lesions

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spinal trauma

Polio

Cause
Tracts affected
Common level
Symptoms

Cause:
Poliovirus infection

Tracts affected:
LMNs bilaterally (ventral horn)

Common level:
Lumbar, sacral

Symptoms:
Lower Motor Neuron symptoms in affected areas of body
1. Flaccid paralysis
2. Muscle atrophy
3. Fasiculations
4. Areflexia

Amyotrophic lateral sclerosis

Tracts affected
Common level
Symptoms

Tracts affected:
Bilateral degenerative disease. Progressive spinal muscular atrophy (ventral horn) - progresses up or down spinal cord
1. LMNs
2. UMNs (corticospinal tract)

Common level:
Cervical

Symptoms:
Purely motor problems - NO sensory deficits
1. Flaccid paralysis of upper limbs (bilateral) = if affecting cervical enlargement (which it usually is), will affect the limbs that are being innervated by the level of the lesion
2. Increased tone and reflexes
3. Spastic paralysis of lower limbs (bilateral)
4. Positive Babinski's sign

Anterior spinal artery (ASA) occlusion

Cause
Tracts affected
Common level
Symptoms

Cause:
Emboli, thrombus

Tracts affected:
- Major blood supply of spinal cord is ASA.
Occlusion causes bilateral signs of tracts
1. corticospinal tracts (UMNs)
2. spinothalamic tracts
3. LMN at level of infarct
(Only dorsal columns spared bc these are fed by posterior spinal arteries)

Common level:
Mid-thoracic levels

Symptoms:
1. Bilateral spastic weakness of lower limbs (below lesion) due to corticospinal tract loss
2. Bilateral flaccid paralysis at level of infarct (LMN)
3. Bilatearl loss of pain and temp below lesion (due to spinothalamic tract loss)
4. Positive Babinski's sign
5. Bilateral Horner's if at T2 or above (ciliospinal nucleus of hypothalamospinal tract)
6. Loss of voluntary bladder and bowel control (sacral parasympathetic centers)
- will have touch/vibratory/pressure bc dorsal columns served by Posterior Spinal Artery (PSA)
(like ALS with some sensory loss)

Tabes dorsalis

Cause
Tracts affected
Common level
Symptoms

Cause:
Late stage syphilis

Tracts affected:
1. Progressive degeneration of dorsal roots
2. Secondary degeneration of dorsal columns
3. Hypersensitivity of anterolateral system
4. Pretectal degeneration
5. Spinocerebellar tracts

Common level:
Lumbar, sacral

Symptoms
1. Paresthesias (impaired vibration/pressure/light touch sense - due to dorsal column degeneration)
2. Pain (anterolateral system - hyper sensitive to touch stimulus)
3. Polyuria (or pt will retain urine)
4. High step, wide gait (sensory ataxia due to loss of propioception)
5. Romberg sign (dorsal column and spinocerebellar columns affected - propioception)
6. Argyll-Robertson pupils (pretectal degeneration)
7. Suppressed reflexes (axons of muscle spindle fibers must cross dorsal column to get to LMN...thus, degeneration of dorsal horn causes suppression of reflexes)

Subacute combined degeneration
(same symptoms seen in Fridreich's ataxia)

Cause
Tracts affected
Common level
Symptoms

Cause:
Antibodies against IF (Pernicious Anemia) > prevent B12 absorption in terminal ileum

Tracts affected:
Demyelination of:
1. Dorsal columns
2. Spinocerebellar tracts
3. Corticospinal tracts (UMNs)
(not spinothalamic tracts...)

Symptoms: (like Tabes Dorsalis + corticospinal tracts)
1. Bilateral altered touch/vibration/pressure below lesion
2. Bilateral spastic weakness and hyperactive weakness (below lesion)
3. Ataxia
4. Positive Babinski's sign

Common level:
Upper thoracic, lower cervical

Syringomyelia

Cause
Tracts affected
Common level
Symptoms

Cause:
Cavitation (compression) of the cord
- can be caused by Arnold-Chiari type II (associated hydrocephalus)

Tracts affected:
Syrinx is enlarging the central canal of spinal cord (or a lesion that impinges on part of spinal cord) > Axons of spinothalamic tracts (bilateral) from just under the central canal which means they are getting pinched (affected)
1. Ventral white commissure affected (aka Spinothalamic tract crossing points)
- "cape-like"" pattern - affects both upper limbs (if at cervical, which it usually is)
2. (as it grows) Affects LMN of that level
- (if cervical) Atrophy of upper limb muscles due to effects of impingement of ventral horn

Common level:
Lower cervical

Symptoms:
1. Bilateral loss of pain and temperature at level of lesion
(as disease progresses)
2. Weakness > flaccid paralysis
3. Atrophy of upper limb muscles due to destruction of ventral horn cells

Brown Sequard Syndrome

Cause
Tracts affected
Common level
Symptoms

Cause:
Lesion that covers half of a spinal cord segment

Tracts affected/Symptoms:
1. Dorsal column - Ipsilateral loss of position/touch/vibratory senses at and below level of lesion
2. Spinothalamic tract: contralateral loss of pain and temperature starting 1 or 2 segments below lesion and bilateral loss at the level of the lesion
3. Corticospinal tract: ipsilateral spastic paresis below level of lesion
- Positive Babinski's sign
4. LMN: ipsilateral flaccid paralysis in muscles supplied by injured spinal cord segment (at level of lesion)
5. Descending hypothalamics: Ipsilateral Horner syndrome (if lesion is above T1) = ptosis, miosis, anhydrosis

Common level:
any

Intervertebral disc herniation

Causes
Common level
Tracts/symptoms

Cause:
Prolapse (herniation) of nucleus pulposus through anulus fibrosus > impinges on spinal cord

Common level
L4 to L5 or L5 to S1 (these comprise 90% of cases)
C5 to C6 or C6 to C7 (10% of cases)

Tracts affected/symptoms
Impinges on spinal roots which cause:
(dorsal spinal roots)
1. Paresthesias
2. Pain
3. Sensory loss

(ventral spinal roots)
4. Hyporeflexia
5. Muscle weakness

Cauda Equina Syndrome

Cause
Tracts affected/symptoms

Cause:
Compression of lumbosacral nerve roots due to:
- Herniated disc
-spinal trauma
-less frequent: tumor

Tracts/symptoms
(gradual and unilateral onset)
- LMN problems
Severe radicular unilateral pain
Sensory distribution in a unilateral saddle-shaped area
Unilateral muscle atrophy
Absent quadriceps (L3) and ankle (S1) jerks
Unremarkable incontinence and sexual functions
Urinary retention

Conus medullaris syndrome

Cause
Symptoms

Cause:
Compression of lumbosacral nerve roots due to:
- Herniated disc
- Intramedullary tumor (e.g. ependymoma)

Symptoms
(sudden and bilateral presentation)
-UMN and LMN problems
Pain (bilateral and not severe, usually)
Sensory dissociation in a bilateral saddle-shaped area
Unremarkable muscle changes
(normal quadriceps and ankle reflexes)
Severely impaired incontinence and sexual function

Which are purely motor deficits?

Polio
ALS

Which are found mainly in lower cervical?

Lower cervical:
ALS
Syringomyelia
Subacute combined (also in thoracic)

Thoracic:
Anterior Spinal Artery (ASA) occlusion
Subacute combined (also in lower cervical)

Lumbar sacral
Polio
Tabes dorsalis
Herniation
Cauda equina/Conus medullaris

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