Neurology localising lesions

Question 1

what are the segments split up into?

Answer 1

C1-C5
C6-T2
T2-L3
L4-S1

Question 2

Steps involved in localising lesions

Answer 2

1) which limbs are affected
2) does the lesion affect the reflex arcs
3) further accurate localisation
4) are the tail, bladder or anus affected

Question 3

reaction tests (7)

Answer 3

proprioceptive placing (knuckling response)
hopping reaction
hemiwalking
wheelbarrowing
extensor postural thrusting
hip sway
visual and tactile placing

Question 4

UMN vs LMN

• muscle tone
• spinal reflexes
• muscle atrophy

Answer 4

UMN vs LMN

• muscle tone: normal/increase vs decrease
• spinal reflexes: normal/exaggerated vs decreased/absent
• muscle atrophy: little and late (disuse) vs early and severe (neurogenic)

Question 5

C1-C5

• Mentation
• Posture
• Gait
• Reflexes
• Proprioception

Answer 5

• menation: normal
• Posture: normal/wide base stance
• Gait: ataxia/tetraparesis/hemeparesis/hemiplegia (ipsilateral)
• Reflexes: normal in ALL limbs
• Proprioception: deficits in all limbs or one side (ipsilateral)

Question 6

C6-T2

• Mentation
• Posture
• Gait
• Reflexes
• Proprioception

Answer 6

• Mentation: normal
• Posture: normal
• Gait: ataxia/ tetraparesis/tetraplegia/ hemiparesis/hemiplegia (ipsilateral)
• Reflexes: absent/decreased in thoracic limbs, normal in pelvic limbs
• Proprioception: deficits in all or in one side (ipsilateral)

Question 7

T3-L3

• Mentation
• Posture
• Gait
• Reflexes
• Proprioception

Answer 7

• Mentation: normal
• Posture: normal
• Gait: pelvic limb ataxia/ paraparesis/paraplegia
• Reflexes: normal in ALL limbs
• Proprioception: normal in thoracic limbs, absent/decreased in pelvic limbs

Question 8

L4-S1

• Mentation
• Posture
• Gait
• Reflexes
• Proprioception

Answer 8

• Mentation: normal
• Posture: normal
• Gait: pelvic limb ataxia/ paraparesis/paraplegia/ monoparesis/ monoplefia (ipsilateral)
• Reflexes: normal in thoracic limbs, absent/decreased in pelvic limbs
• Proprioception: normal in thoracic limbs, absent/decreased in pelvic limbs

Question 9

How do you assess the involvement of tail, bladder and anus?

Answer 9

• tail paresis/plegia
• dilated anus and reduced perianal reflex
• flaccid and easy to express bladder

Question 10

Grading spinal injury : motor function

Answer 10

normal –> back pain –> weakness –> total paralysis

Question 11

Grading spinal injury: sensory function

Answer 11

normal –> loss of proprioception –> loss of superficial pain perception –> loss of deep pain perception

Question 12

Overall Grading of spinal injury

Answer 12

0: normal
1: pain (no neurological deficits)
2: ambulatory paresis
3: non-ambulatory paresis
4: plegia
5: plegia with absent deep pain sensation