SpinalCordCNSLesionsDrBales - 10 am April 20. Most of this...

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10 am April 20. Most of this is review. Real-world lesions. Was there a handout for this?? He talks like there was (3 columns?). Syringomyelia , abnormal expansion of central canal of spinal cord. What anatomical structure will be damaged by syringomyelia C4-C8? Ventral white commissure. Main sensory deficit = pain and temperature from upper limb. Will be bilateral because pain/temp is contralateral but this is a *midline* lesion. Occlusion of posterior spinal arteries – posterior 1/3 syndrome. Which anatomical structures will be lesioned? Dorsal column, specifically fasciculus gracilis (lower limb) and cuneatus (upper limb). Deficit = touch and conscious proprioception. If at C6, loss will be upper limb and everything below. If both of the arteries, would be bilateral. Lamina 2 = substantia gelatinosa, which processes pain & temperature. Lissauer's tract = cap of white matter over dorsal horn Lissauer's. Could also have bilateral loss from tumor compression, instead of from arterial occlusion. Anterior spinal artery occlusion at T8. Anterior 2/3 syndrome. Will be bilateral because anterior artery is unpaired. Will have both sensory and motor effects. Sensory deficits: Gracilis, not cuneatus (cuneatus is at T6 and above). Will lose touch and conscious proprioception of lower limb bilaterally. Ventral white commissure, pain and temperature, lower limb, bilaterally. Motor deficits: corticospinal tract, which has 2 parts (anterior and lateral fibers). Hemiplegia of lower limbs below level of lesion. Flaccid or spastic? Spastic because these fibers are upper motor neurons. Ventral horn also damaged, lose all somatic efferent neurons. Bilateral paralysis *at* the level of lesion. Flaccid because lower motor neurons locked out. Brown-Sequard Syndrome at C4, hemi-section lesion of spinal cord. Sensory losses = fasciculus gracilis and cuneatus, lose touch and conscious proprioception upper and lower limbs. Ipsilaterally because we’re below the arcuate fibers. Will knock out Lissauer's tracts & substantia gelatinosa. Will also knock out pain and temperature at the level or starting below level, ALS (AnteroLateral System = pain & temp) which is sandwiched between ventral horn and surface ventral spinal cerebellar tract. Contralateral, all ALS lesions are contralateral. Spinal cerebellar tracts for conscious and unconscious proprioception, which is ipsilateral. Motor deficit = anterior and lateral corticospinal tracts, spastic hemiplegia of upper and lower limbs. Ipsilateral because we’re below the pyramids. (color in the brainstem levels in neuroanatomy coloring book) Dejerine syndrome = Medial medullary syndrome or paramedian medullary syndrome. Penetrating brs of anterior spinal artery. Sensory deficits
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This note was uploaded on 05/20/2008 for the course NEURO 5125 taught by Professor Bales during the Spring '08 term at Western University of Health Sciences.

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SpinalCordCNSLesionsDrBales - 10 am April 20. Most of this...

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