Neuroscience

DISEASES OF THE SPINAL CORD MAJOR SENSORY OR ASCENDING TRACTS
Kathreen Jane A. Lara,MD, FPNA

Name Location Function
Objectives Fasciculus gracilis Posterior Discriminative touch,
 To learn some basic anatomy of the spinal cord Column proprioception
 To have an idea about symptoms and signs of spinal Weight discrimination
cord Fasciculus Cuneatus Posterior Same as FG
 How would you approach a patient with spinal cord Column
diseases? Lateral Spinothalamic Laterl Pain and Thermal
 Common spinal cord diseases Column Sensations
FUNCTIONAL ORGANIZATION of the Nuclei within the Gray Anterior Anterior Itch, Tickle, Pressure,
Matter of the Spinal Cord Spinothalamic Column Crude touch sensations
Posterior & Anterior Lateral Proprioceptors
Spinocerebellar Column
Organization of Sensory or Ascending Pathways
Location of Ascending and Descending Tracts of the Spinal

Cord
Upper vs. Lower Motor Neuron

 Upper motor neuron lesion
o Motor cortex  internal capsule 
brainstem  spinal cord
 Lower motor neuron lesion
o Anterior horn cell  nerve root  plexus 
peripheral nerve  neuromuscular junction
 muscle
ALFONSO.CONAG.CONTILLO 1
NE: MOTOR EXAM
 Upper cervical
- Quadriplegia with impaired respiration
 Lower cervical
- Proximal arm strength preserved
- Hand weakness and leg weakness
 Thoracic
- Paraplegia
 Tone – Increased distal to the lesion
NE: SENSORY EXAM

 Establish a sensory level
o Dermatomes
 Nipples: T4-5
 Umbilicus: T8-9
 Posterior columns
o Vibration
o Joint position sense ( proprioception)
LOCALIZING SPINAL CORD LESIONS  Spinothalamic tracts
Upper Motor neuron o Pain
 Aka supranuclear, neurons in CNS o Temperature
 Weakness
 Spastic, increased tone Important Dermatomal Landmarks: Sensory Exam
 Increased DTRs (muscle spindle threshold decreased) C2 Posterior half of the skull cap
 Clonus: contraction of one group mm  initiate C3 Area correlating to a high turtle neck shirt
monotactic reflexes in their antagonists C4 Are correlating to a low- collar shirt
 Some atrophy – disuse C6 (radial nerve) and 2 nd and 3rd digit
 Toes up C8 (ulnar nerve) 4th and 5th digit
 No fasciculations T4 Nipples
Lower Motor Neuron T5 Inflammatory fold
 Aka infranuclear, nuclear;CNS neuron or PNS fibers
T6/T7 Xiphoid process
 WEAKNESS
T10 Umbilicus (important for early appendicitis pain
 Flaccid, decreased tonr
 Decreased DTRs (efferent limb interrupted) T12 Pubic bone area
 No clonus L1 Inguinal ligament
 ATROPHY L4 Includes the knee caps
 Toes down
 Fasciculations present (exotoxicity)
o Loss of vibration/ proprioception
ipsilateral to the lesion
 These pathways cross at the
level of the brainstem
- Weakness and UMN findings ipsilateral to the
lesion
NE: AUTONOMIC DISTURBANCES
Neurogenic bladder
- Urgency, incontinence, retention
Bowel dysfunction
- Constipation more frequent than incontinence Syringomyelia
With high cord lesion, loss of blood pressure control - Fluid filled cavitation in the center of the cord
Alteraton in sweating - Cervical cord most common site
o Loss of pain and temperature related to
ACUTE SUBACUTE CHRONIC the crossing of fibers occurs early
Trauma X  ???
Mass Lesion X X o Weakness of muscles in arms with
Infectious X X X atrophy and hyporeflexia
o Ater- CST involvement with brisk reflexes
Inherited X
in the legs, spasticity, and weakness
Vascular X X X
- May occur as a late sequelae to trauma
Autoimmune X X
- Can see in association with Arnold Chiari
Nutritional X
malformation
CLASSICAL SPINAL CORD SYNDROMES
- Anterior spinal artery infarct
- Brown Sequard Syndrome
- Syringomyelia
- Conus Medullaris/ Cauda Equina Syndrome
Brown Sequard Syndrome

