🥵 HARD

 

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  • Identify and describe the location, functions, and route taken by (from origin to termination, including decussation point) the main descending tracts (corticospinal, vestibulospinal)
  • Describe the territories of the anterior and posterior spinal arteries and be able to predict the main functional deficits resulting from the blockage of a given artery
  • Distinguish between an upper and a lower motor neuron, explain the signs and symptoms associated with damage to each, and explain what types of injury can lead to upper or lower motor neuron symptoms- relating to the ascending or descending tracts and their functions. 
  • Deduce the signs, symptoms and functional consequences arising from an injury at a given spinal cord level/vertebral level, or vice versa

Descending Tracts

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Question 1

Question 1 of 5

A 65 year old male presents with sudden onset paresis and paraesthesia in the right C5-T1 dermatomyotomes. He is unable to lift his hands above his head and has slurring of speech.
What is the best matched differential?
A
Right internal capsule infarct causing an upper motor neuron sign set
B
Right lateral primary motor cortex infarct causing an upper motor neuron sign set
C
Left internal capsule infarct causing an upper motor neuron sign set
D
Left lateral primary motor cortex infarct causing an upper motor neuron sign set
E
None of the above
Question 2

Question 2 of 5

On neurological examination, which of the below best match potential signs you could elicit?
A
Rapid dorsiflexion triggering cyclical plantarflexion and dorsiflexion
B
Areflexic response despite deep tendon reflex initiation
C
Fibrillations of the muscle belly on EMG
D
Notable atrophy on the muscles during general inspection
E
Absence of the plantar reflex
Question 3

Question 3 of 5

As the affected fibre bundle projects sub-cortically, which of the following is a common site of synapse?
A
Anterior midbrain
B
Anterior pons
C
Anterior medulla
D
Dorsal white matter of the spinal cord
E
Lateral white matter of the spinal cord
Question 4

Question 4 of 5

Which arterial occlusion would cause bilateral signs of (amongst other findings) reduced upper motor neuron tone to the flexor "gravity" muscles?
A
Posterior spinal artery
B
Anterior cerebral artery
C
Anterior choroidal artery
D
Anterior spinal artery
E
Posterior communicating artery
Question 5

Question 5 of 5

Which portion of subcortex permits planned motor activity to terminally activate the upper motor neurons?
A
Putamen
B
Globus pallidus
C
Thalamocortical fibres
D
Corticostriate fibres
E
Substantia nigra pars reticularis
Question 6
Which of the following are false statements of the supplementary motor cortex?
A
It predominately receives vascular supply from the superior branch of the MCA
B
It receives vascular supply from the ACA (pericallosal, callosomarginal)
C
It is involved in the initiation of movement
D
It is mainly involved in the planning of skilled motor movement
E
It does not provide fibres to the corticospinal tract projection fibres
Question 7
The tract conveying conscious, skilled movement mostly decussates at which point?
A
The rostral midbrain
B
The caudal midbrain
C
The rostral pons
D
The caudal pons
E
The caudal medulla
Question 8
A patient is recovering from a haemorrhagic stroke to the superior branch of the MCA (M3).  His examination is notable for spastic paralysis in the contralateral upper/lower limbs.
Which tract is mostly responsible for the rationale behind the sign demonstrated?
A
Rubrospinal tract
B
Anterior corticospinal tract
C
Lateral vestibulospinal tract
D
Reticulospinal tract
E
Lateral corticospinal tract
Question 9
Which of the following projection fibre systems are supplied by the posterior spinal arteries?
A
Lateral corticospinal tract
B
Anterior corticospinal tract
C
Gracile fasciculus
D
Cuneate fasciculus
E
Lateral vestibulospinal tract
Question 10
Which of the following fibre types are responsible for maintaining muscle spindle tension during relaxation?
A
Alpha motor neurons
B
Gamma motor neurons
C
Renshaw cells
D
Lateral vestibulospinal tract neurons
E
Anterior corticospinal tract neurons
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