of his trunk - dorsal columnarms normal, legs no feeling and no strengthlesion in spinal cord, (between cervical and lumbar)Transverse myelitisspinal cord swollen. Transverse - side to side (at T6-T7) myelitis (inflammation of spinal cord)Treatment is steroids but not always effectiveCase 7: B12 defdorsal column, back of the spinehyperreflexia (descending pathway) two upper motor neuron signs - deep tendon reflexer and toes upping)Case 8: descending lateral spinal pathway has been affected because of hyperreflexiaNSC 4366 1nd Edition Lecture 6Outline of Last Lecture I. Spinal cord anatomyOutline of Current Lecture II. CasesCurrent Lecture:Case 1: can’t feel pain but can feel vibrationShe had a tumor coming from the ventral side that continued to grow until she lost dorsal column function, leaving her paralyzeddidn’t have a stroke because her symptoms didn’t happen at the same timeThese 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 sidesareflexic - lost reflexes and sensory inputbrisk lower limb reflexes - means she’s hyperactive (hyperreflexia)both upper and motor neuron injurieslesion in cervicospinal cordlost pain and temp sensation - spinothalamic tractnot the entire spinal cord, in the center of the spinal cord (central cord syndrome)she has a syrinxthe 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 reflexiveCase 3: Anterior spinal artery infarctwhen 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 reduceddescending corticospinal pathway has been mildly affectedspinothalamic pathway affectedVitamin B12 deficiency, can be fixed with vitamin B12Case 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 lossspinal 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 gelatinousbroke his backmemorize Brown-Sequard (hemicore injury, half spinal cord has been injured) gives you dissociated sensory lossthe side that the lesion is on is theMRI 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 andfasciculus 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’sjust 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 atrophyboth lower and upper motor neuron lesionCase 6: Transverse myelitistingling inmiddle ofhis trunk -dorsalcolumnarmsnormal,legs nofeelingand nostrengthlesion in spinal cord, (between cervical and lumbar)Transverse myelitisspinal cordswollen.Transverse - side to side (at T6-T7) myelitis (inflammation of spinal cord)Treatment