Regional lesions in SC and Brainstem

Question 1

what are the structures affected and clinical manifestation

Spinal Cord Hemisection or Brown-Sequard Syndrome

Answer 1

(half of SC section lesioned)
Structures Affected:
1. Fasiculus Gracilus(lumbar) & Fasciculus Cuneatus
2. Lateral Corticospinal tracts
3. Anterolateral system (spinothalamic tracts)

Clinical Manifestations:
1. Ipsilateral loss of fine touch, positional and vibratory sense below this [cervical,thoracic, lumbar] level
2. Ipsilateral spastic paresis, hypertonia/relflexia, below this [cervial, thoracic, lumbar] level
3. contralateral loss of pain & temp. Below this [cervical, thoracic, lumbar] section

lumbar only has fasciculus gracilus for #1 above.

Question 2

structures affected and clinical manifestations

Syringomyelia

Answer 2

Structures Affected:
1. anterior white commussure
2. anterior horn

clinical manifestations:

1. bilateral loss of pain and temp. at this [cervical,lumbar] level ONLY
2. bilateral flaccid paralysis, hypotonia, hyporeflexia, to this [cervical,lumbar] level ONLY

Question 3

structures affected and clinical manifestations

Posterior Column Disease (Tabes Doralis)

Answer 3

Strctures Affected:
1. Posterior funiculi (facilulus cuneatus & gracilus[lumbar])

Clinical manifestations:
1. bilateral loss of fine touch, positional and vibratory sense below this [cervial,lumbar] level

lumbar section only fasciculs gracilus affected in #1 above.

Question 4

structures affected and clinical manifestations

Vitamin B12 Neuropathy

Answer 4

Structures affected:
1. posterior funiculi (fasciculus cuneatus & gracilus)
2. anterior and posterior spinocerebellar tracts
3. lateral corticospinal tracts

Clinical manifestations:
1. bilateral loss of fine touch, positional and vibratory sense below this cervical level
2. ataxia (loss of motor coordination)
3. bilateral spastic paresis, hypertonia/reflexia below this cervical level

Question 5

structures affected and clinical manifestations

Poliomyelitis

Answer 5

Strucutres Affected:
1. anterior horns (lower motor neurons)

clinical manifestations:
1. bilateral flaccid paralysis hypotonia/reflexia, atrophy at this lumbar section only

Question 6

structures affected and clinical manifestations

Amyotrophic lateral Sclerosis (ALS) a.k.a. Lou Gehring’s disease

Answer 6

Structures affected:
1.anterior horns (LMN)
2.lateral corticospinal tracts

clinical manifestations:
1.bilateral flaccid paralysis hypotonia/reflexia, atrophy at this cervical section only
2.bilateral soactic paresis. hypotonia/reflexia below this cervical level

Question 7

structures affected and clinical manifestations

Anterior Spinal Artery Thrombosis

Answer 7

Strctures Affected:
1. anterolateral system (spinothalamic tracts)
2. lateral corticospinal tracts

Clinical Manifestations:
1. bilateral loss of pain and temp. below this cervical section
2. bilateral spastic paresis, hypertonia/reflexia, below this cervical level

Question 8

structures affected and clinical manifestations

Medial Medullary syndrome

Answer 8

Strcutures affected:
1. corticospinal tracts
2. medical lemniscus
3. hypoglossal nerve

clinical manifestations:
1. contralateral spastic paresis, hypertonia/reflexia, neck and below (body)
2. contralateral loss of fine touch, positional and cibratory sense neck and below (body)
3. ipsilateral atrophy of the tongue

(frog brainstem slide)

Question 9

Lateral medullary syndrome a.k.a. Wallenberg’s syndrome (PICA syndrome)

Answer 9

Structures Affected:
1. anterolateral system (ALS)
2. spinal trigeminal nucleus & tract (STN & STT)
3. Nucleus Ambiguus (NA)
4. Inferior cerebellae peduncle (ICP)
5. vestibular nuclei
6. descending hypothalamospinal tracts

clinical manifestations:
1. contralateral loss of pain & temp. from the body
2. ipsilateral loss of pain & temo from the face
3. ipsilateral dysarthria &loss of gag reflex
4. ipsilateral ataxia
5. vertigo, nausea, nystagmus
6. ipsilateral Horner’s syndrome: ptosis, miosis, hemianhydrosis

Question 10

structures affected and clinical manifestations

Medical pontine syndrome

Answer 10

structures affected:
1. corticospinal tracts
2. medical lemniscus
3. adbucens nerve

clinical manifestations:
1.contralateral spastic paresis, hypertonia/reflexia, neck and below (body)
2.contralateral loss of the fine touch, positional and vibratory sense neck and below (body)
3.ipsilateral medical strabismus

Question 11

structures affected and clinical manifestations

Medial Midbrain syndrome
a.k.a. Weber’s syndrome, or superior alternating hemiplegia

Answer 11

structures affected:
1. corticospinal tracts
2. occulomotor nerve

clinical manifestations:
1. contralateral spastic paresis, hypertonia, reflexia, neck and below (body)
2. ipsilateral lateral strabismus

Question 12

structures affected and clinical manifestations

middle alternating hemiplegia

Answer 12

structures affected:
1. corticospinal tracts
2. abducens nerve

clinical manifestations:
1. contralateral spastic paresis, hypertonia/reflexia, neck and below (body)
2. ipsilateral medial strabismus

Question 13

structures affected and clinical manifestations

inferior alternating hemiplegia

Answer 13

structures affected:
1. corticospinal tracts
2. hypoglossal nerve

clinical manifestations:
1. contralateral spastic paresis, hypertonia/reflexia, neck and below (body)
2. ipsilateral atrophy of the tongue