Spinal Lesions

Question 1

hypertonia, weakness hip extension and knee flexion, upgoing plantars

Answer 1

L5 radiculopathy due to L4 lesion

Question 2

1. Wasting, weakness of intrinsic hand muscles - charcot’s
2. Rarely loss of tone and reflexes
3. Loss of pain and temperature, cape and back of head
4. Dissociated sensory loss

Answer 2

usually T1 syrinx/ intramedullary tumor, if loss of reflexes has extended upwards.
Key is dissociated sensory loss - vibration, joint, fine touch still ok
horner’s, cold and swollen hands le main succulente

Question 3

1. Dysarthria
2. Pes Cavus
3. Kyphoscoliosis
4. Cerebellar wide based gait
5. Spasticity
6. Weakness
7. Loss of ankle, knee reflexes
8. Extensor plantars

How would you investigate?

Answer 3

Friedrichs
DDx 
SACDC
Tabes Dorsalis - 
- Argyll Robertson
- IDC due to neuropathic bladder
- charcot feet

Ix:

Question 4

In Summary

Answer 4

Mr XX has presented with altered gait, with examination findings of absent ankle jerks and extensor plantar reflexes.

More detailed examination findings include
Pes Cavus and a wide based gait
Spastic paresis with loss knee and ankle reflexes
Extensor plantars and a sensorimotor neuropathy
He also had an indwelling catheter.

My DDX are
Friedrichs
Tabes
SACDC

I would take a medical social, drug and family history
EMG axonal neuropathy and frataxin gene testing manage with physiotherapy and occupational therapy and offer genetic counselling
investigate with treponemal and specific immunoassay, VDRL and RPR
Treat with penicillin if +ve
Ix B12 deficiency and treat