PBL 1

Question 1

A patient is not noticing temperature in both hands, but still feels touch. Hair loss, recently developed fear of heights.

We found there was no vibratory sensation from the right leg up until high thoracic level (T1). The patient has damage to….

Answer 1

DORSAL COLUMN
As it affects the right side, the lesion is at right high thoracic levels. Sensory info from anything under that won’t reach,as there is an “obstacle” in the way.
Crossing for vibration occurs in the brainstem

Question 2

Side and level of the injury (related to the loss of vibration)

Answer 2

Right high dorsal

Question 3

Side and level of injury (related to the loss of thermal notice)

Answer 3

Lateral spinothalamic fibers at the decussation
IT IS PART OF THE ANTEROLATERAL SYSTEM

Question 4

The patient also has no reflexes on upper right limb, and exalted reflexes on lower right limb.
1. What does this mean?
2. Where is the corticospinal path injured?

Answer 4

1. Either the motor or sensory neurons might be injured if he has no reflexes.
   If reflexes are exalted, it means that upper motor neuron is injured and the inferior one gets crazy.
2. Cervical spinal cord (injury of the lower neuron of the arm, and upper neuron of the leg), specifically Central-spinal, levels C2-T3, with right extension

Question 5

Tendon reflexes are …

Answer 5

Monosynaptic