Neurolocalization with Dr Jukier

Question 1

Proprioception

Answer 1

• Ability to recognize where you are in space
• Requires cortical processing (i.e. the brain)
• Starts in the foot

Question 2

UMN

Answer 2

Any neuron above the area that we are evaluating

Question 3

LMN

Answer 3

• Any neuron we are evaluating at a specific area

Question 4

Paresis

Answer 4

• Difficulty generating gati

Question 5

Plegia

Answer 5

• Loss of VOLUNTARY motor

Question 6

UMN reflexes

Answer 6

• Normal or increased

Question 7

LMN reflexes

Answer 7

• Decreased

Question 8

Which reflexes evaluate the thoracic limb?

Answer 8

• WIthdrawal reflex
• Extensor carpi radialis reflex
• Triceps reflex
• Musculocutaneous reflex

Question 9

Pelvic limb reflexes

Answer 9

• Patellar reflex
• Withdrawal reflex
• Cranial tibial reflex
• Gastrocnemius reflex

Question 10

C1-C5 lesions

• Which limbs are affected?

Answer 10

• Tetraparesis to tetraplegia
• Normal to increased reflexes in all four limbs
• Increased muscle tone

Question 11

C6-T2 lesions

• Which limbs are affected?

Answer 11

• Tetraparesis to tetraplegia
• LMN thoracic limbs (decreased reflexes and decreased muscle tone)
• UMN pelvic limbs (normal to increased reflexes and increased/normal muscle tone)

Question 12

T3-L3 lesions

• Which limbs are affected?

Answer 12

• Thoracic limbs are normal
• Pelvic limbs have paraparesis/plegia
• Reflexes are normal to increased
• Muscle tone in pelvic limbs is normal to increased

Question 13

L4-S1 myelopathy

• Which limbs?

Answer 13

• Thoracic limbs are normal
• Paraparesis to paraplegia
• Decreased to absent reflexes
• Decreased muscle tone

Question 14

What are the two ways to assess pain?

Answer 14

• SPinal palpation

- Limb pain sensation

Question 15

When to do limb pain sensation?

Answer 15

• Only if the limb is plegic!

Question 16

Superficial pain

Answer 16

• Pinch webbing of toes

Question 17

Deep pain

Answer 17

• Pinch the toe

Question 18

When does spinal shock occur?

Answer 18

• Complex process, not clearly understood

Question 19

What are the 3 phases in people of spinal shock?

Answer 19

• Acute phase 0-24 hr (areflexia/hyporeflexia)
• Phase 2 at 1-3 days post injury –> some simple reflexes return, patellar remains absent

Phase 3 at 4-30 days after injury –> more reflexes return and should normalize

Question 20

What does spinal shock look like?

Answer 20

• They can have LMN signs downstream without L4-S1 lesions
• It’s a thing where they look like they are L4-S1, but actually it’s more like T3-L3
• Looks like LMN

Question 21

Neurolocalization:

• non-ambulatory paraparesis, normal reflexes in the pelvic limbs

Answer 21

T3-L3

Question 22

Neurolocalization:

• non-ambulatory tetraparesis
• Decreased withdrawal in the TL, normal in the PL

Answer 22

• C6-T2

Question 23

Non-ambulatory paraplegia

• Decreased PL withdrawals and patellar reflexes

Answer 23

• L4-S1

Question 24

Non-ambulatory paraplegia

Normal reflexes

Answer 24

• T3-L3

Question 25

How can you further localize lumbosacral intumescence?

Answer 25

• based on the reflexes

Question 26

Localization for absent patella and normal withdrawal?

Answer 26

L4-L6 (femoral nerve)

Question 27

Localization for absent withdrawal and normal patellar?

Answer 27

• L6-S1 (sciatic distribution)

- Always localize to L4-S1/3 then add a note that it may be L6-S1

Question 28

Pseudohyperreflexia again

Answer 28

• Absent withdrawal might have hyper-reflexive patellar reflex and look UMN

Question 29

Where do you start pinching with the cutaneous trunci reflex?

Answer 29

• At the wings of the ilium

Question 30

Steps of cutaneous trunci innervation

Answer 30

1. Pinch skin
2. SIgnal enters cord ~ segments cranially
3. Signal moves cranially on both sides of the cord
4. Synapses onto neurons in C8-T1
5. Neurons from C8-T1 send axons forming the lateral thoracic nerve
6. Axons innervate cutaneous trunci