Spinal Cord Injury

SPINAL CORD INJURY

Q. 1

All are true about brown sequard syndrome

 A

Ipsilateral loss of joint sensation

 B

Contralateral loss of joint sensation

 C

Segmental sign are bilateral

 D

Contralateral loss of vibration

Q. 1

All are true about brown sequard syndrome

 A

Ipsilateral loss of joint sensation

 B

Contralateral loss of joint sensation

 C

Segmental sign are bilateral

 D

Contralateral loss of vibration

Ans. A

Explanation:

A i.e. Ipsilateral loss of joint sensation


Q. 2

Unlikely to be involved in lesion of anterior spinal artery is:

 A

Pain and temp

 B

Vibration and proprioception

 C

Pyramidal tract

 D

Sphincters

Q. 2

Unlikely to be involved in lesion of anterior spinal artery is:

 A

Pain and temp

 B

Vibration and proprioception

 C

Pyramidal tract

 D

Sphincters

Ans. B

Explanation:

B i.e. Vibration and Proprioception

In anterior spinal artery syndrome all spinal cord function (motor, sensory and autonomic) are lost below the level of lesion with the striking exception of retained vibration and position senseQ.[As posterior column is supplied by posterior spinal artery]


Q. 3

A 40 years old male after RTA, attains spinal injury. His lower limb power is greater than that of upper limb and sacral sensations are present. Type of spinal cord lesion is: 

 A

Central cord syndrome

 B

Anterior cord syndrome

 C

Posterior cord syndrome

 D

Complete spinal cord injury.

Q. 3

A 40 years old male after RTA, attains spinal injury. His lower limb power is greater than that of upper limb and sacral sensations are present. Type of spinal cord lesion is: 

 A

Central cord syndrome

 B

Anterior cord syndrome

 C

Posterior cord syndrome

 D

Complete spinal cord injury.

Ans. A

Explanation:

A i.e. Central cord syndrome

Central cord syndrome is defined by American spinal injury Association (ASIA) as a clinical presentation, characterized by “dissociation” in degree of motor weakness weakness with lower limbs stronger than upper limbs and sacral sparing presentQ

Complete lesion (transection)

No motor or sensory function in the lowest sacral segments (S4 – Ss)/ below the level of spinal cord injuryQ in the absence of spinal shock.

Patients may gain some root function about the level of injury – a phenomenon called root escape, because this damage to nerve roots is a peripheral nerve injury (& may be neuroprexia). And it should not be taken as potential return of spinal cord function.

Incomplete lesion

Any evidence of neurological function (sensory or motor) distal to the level of injury.

Documentation of sacral nerve !but function (perianal sensation, rectal tone and flexion of great toe) may be the only sign of partially functioning spinal cord or incomplete lesion.

Central Cord Syndrome

It occurs d/t damage of spinal cord near central canal area. Main causes are hyperextension trauma, Syringomyelia, tumor and anterior spinal artery ischemia. It is most frequent of incomplete cord syndromes and occurs most frequently in elderly people with underlying degenerative spolidylosis.

Dissociative motor weakness with arm weakness out of proportion to leg weaknessQ

Sacral sensory sparingQ

– ‘Dissociated sensory loss’ signifying a loss of pain and temperature sense (lateral spinothalmic tract) in a cape distribution over the shoulders, lower neck, and upper trunk in contrast to intact light touch, joint position,

and vibration sense (posterior column) in these regions.

– 50- 75% show some neurological improvement in following order- return of lower extremity strength, return of bladder function, return of upper extremity strength, and return of intrinsic function of the hand.

Anterior Cord Syndrome

Both spinoth­almic & corti­cospinal tracts (located in the anterior aspe­ct of spinal cord) are injured with preserv-ation of dorsal columns

Variable loss of pain and temperature sensation and motor functions with preservation of proprioceptio n, vibrator sense and deep pressure sensationQ

Brown Sequard Syndrome

It is functional hemisection of spinal cord 1/t motor weakness on ipsilateral side of lesion & sensory deficit on the contralateral side (in broad terms.)

It consist of ipsilateral motor (corticospinal tract) and propriaception (posterior column) loss and contralateral pain & temperature (spinothalmic tract) sensory lossQ.

Segmental signs, such as radicular pain, muscle atrophy, or loss of deep tendon reflex, are unilateral.

Posterior Cord Syndrome

– Posteriorly located dorsal column is injured with intact spinothalmic and corticospinal tracts.

– Loss of position and vibratory sense below the level of injury


Q. 4

Type of sensation lost on same side in Brown sequard syndrome is:

 A

Pain

 B

Touch

 C

Proprioception

 D

Temperatiure

Q. 4

Type of sensation lost on same side in Brown sequard syndrome is:

 A

Pain

 B

Touch

 C

Proprioception

 D

Temperatiure

Ans. C

Explanation:

Answer is C (Proprioception):

Proprioception is lost on the same side of lesion in Brown Sequard Syndrome.

Brown sequard syndrome or hemisection of the cord is associated with loss of posterior column sensations (vibration joint position sense, proprioception, fine touch) on the same side of lesion.

