Tracts of the spinal cord

Idara C.E.

Anterolateral System

Tract arrangement in the spinal cord

medulla

Midbrain

Dorsal column – medial lemniscal system

Dorsal column –medial lemniscal system

Monosynaptic reflex

Ventral and Dorsal Spinocerebellar Tracts and Cuneocerebellar Tracts

Relationship of the spinal cord segments to vertebral numbers

7

Corticospinal Tract

Cerebrum

Case 1

Mrs. sauna was rushed to the ER after a motor vehicle accident in which she sustained severe injuries with spinal cord involvement.

On examination, the physician noticed that she didn’t respond to pin- prick from the level of the umbilicus downwards on the left and touch, vibration sensations were lost on the right at some segments above the umbilicus downwards.

1. What tracts are involved?2. Where is the injury site (what level and side)?

2

One of these sensations is not conveyed by the dorsal column?

a. Proprioceptionb. Vibrationc. Heatd. Discriminative touch

3

During a neurologic examination, a patient cannot tell with her eyes closed if the neurologist flexed or extended her fingers. There is likely damage to

a. Anterior spinothalamic tractb. Anterior spinocerebellar tractc. Cuneocerebellar tractd. Fasciculus gracilise. Fasciculus cuneatus

4. A 25 year old male presented to the emergency room,

transported by ambulance. He was stabbed in the posterior mid-thoracic region. Admission blood pressure was 90/60. Pulse was 120 per minute. He was ashen and appeared to be in shock. Chest x-ray showed a left sided pneumothorax (collapsed lung) and associated left sided hemothorax (bleeding in the chest). Examination revealed a 2 inch stab wound to the back at about the level of the T6. Neurologic exam revealed complete loss of left sided motor function below T6 and loss of sensation on the right below T6. Admission hemoglobin was 9.6 gms% and hematocrit is 37. He began to show signs of respiratory distress. The patient was intubated (breathing tube) and placed on an assisted ventilation respirator

5.

A 4o year old man was brought to the clinic with bilateral weakness of both arms, he was involved in a motor vehicle accident and he stated that his head was thrown backwards.

Physical examination revealed flaccid paralysis of his arms with absent deep tendon reflexes but his lower extremities was normal.

Weeks later, his upper limbs showed signs of spasticity, hyperreflexia but there was no return of sensory sensation.

6.A 17 year old male presents to your office with

difficulty walking. On physical examination, he has thoracic kyphoscoliosis and multiple small scars on his hands. When asked about these, he reports that he repeatedly accidentally burns his hands because he “ cannot feel the heat”. Neurologic exams reveal that his biceps reflex is 1+ and patella reflex 3+ bilaterally, as well as decreased muscle strength in the upper and lower extremities. What’s the cause of his complaint?

a. Amyotrophic lateral sclerosisb. Guilain-Barre Syndromec. Syringomyeliad. Multiple Sclerosis