Myelopathies- definitions

Question 1

Differentiate gait abnormalities with LMN vs UMN lesions

Answer 1

LMN dysfunction= steppage gait
UMN dysfunction= circumduction/ spastic gait.
Both caused by weakness of foot dorsiflexion

Question 2

In UMN dysfunction with thoracic myelopathy, which muscles are weaker: (distal/ proximal); (flexor/ extensor); (dorsiflexion/ plantar flexion)

Answer 2

Distal weaker than proximal
Flexor weaker than extensor
Dorsiflexion weaker than plantar flexion

Question 3

In UMN dysfunction with cervical myelopathy, which muscles are weaker: (distal/ proximal); (extensor/ flexor); (supinator/ pronator)

Answer 3

Distal weaker than proximal
Extensor weaker than flexor
Supinator weaker than pronator

Question 4

Somatosensory abnormalities in perineum
No obvious UMN or LMN abnormalities
Can have loss of control of urination, defecation, genital function

Answer 4

Lower sacral myelopathy, cauda equina syndrome

Question 5

Somatosensory abnormalities at the level of the lesion and below
LMN abnormalities at the level of the lesion and UMN abnormalities below the lesion
Can have loss of control of urination, defecation, genital function

Answer 5

Lumbosacral enlargement myelopathy

Question 6

Somatosensory abnormalities of all of the dermatomes inferior to a horizontal line encircling the chest
Spastic paraparesis: LMN abnormalities at the level of the lesion and UMN signs of all myotomes below the lesion
Loss of control of urination, defecation, genital function

Answer 6

Thoracic myelopathy

Question 7

Somatosensory abnormalities of all dermatomes below the level of the lesion
LMN abnormalities at the level of the lesion

Answer 7

Cervical enlargement myelopathy

Question 8

Somatosensory abnormalities of all levels below a horizontal line encircling the neck
Spastic quadriparesis, LMN abnormalities at th elevel of the lesion and UMN abnormalities below the level of the lesion; pronator drift, slowed fine finger movements, respiratory muscle weakness
Loss of control of urination, defecation, genital function

Answer 8

Upper cervical myelopathy

Question 9

Ipsilateral somatosensory abnormalities of all modalities at the level of the lesion; loss of position/ vibration/ fine touch at all ipsilateral dermatomes below the lesion; loss of pain/ temp/ gross touch at all contralateral dermatomes below the lesion
Ipsilateral LMN abnormalities at the level of the lesion; UMN abnormalities at all ipsilateral myotomes below the lesion

Answer 9

Unilateral myelopathy (Brown-Sequard syndrome)

Question 10

Loss of all somatosensory modalities of the ipsilateral dermatome at the level of the lesion
Loss of position, vibration, fine touch from all ipsilateral dermatomes below the lesion
No motor abnormalities

Answer 10

Posterior spinal artery syndrome

Question 11

Bilateral loss of pain/ temp/ gross touch below the level of the lesion
Bilateral LMN abnormalities at the level of the lesion; bilateral UMN abnormalities of all myotomes below the lesion
Loss of control of urination, defecation, genital function

Answer 11

Anterior spinal artery syndrome