Clinical Case. A 45 year old woman complained of pain in her right breast and progressive weakness of her right lower limb for a period of two months, she contacted her Family physician, Her Family physician referred her to a neurologist.
This patient noticed ulcers on the fingers of both of his hands. They were associated with no pain and appeared to be the residua of burns. The probable site of damage responsible for this defect is the
a. Posterior column
b. Anterior horn
c. Clarke’s column
d. Spinothalamic tract
e. Spinocerebellar tract
A 45 year old man noticed a weakness of his right hand which was progressing and causing him problems. He decided to see his doctor.
MRI investigation showed a central cavitation at C-2 through T-7 which expanded symmetrically in all directions. It involved the anterior white commissure (spinothalamic fibers) and included portions of the posterior white columns, lateral white funiculus, and anterior gray horns.
spinal cord injury
An 85-year-old man is being evaluated for gait difficulties. On examination it is found that joint proprioception is absent in his toes. People with
impaired position sense will usually fall if they stand with their feet together and do which of the following?
The ability to recognize an unseen familiar object placed in the hand depends on the integrity of which pathway
A patient displays a symmetrical loss of pain and temperature on the shoulder area on bothSides of the body with no loss of tactile sensation. Pain and temperature and tactile sensationAre normal over the rest of the body. This condition would be due mostly likely to lesion of :
A 54 year old male presents with complaints of loss of pain and temperature sensation in his arms and chest only. What is the lesion causing these symptoms
1. Which of the following in not characteristic of the Brown-Sequard syndrome.
Provides sensations of “crude” touch, pressure, pain, and temperature
Ascend within the anterior or lateral spinothalamic tracts:
Following an automobile accident, an eighteen year old male was hospitalized for several weeks. A neurological exam at that time revealed the following:
1. Complete loss of conscious proprioception in the right lower limb.
2. Babinski sign on the right.
3. Inability to detect pain and temperature sensation on the medial side of the antecubital fossa (medialepicondyle) on both upper limbs.
4. Inability to detect pain and temperature at the apex of the left axilla, in all the intercostal spaces on the left, and in the left lower limb.
5. The patient could feel a gentle squeezing of both thumbs, right and left middle fingers, and the left little finger.
6. No sensation to squeezing could be detected in the right little finger.
Based on this exam, a single lesion may be found at which of the following levels?
It may be possible to also demonstrate a "Lower Motor Neuron Syndrome" or flaccid paralysis ipsilaterally at the level of the lesion. If the anterior horn cells supplying the skeletal muscles are injured at the level of the lesion then these muscles are denervated. This paralysis is of the flaccid type; muscles undergo rapid atrophy due to loss of the trophic influence of the nerves as well as disuse. Tone and tendon reflexes are diminished since they are reflex responses and the injured lower motor neurons are the "final common pathway" to the muscle in the stretch reflex, hence, there is no reflex.
Loss of conscious proprioception, two-point discrimination and vibratory sense ipsilaterally is due to interruption of the posterior white columns (fasciculus gracilis/cuneatus). This is frequently accompanied by a Romberg sign. A normal individual, standing erect with heels together and eyes closed, sways only slightly. Stable posture is achieve by 1) a sense of position from the vestibular system, 2) awareness of the position and status of muscles and joints by conscious proprioception and 3) visual input regarding our position. Closing the eyes has only slight effect on the normal individual's stance since the vestibular and conscious proprioception systems are sufficient. In a patient with an impaired posterior column conscious proprioception is diminished; when the eyes are closed loss of both systems renders the patient unstable and they are likely to sway or fall to the side.
Pain and temperature sensation is lost below the lesion, on the opposite sidebeginning about one dermatomal segment below the level of the lesion. These sensations are carried by the lateral spinothalamic tract whose fibers originated on the side opposite the lesion but which crossed in the anterior white commissure. Dorsal root afferents carrying pain and temperature synapse in the dorsal gray; the second order neuron crosses in the anterior white commissure along an ascending path for a distance of about one spinal segment. Because of the oblique ascent of the crossing fibers in the anterior white commissure, injury of the spinothalamic tract is not likely to be carrying sensation from that level.
A careful sensory evaluation may reveal that at the dermatomal level of the lesion there is a bilateral loss of pain and temperature sensation. Since the second order neurons from both sides cross in the midline below the central canal, a hemisection of the cord may interrupt the crossing fibers from both sides and produce this limited bilateral deficit.
Typically seen following hyperflexion injuries with impingement of bone or herniated disc tissue directly on the anterior spinal cord
Due to mechanical compression of the anterior spinal artery and secondary infarction of the anterior spinal cord
Rarely due to aortic dissection interrupting the blood supply to the anterior spinal arteries
posterior column function is not affected (position sense and vibration sense)Anterior cord syndrome
Usually due to posterior spinal artery occlusion, chronic atherosclerosis and impaired collateral circulation, tumors or discs compressing the posterior spinal cord, or vitamin B12 deficiency.
Pain and temperature sensory function + motor function not affected.Posterior cord syndrome
Ipsilateral loss of motor function and proprioceptive sensory function + contralateral loss of pain-temperature sensation.
Most commonly due to traumatic hemisection of the spinal cord (eg. stabbing knife thrust)Brown-Sequard syndrome
Conclusion of the diagnosis that the patient was determined to have an extramedullary tumor expanding from the dorsal roots at spinal cord levels T-5,6.
MRI investigation showed a central cavitation at C-2 through T-7 which expanded symmetrically in all directions.
In this patient, where would you expect the pain and temperature abnormalities to begin?