Localising Spinal Cord Lesions

Question 1

What steps must be completed to allow localisation of spinal cord lesion?

Answer 1

(Mentation)
Gait
Proprioception + postural reactions
(Cranial nerves)
Spinal reflexes including muscle tone and strength
Pain perception

Question 2

What deficits does a C1-C5 lesion produce?

Answer 2

All 4 limbs equally affected
UMN gait
UMN paresis
decreased proprioception
postural reaction deficits

Question 3

What deficits does a C6-T2 lesion produce?

Answer 3

LMN forelimbs - weakness, reduced reflexes, rapid muscle atrophy and short, choppy gait

UMN hindlimbs - increased extensor tone, increased reflexes, (muscle atrophy if chronic) and classic UMN gait

Question 4

What spinal cord segments are implicated with Horner’s syndrome?

Answer 4

T1-T2

Question 5

What could a severe lesion at C5-C7 cause?

Answer 5

Diaphragmatic paralysis- phrenic nerve originates C5-C7

Question 6

What deficits does a T3-L3 lesion produce?

Answer 6

UMN paresis
UMN gait

As compression becomes more severe ataxia-assisted walking-paraplegia-UMN bladder-loss of deep pain

Question 7

What is UMN bladder?

Answer 7

Lesions cranial to L5 vertebral body (sacral segments) cause reflex hyperexcitability of urethral sphincter-

A large bladder that is impossible to express

Question 8

If motor function is lost due to T3-L3 lesions, what must be checked?

Answer 8

Presence of UMN bladder and urine retention

Question 9

What deficits does a L4-S3 lesion produce?

Answer 9

LMN paresis
LMN gait
Bladder dysfunction
Paresis/paralysis of anal sphincter 
Low tail carriage

Question 10

What is a typical UMN paresis?

Answer 10

Delay in onset of movement, long stiff stride.

Release of inhibition on LMNs- apparent in extensor muscles causing spastic paresis

Question 11

What is a typical LMN paresis?

Answer 11

Only paresis- not ataxia

Difficulty in weight bearing- either a choppy gait or complete inability to support weight