Lesions Of The Spinal Cord And Brainstem

Question 1

UMN

Answer 1

Weakness
Mostly no atrophy (flaccidity is exception)
No fasciculations
Decreased reflexes in acute stage
Increased reflexes in chronic stage
Decreased tone in acute stage
Increased tone in acute stage

Question 2

LMN

Answer 2

Weakness
Atrophy
Fasciculations
Decreased reflexes
Decreased tone

Question 3

ALS

Answer 3

Temperature
Pain
Touch
Deep pressure
Arranged lateral (coccygeal/sacral) to medial (cervical)

Question 4

DCML

Answer 4

Joint sensation
Vibration
Pressure
Discriminative touch
Arranged medial (sacral) to lateral (cervical)

Question 5

Arrangement of lateral Corticospinal tract

Answer 5

Same as ALS

Lateral (sacral) to medial (cervical)

Question 6

When I say medial, you say:

Answer 6

Motor

Medial lesions are associated with ipsilateral motor deficits

Question 7

When I say lateral, you say:

Answer 7

Sensory

Question 8

At the level of CN8 and T10, what does the anterior spinal artery supply?

Answer 8

ALS and Corticospinal tracts (ventral)

Question 9

At the level of CN8 and T10, what tract does the posterior spinal artery supply?

Answer 9

DCML

Question 10

Is pure hemi-section of the spinal cord common?

Answer 10

No, very rare

Question 11

Ipsilateral Corticospinal tract lesion

Answer 11

UMN

Loss of voluntary motor control

Question 12

Ipsilateral DCML

Answer 12

Discriminative touch, pressure, proprioception, vibration

Question 13

Contralateral ALS

Answer 13

Pain, temperature, crude touch

Question 14

Lesion at a particular level

Answer 14

All sensation coming into dorsal horn would be lost

Motor nerve exiting ventral horn (LMN) lost

Question 15

Ventral (anterior) horn cell lesion (or disease)

Answer 15

Spinal muscular atrophy
Polio
PMN involvement

Question 16

Amyotrophic lateral sclerosis

Answer 16

Ventral horn and CST involvement producing UMN and LMN signs

Question 17

Anterior cord syndrome

Answer 17

Anterior spinal artery ischemia or infarct
Loss of voluntary motor control and loss of pain, temperature and crude touch below infarct
Discriminative touch, pressure, proprioception spared
More rostral = more dysfunction

Question 18

Commissural syndrome of the spinal cord

Answer 18

Lesion to ventral white commisure
Bilateral symmetric loss of pain and temperature in dermatomal distribution of spinal cord segments
Not typical but likely a precursor to central cord syndrome

Question 19

Central cord syndrome

Answer 19

• bilateral damage of central part of spinal cord
• loss of sensation and voluntary motor control in the area of peripheral distribution of more rostral spinal cord segments
• sacral sparing: due to somatotopic organization; Rostand neurons more medial

Question 20

Medial brainstem lesions of midbrain

Answer 20

• oculomotor nerve LMN: same side damage = ipsilateral eye down and out
• Corticospinal tract: opposite limbs with spastic paresis

Question 21

Medial brainstem lesions in pons

Answer 21

• Abducens nerve LMN: same side damage = ipsilateral eye addicted
• Corticospinal tract: opposite limbs with spastic hemiparesis

Question 22

Medial brainstem lesions in medulla

Answer 22

• hypoglossal nerve LMN: same side damage = tongue protrudes toward affected side
• Corticospinal tract: opposite limbs with spastic hemiparesis

Question 23

Lateral brainstem lesion in mid pons

Answer 23

• CN V motor and sensory loss on same side
• pain and temp lost on same side of face
• opposite side of body pain and temperature loss

Question 24

Lateral brainstem lesion in caudal pons

Answer 24

• mostly AICA
• CN VII motor LMN
• CN V sensory

Question 25

Lateral brainstem lesion rostral medulla

Answer 25

• palatial arches and uvula: sensory CN IX and motor CN X

- uvula deviates away from side of LMN lesion

Question 26

Lateral brainstem lesion in midbrain

Answer 26

• no motor symptoms
• face/ body pain, temp, touch all lost on contralateral side
• spinothalamic, medial lemniscus, trigeminothalamic all crossed