- Cord hemisection
- Trauma or tumor
- Dissociated sensory loss
o Loss of pain and temperature
contralateral to lesion, one or 2 levels
below
 Crossing of spinothalamic tract
1-2 segments above where they
enter
Tumors INFECTIONS INVOLVING THE SPINAL CORD
- Metastatic or primary Polio
- Extramedullary - Only on the anterior horn cells are infected
o Extradural- most common Tabes dorsalis
 Bony- breast, prostate - Dorsal root ganglia and dorsal columns are
o Intradural – very rare involved
 Meninges- meningioma - Tertiary syphilis
 Nerve root- swannoma - Sensory ataxia, “lightening pains”
o Intramedullary- very rare HIV myelopathy
 Metastatic - Mimics B12 deficiency
 Primary- astrocytoma or HLTV-1 myelopathy
ependymoma - topical spastic paraparesis
B12 Deficiency Multiple Sclerosis
- Subacutte combine degeneration of the cord - Demyelination is the underlying pathology
- Malabsorption of b12 secondary to pernicious - Cord disease can be presenting feature of MS or
anemia or surgery occur at any time during the course of the
- Insufficient dietary intake- vegan disease
- Posterior columns and CST involvement with - Lesion can be at any level of the cord
superimposed peripheral neuropathy o Patchy
o Transverse
- Devic’s syndrome or myelitis optica
o Transverse myelitis with optic neuritis
VASCULAR DISEASES OF THE SPINAL CORD
Infarcts
- Anterior spinal artery infarct
o From atherosclerosis, during surgery in
which the aorta is clumped, dissecting
aortic aneurysm
Transverse myelitis  Less often, chronic meningitis or
- Inflammation of the spinal cord following trauma
o Post-infectious o Posterior columns preserved (JPS,vib)
o Post- vaccinal o Weakness (CST) and pain/temperature
o Multiple sclerosis loss (spinothalamic tracts)
- Pain at level of lesion may preceed onset of - Artery of Adamkiewicz at T10-11
weakness/ sensory change/ b&b disturbance - Watershed are
o Upper thoracic
- Arteriovenous malformation and venous
angiomas
o Both occur in primarily the thoracic cord
o May present either acutely, subacutely
or chronically (act as a compressive
lesion)
o Can cause recurrent symptoms
o If they blees
 Associated with pain and bloody
CSF
o Notoriously difficult to diagnose
- Hematoma- trauma, occasionally tumor
OTHER DISEASE OF THE SPINAL CORD
Hereditary spastic paraparesis

- Usually autosomal dominant
Infectious process of the vertebrae

- TB, Bacterial
Herniated disc with cord compression

- Most herniated discs are lateral and only
compress a nerve root
Degenerative disease of the vertebrae

- Cervical Spondyosis with myelopathy
- Spinal stenosis

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DISEASES OF THE SPINAL CORD MAJOR SENSORY OR ASCENDING TRACTS

Kathreen Jane A. Lara,MD, FPNA

Organization of Sensory or Ascending Pathways

Location of Ascending and Descending Tracts of the Spinal

Upper vs. Lower Motor Neuron

NE: SENSORY EXAM

NE: AUTONOMIC DISTURBANCES

Brown Sequard Syndrome

VASCULAR DISEASES OF THE SPINAL CORD

OTHER DISEASE OF THE SPINAL CORD

Hereditary spastic paraparesis

Infectious process of the vertebrae

Herniated disc with cord compression

Degenerative disease of the vertebrae

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