Sensations transmitted by the anterolateral column or spinothalamic tract (pain, touch, temperature) are lost on the opposite side of lesion

Sensations lost on the same side as the lesion

Sensations transmitted by the posterior column are lost on the same side

Brown Sequard Syndrome (Hemisection of the cord)

Ipsilateral posterior column involvement

  • Vibration
  • Joint position (proprioception)Q
  • Fine touch

Motor power is lost on the same side as that of the lesion (Ipsilateral corticospinal tract involvement)

Sensation lost on the opposite side of lesion

Sensations transmitted by the anterolateral spinothalamic tracts are lost on the opposite side Contralateral spinothalamic tract involvement

  • Touch (Crude touch)
  • Pain
  • Temperature

Q. 5

All of the following are true about Brown Sequard Syndrome, except:

 A

Ipsilateral Pyramidal Tract Features

 B

Contralateral Spinothalamic Tract Features

 C

Contralateral Posterior Column Features

 D

Ipsilateral Planter Extensor

Q. 5

All of the following are true about Brown Sequard Syndrome, except:

 A

Ipsilateral Pyramidal Tract Features

 B

Contralateral Spinothalamic Tract Features

 C

Contralateral Posterior Column Features

 D

Ipsilateral Planter Extensor

Ans. C

Explanation:

Answer is C (Contralateral Posterior Column Features):

Brown-Sequard Syndrome (Hemisection of spinal cord) is characterized by lesions of the ipsilateral posterior column (and not contralateral posterior column).

 The_pvramidal tract (corticospinal tract) is involved on the same side (ipsilateral pyramidal tract features), which also explains the ipsilateral planter extensor response. The spinothalamic tract is involved on the contralateral side since fibres of the spinothalamic tract ascends in the spinal cord after having crossed at their respective spinal levels.


Q. 6

The following are components of Brown Sequard syndrome except :

 A

Ipsilateral extensor plantar response

 B

Ipsilateral pyramidal tract involvement

 C

Contralateral spinothalamic tract involvement

 D

Contralateral posterior column involvement

Q. 6

The following are components of Brown Sequard syndrome except :

 A

Ipsilateral extensor plantar response

 B

Ipsilateral pyramidal tract involvement

 C

Contralateral spinothalamic tract involvement

 D

Contralateral posterior column involvement

Ans. D

Explanation:

Answer is D (Contralateral posterior column involvement):

Brown – Sequard syndrome or hemisection of the spinal cord leads to loss of joint position and vibratory sense (posterior coluntn movement) on the ipsilateral side and not on the contralateral side. – Harrison 16th / 2441, 144

Brown sequard syndrome: Hemisection of spinal cord

  • Ipsilateral involvement of corticospinal tract : ipsilateral loss of motor power.
  • Ipsilateral involvement of posterior column : ipsilateral loss of joint position and vibratory sense.
  • Contralateral involvement of spinothalamic tract : contralateral loss of joint position and vibratory sense.

Segmental signs such as radicular pain muscle atrophy or loss of deep tendon reflexes arc unilateral (Lower motor neuron signs at level of lesion).


Q. 7

Which of the following statements about Brown Sequard Syndrome is true:

 A

Ipsilateral loss of temperature

 B

Contralateral loss of pain

 C

Contralateral loss of vibration

 D

Bilateral Segmental signs

Q. 7

Which of the following statements about Brown Sequard Syndrome is true:

 A

Ipsilateral loss of temperature

 B

Contralateral loss of pain

 C

Contralateral loss of vibration

 D

Bilateral Segmental signs

Ans. B

Explanation:

Answer is B (Contralateral loss of pain):

Brown-Sequard Hemicord Syndrome is associated with contralateral loss of pain and temperature sense

  • Ipsilateral Weakness (corticospinal tract)
  • Ipsilateral Loss of joint position and vibratory sense (posterior column),
  • Contralateral Pain and temperature sense (spinothalamic tract) one or two levels below the lesion
  • Unilateral Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex

Q. 8

Hypotension in Acute Spinal Cord Injury is due to :

 A

Loss of Sympathetic tone

 B

Loss of Parasympathetic tone

 C

Vasovagal Attack

 D

Orthostatic Hypotension

Q. 8

Hypotension in Acute Spinal Cord Injury is due to :

 A

Loss of Sympathetic tone

 B

Loss of Parasympathetic tone

 C

Vasovagal Attack

 D

Orthostatic Hypotension

Ans. A

Explanation:

Answer is A (Loss of sympathetic tone) :

Spinal cord il4tiry mat’ produce hjpotension due to loss ofsympathetic tone. – ATLS 7th / 73

Interruption of sympathetic vasomotor input after a high cervical spinal cord injury may result in neurogenic shock. – Harrison

Shock associated with spinal cord injury

Neurogenic Shock

  • Produced as a result of loss of sympathetic tone.
  • It results from impartment of the descending sympathetic pathways in the spinal cord.
  • Classical picture of Neurogenic shock is hypotension without tachycardia or cutaenous vasoconstriction.

Spinal Shock

  • Refers to flaccidity and loss of reflexes seen after spinal cord injury.
  • The ‘shock’ here is to the ‘injured cord’ which makes it appear completely functionless although all areas are not necessary destroyed.
  • The duration of spinal shock is variable.

 


Q. 9

Anterior spinal Artery thrombosis is characterized by all, except:

 A

Loss of pain & touch

 B

Loss of vibration sense

 C

Loss of power in lower limb

 D

Sphincter dysfunction

Q. 9

Anterior spinal Artery thrombosis is characterized by all, except:

 A

Loss of pain & touch

 B

Loss of vibration sense

 C

Loss of power in lower limb

 D

Sphincter dysfunction

Ans. B

Explanation:

Answer is B (Loss of vibration sense):

Anterior spinal artery thrombosis does not involve the posterior column and hence vibration sense and joint positions sense (proprioception) are preserved.



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