HY Gross Anatomy - spinal cord and spinal nerves

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high yield gross anatomy

gray matter consists of (1) and is divided into .. (2)

(1) neuronal cell bodies
(2) dorsal horn, ventral horn and lateral horn

white matter consists of (1) and is divided into.. (2)

(1) neuronal fibers
(2) dorsal funiculus, ventral funiculus and lateral funiculus

ventral median fissure is related to..

anterior spinal artery

dorsal intermediate septum

present only at and above vertebra T6 --> distinguishes ascending fibers within the gracile fasciculus (lower extremity) from cuneate fasciculus (upper extremity)

conus medullaris

L1 in adult
L3 in newborns

caude equina

dorsal and ventral nerve roots of spinal nerves L1 through coccygeal 1

filum terminale

extension of pia mater that reaches from the conus medullaris to the end of the dursal sac at the vertebral level S2

what is contained with epidural space?

fat and internal vertebral venous plexuses

denticulate ligaments

lateral extensions of pia mater that attach to dura mater, thereby suspending the spinal cord w/in the dural sac

which artery supplies the ventral 2/3 of the spinal cord?

anterior spinal artery (arises from vertebral arteries)

which artery(s) supplies the dorsal 1/3 of the spinal cord?

posterior spinal arteries (2 of them) that arise from vertebral arteries or the PICA

significance of great radicular artery (artery of Adamkiewicz)

this artery makes a major contribution to the anterior spinal artery and provides the main blood supply to lower part of spinal cord

anterior spinal artery syndrome -- cause?

ligation of great radicular artery during resection of an abdominal aortic aneurysm

anterior spinal artery syndrome - symptoms

paraplegia - bilateral spastic paresis w/ pyramidal signs below lesion
impotence
loss of voluntary control of bladder and bowel
bilateral loss of pain and temperature sensation
bilateral Horner syndrome
bilateral flaccid paralysis

how many spinal nerves are there?

31 pairs
8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal

dorsal primary ramus

innervates skin and deep muscles of the back

ventral primary ramus

innervates remainder of the body

white communicating rami

contain myelinated preganglionic SNS nerve fibers
present only in spinal nerves T1-L3

gray communicating rami

contain unmyelinated POST-SNS nerve fibers
present in all spinal nerves

which tract mediates tactile discrimination, vibration sensation, form recognition and proprioception?

dorsal column medial lemniscus pathway

which tract mediates pain and temperature sensation?

lateral spinothalamic pathway

which tracts transmit info about proprioceptive and muscle reflex activity from the spinal cord to the cerebellum?

dorsal and ventral spinocerebellar tracts

interruption of which tract above T1 results in Horner's syndrome?

hypothalamospinal tract

poliomyelitis and Werdnig-Hoffman disease

caused by damage to alpha motor neurons w/in ventral gray horn --> LMN lesion

clinical findings in LMN lesion

flaccid paralysis
arreflexia
atrophy
fasciculations and fibrillations
absent Babinski sign

amyotrophic lateral sclerosis (Lou Gehrig's disease)

damage to alpha motor neurons within the ventral gray horn and the lateral corticospinal tract; both UMN and LMN lesion

clinical findings in combined LMN/UMN lesion

spastic paralysis or paresis
no atrophy
hyperreflexia
no fasciculations or fibrillations
positive Babinski sign

tabes dorsalis

caused by damage to sensory pathways of dorsal columns
CF = loss of tactile discrimination, vibration sensation and proprioception

Brown-Sequard syndrome

hemisection of spinal cord - caused by a penetrating blow

clinical findings in Brown-Sequard syndrome

ipsilateral:
loss of tactile discrimination, vibration, proprioception
spastic paresis with pyramidal signs below lesion
Horner syndrome
flaccid paralysis

contralateral:
loss of pain and temp one segment below the lesion

what causes damage to dorsal columns, lateral corticospinal tracts and spinocerebellar tracts?

vitamin B12 neuropathy - deficiency

clinical findings in vitamin B12 neuropathy

bilateral loss of tactile discrimination, vibration, proprioception
bilateral spastic paresis with pyramidal signs
bilateral arm and leg dystaxia

syringomyelia

central cavitation of cervical spinal cord whose etiology is unknown but results in damage to ventral white commissure (involving decussating lateral spinothalamic axons) and ventral gray horns

clinical findings in syringomyelia

bilateral loss of pain and temperature
flaccid paralysis of the intrinsic muscles of the hand

what are some complications of spinal cord injury?

hypotension
ileus
renal stones, pyelonephritis, renal failure
DVT

MC intramedullary tumor of spinal cord

ependymoma

common locations of ependymomas

- cervical region - near obliterated central canal
- lumbosacral region associated with conus medullaris

where do astrocytomas commonly occur in spinal cord?

cervical and thoracic regions

MC location of meningioma of spinal cord

thoracic region

MC type of extradural tumors of spinal cord

metastasis (lung, breast and prostate) MC metastasize to the body of vertebrae

chordoma

arises from remnants of embyronic notochord; usually occur in sacral or clival regions

where is lumbar puncture performed?

above or below the spinous process of vertebra L4 (i.e. L3-L4 or L4-L5 interspace)

spinal anesthesia

produced by injected anesthetic into subarachnoid space
up to spinal nerve T10 for vaginal delivery, and up to T4 in cesarean section

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