9. Somatosensory 4

Front 1

Main difference in how spinal cord lesions affect loss of
-Tactile/discriminative sense
-Pain/temp sense

Back 1

-Dorsal column lesions cause loss AT the lesion or just below
-Anterolateral lesions cause loss 2-3 segments below

Front 2

What will result from lesion of one entire SIDE (1/2) of the spinal cord?

Back 2

-Loss of ipsilateral dorsal columns JUST BELOW the cut
-Loss of contralateral anterolateral columns 2-3 segments BELOW the cut
-Loss of SOME contralateral crude touch

Front 3

If a patient has ALTERNATING sensory loss (fine touch on one side, pain/temp on the other) what should you think?

Back 3

Unilateral lesion

Front 4

What do lesions in the brainstem above the caudal medulla result in?

Back 4

Contralateral loss of BOTH pain/temp and fine touch.

Front 5

What is dorsal rhizotomy?

Back 5

Cutting of the dorsal nerve ROOTS

Front 6

What does dorsal rhizotomy result in?

Back 6

Anesthesia of all sensation from the same side of body, in the dermatome of the level cut.

Front 7

Does cutting one spinal cord segment remove all sensation from a dermatome?

Back 7

No; there is overlap

Front 8

To relieve pain in the T7 dermatome where would you cut?

Back 8

T6-T8

Front 9

Cordotomy is what?

Back 9

Cutting the anterolateral tracts to remove pain/temp sensation from the opposite side, 2-3 segments below the cut.

Front 10

Where should you make the cut when doing a cordotomy?

Back 10

2-3 levels above where you want pain/temp loss.

Front 11

Is cordotomy usually unilateral or bilateral?

Back 11

Bilateral

Front 12

What is the result of dorsal rhizotomy and cordotomy?

Back 12

Pain often recurs in both.

Front 13

What is loss of pain/temp and discrimination in only PARTS of limbs indicative of?

Back 13

Peripheral nerve lesions

Front 14

3 common causes of peripheral nerve lesions:

Back 14

-Diabetes
-Neuropathy
-Trauma

Front 15

Complete cord transection results in:

Back 15

Complete loss of all sensation on both sides of the body + loss of motor control

Front 16

2 Diseases that can cause complete cord transection:

Back 16

-Tumor
-Multiple sclerosis

Front 17

What is the most typical cause of cord transection?

Back 17

Penetrating trauma - knife wounds or bullets.

Front 18

What is anterior cord syndrome?

Back 18

A lesion of the anterolateral tracts

Front 19

2 Typical causes of anterior cord syndrome:

Back 19

1. Fractured vertebrae
2. Infarct from a blood clot

Front 20

Deficit in anterior cord syndrome:

Back 20

Bilateral loss of anterolateral info

Front 21

If anterior cord syndrome is caused by a blood clot, what artery would this be in?

Back 21

The anterior spinal artery

Front 22

What is posterior cord syndrome?

Back 22

Lesion of the dorsal columns

Front 23

What is the most common cause of posterior cord syndrome?

Back 23

2ndary syphilis - tabes dorsalis

Front 24

Central cord syndrome will affect:

Back 24

Pain/temp from both sides, only at the dermatome where the lesion is.

Front 25

3 causes of central cord syndrome:

Back 25

-syringomyelia
-gliosis
-hyperextension of the spine

Front 26

What spinal levels most often will develop central cord syndrome?

Back 26

-Lower Cervical (most)
-Upper thoracic

Front 27

What is the typical general sensory loss patients with central cord syndrome that is just a SMALL lesion will present with?

Back 27

Capelike loss of pain/temp in the upper arms and shoulders.

Front 28

How is central cord syndrome with a LARGE lesion different from a small lesion?

Back 28

Can affect the dorsal columns as well as anterolateral and motor.

Front 29

Who had large lesion central cord syndrome and what caused it?

Back 29

Christopher reeve; hyperextension caused a fluid-filled cyst in the cord.

Front 30

What is Brown-Sequard syndrome?

Back 30

Hemisection of the spine - loss of 1/2 of cord. Ipsilateral dorsals, contralateral anterolaterals

Front 31

Unilateral lesion of Rostral Medulla loses:

Back 31

Contralateral everything from body

Front 32

Unilateral lesion of VPL loses:

Back 32

Contralateral everything from BODY only.

Front 33

Result of unilateral lesion of VPM:

Back 33

Contralateral loss of fine touch and pain/temp from face/head

Front 34

Result of unilateral lesion in Primary cortex S1:

Back 34

Contralateral loss of everything in body and/or face (depending on if lesion is more medial or lateral)

Front 35

Where in the medulla does a lesion have to be to affect FACE as well as anterolateral tracts?

Back 35

LATERAL

Front 36

What deficit will result from lesion of the medulla in its lateral portion?

Back 36

Contralateral anterolateral loss
Ipsilateral facial loss of ONLY pain/temp (descending afferents haven't crossed yet)

Front 37

Why isn't fine touch of the face affected by a lateral medulla lesion?

Back 37

Because these enter the spinal cord at the pons, and most immediately cross over to the trigeminal lemniscus to ascend.

Front 38

So unilateral lesion of lateral medulla will result in loss of:

Back 38

-Ipsilateral facial pain/temp
-Contralateral body pain/temp

Front 39

most likely site of an infarct:

Back 39

VPL