Session 6 - Group Work Flashcards
1) A patient has suffered from a spinal cord injury which has led to complete bilateral destruction of the C3 and C4 cord segments.
a) Where will the patient experience sensory disturbance?
Across the clavicle, shoulder deltoids etc.
C3/C4 dermatome
1) A patient has suffered from a spinal cord injury which has led to complete bilateral destruction of the C3 and C4 cord segments.
b) Which modalities will be lost, and where? Think carefully!
Loss of all 7 sensory modalities in the C3 and C4 cord segments and the motor function
1) A patient has suffered from a spinal cord injury which has led to complete bilateral destruction of the C3 and C4 cord segments.
c) Where will the patient experience paralysis?
Diaphragm
Everything below C3 will be affected (all the dermatomes)
The patient will have to be ventilated to be alive, because his diaphragm has been affected.
Initially he will have a flaccid paralysis (loss of descending inhibition in the lower motor neurone), but then it will develop into the spastic paralysis (due to upper motor neurone - affecting . So the patient, if they lived, will encounter spastic paralysis.
1) A patient has suffered from a spinal cord injury which has led to complete bilateral destruction of the C3 and C4 cord segments.
d) Will there be upper or lower motor neurone signs, or both? If so, where?
This is the idea of spinal shock. Immediately after an upper motor neurone lesion, lower motor neurones actually decrease their level of activity. This means that in the early phase of a stroke for example, a patient will actually have hypotonia and hyporeflexia. Only after a few days to weeks will this then convert into the classic UMN syndrome. The reason for this is obscure, but I like to think of the LMN getting a bit ‘depressed’ after it has been deprived of its inputs!
2) A patient has suffered from a complete spinal cord injury due to a sharp transection sitting directly between the C3 and C4 cord segments.
a) Where will the patient experience sensory disturbance?
C4 sensory dermatomes downwards
2) A patient has suffered from a complete spinal cord injury due to a sharp transection sitting directly between the C3 and C4 cord segments.
b) Which modalities will be lost, and where? Think carefully!
All sensory and motor modalities from C4 downwards
2) A patient has suffered from a complete spinal cord injury due to a sharp transection sitting directly between the C3 and C4 cord segments.
c) Where will the patient experience paralysis?
From C4 downwards - the diaphragm may be spared because C3 is still intact, but it would be much weaker
2) A patient has suffered from a complete spinal cord injury due to a sharp transection sitting directly between the C3 and C4 cord segments.
d) Will there be upper or lower motor neurone signs, or both? If so, where?
Just at the level of C3 you get a lower motor neuron sign, but everything below C4 you will have both upper and lower motor neuron lesions
3) A 63 year old man presents to his GP with a 3 month history of increasing difficulty at work. He has a manual job and complains of difficulty in performing manual tasks due to weakness in his hands. He has also noted some mild slurring of speech.
The GP performs a neurological examination and notes wasting and fasciculation of the tongue. He also has weakness with wasting and fasciculation in the small muscles of his hands and in his lower limbs bilaterally. The only other finding of note is bilateral up-going plantar reflexes.
a) The clinical picture is suggestive of motor neurone disease (MND). Which population of motor neurones has been predominantly affected?
Lower Motor Neurons, because the patient is demonstrating fasciculations which are involuntary contractions of muscle. This is thought to be due nACh upregulation in the muscle.
Additionally, he also has demonstrated wasting of the muscles of the hands because of the loss of trophic factors to that muscle.
3) A 63 year old man presents to his GP with a 3 month history of increasing difficulty at work. He has a manual job and complains of difficulty in performing manual tasks due to weakness in his hands. He has also noted some mild slurring of speech.
The GP performs a neurological examination and notes wasting and fasciculation of the tongue. He also has weakness with wasting and fasciculation in the small muscles of his hands and in his lower limbs bilaterally. The only other finding of note is bilateral up-going plantar reflexes.
b) Why does he have slurred speech?
Slower neurones (demyelination) so APs not firing as rapidly as normal, hence lower speech
Also weaker muscles?
3) A 63 year old man presents to his GP with a 3 month history of increasing difficulty at work. He has a manual job and complains of difficulty in performing manual tasks due to weakness in his hands. He has also noted some mild slurring of speech.
The GP performs a neurological examination and notes wasting and fasciculation of the tongue. He also has weakness with wasting and fasciculation in the small muscles of his hands and in his lower limbs bilaterally. The only other finding of note is bilateral up-going plantar reflexes.
c) Do we know what causes MND?
Although the disease progression is fairly well known, the absolutely causes of MND are not well known. It is thought to be a combination of environmental, genetic and lifestyle factors however it is not fully known.
4) A 73 year old woman presents with a tremor, predominantly affecting her left hand. She is also noted to have increased tone affecting both sides of the body, but particularly pronounced on the left side. She walks with short, shuffling steps and finds it difficult to initiate movements.
a) Precisely which region of the brain is she likely to have neurodegeneration in? Which side has lost most
neurones?
A loss of neurones in the basal ganglia (substantia nigra) has reduced the levels of dopamine produce. This is bilateral, but worse within the right hemisphere.
4) A 73 year old woman presents with a tremor, predominantly affecting her left hand. She is also noted to have increased tone affecting both sides of the body, but particularly pronounced on the left side. She walks with short, shuffling steps and finds it difficult to initiate movements.
b) Which parts of the diagram below represent grey matter structures? Which parts represent the axons?
Grey matter - All the blue boxes
Axons - Arrows
4) A 73 year old woman presents with a tremor, predominantly affecting her left hand. She is also noted to have increased tone affecting both sides of the body, but particularly pronounced on the left side. She walks with short, shuffling steps and finds it difficult to initiate movements.
c) Use the diagram to explain why she has paucity (reduction) of movement.
If you lose dopamine then you will not get as much excitation so we get reduced movement
(At rest you are inhibiting the thalamus - you don’t want it always firing. When we initiate movement we take the inhibition away for the thalamus to activate. We want dopamine when we have movement, and we don’t want dopamine when there isn’t)
5) A 29 year old woman presents with unsteady gait and vertigo, which has been gradually getting worse over the last 3 months. Examination reveals impaired co-ordination in the upper and lower limbs, particularly severe on the right hand side. She is also noted to have nystagmus and mildly slurred speech.
a) Where is the lesion most likely to be, and why?
Right cerebellar hemisphere because of the nystagmus
