Somatosensory Review

Question 1

Modality of Dorsal column/ ML

Answer 1

fine touch, vibration, limb position

Question 2

Modality of Anterolateral

Answer 2

pain/temp/crude touch

Question 3

Major tract of Dorsal column/ML

Answer 3

F. gracilis
F. cuneatus
–> at medulla, both enter Medial lemniscus

Question 4

Major tract of Anterolateral tract

Answer 4

• spinoreticular
• spinothalmic
• spinomesenphalic

Question 5

Placement of tract for Dorsal Column/ML

Answer 5

Located dorsally, middle part of dorsal sp cd on both sides—- posterior fasciculus

Question 6

Placement of tract for Anterolateral

Answer 6

Ventral, lateral sp cd on both sides

Question 7

Diversity of pathways: Dorsal Column

Answer 7

1 path to medulla (through sp cd)

1 major path to thalamus

Question 8

Diversity of pathway for anterolateral system

Answer 8

3 major that run together in sp cd but terminate in dif places
Spinothalmic: thalamus
Spinoreticular: reticular formation in medulla or pons
Spinomesenphalic: midbrain PAG, superior colliculus

Question 9

Crossing pt for Dorsal column/ML

Answer 9

X to opp side in ONE place = Sensory decussation in caudal medulla where they then synapse and head up Medial lemniscus

Question 10

Crossing pt for Anterolateral system

Answer 10

X to opp side in sp cd and cross all along at levels near where primary afferents enter (w/in 2-3 segments of entering)

Question 11

Results of damaged sp cd: Dorsal Column

Answer 11

Ipsilateral loss of tactile, vibration, jt position below level of lesion

Question 12

Result of damaged sp cd: Anterolateral

Answer 12

Contrlateral loss of pain and temp w/in 2-3 cord segments of lesion

Question 13

By the ________ and _______ both pain and touch fibers are simular and all information has crossed

Answer 13

thalamus and cortex

Question 14

Lesions in thalamus and cortex for both pain and fine touch will produce ________ deficiets

Answer 14

contralateral

Question 15

Somatosensory information goes _____ thus lesion will cause loss of sensation _____

Answer 15

up

below

Question 16

A patient presenting with alternating sensory loss is key for what kind of lesion

Answer 16

Unilateral lesions in spinal cord

Question 17

Sugical cutting of dorsal root
Use for pain relief
cut dorsal roots that innervate affected dermatome

Answer 17

Rhizotomy

Question 18

Rhizotomy will result in

Answer 18

loss of fine discr, jp, vibration AND pain and temperature in just dermatome of affected cut roots IPSILATERAL to lesion
-pain often reoccurs

Question 19

Surgical cutting of anterolateral fiber tracts in cord for pain relief in terminally ill
cut 2-3 above area you want to relieve pain

Answer 19

Cordotomy

Question 20

Cut one side anterolateral tract for cordotomy you will lose pain/temp on the _____

Answer 20

contrallateral side

Question 21

Loss of fine touch/pain temp in specific dermatome ______ results in loss of feeling in foot, back of calf and shin

Answer 21

L4/L5/S1

–Herniated disk

Question 22

Glove and stocking deficeits result from

Answer 22

Peripheral neuropathy (diabetes)
affects multple derms and d/t

Question 23

A herniated disk in L4/L5 will affect

Answer 23

L5 spinal nerve

Question 24

Bilateral loss of all sensation below lesion and loss of motorl control and voluntary musle contration below lesion

Answer 24

Complete cord transection

Question 25

causes of cord transection

Answer 25

trauma/tumor/bullet or knife wound

Question 26

Bilateral loss of pain and temp below lesion and often weakness, ususally spares DCs so fine discriination and jp is okay

Answer 26

Anterior cord syndrome

Question 27

cause of anterior cord syndrome

Answer 27

anterior spinal artery syndrome frxt vertebrae, contusion of sp cd infarct or ischemia form anterior spinal artery, emoblism or compresion of artery

Question 28

loss of fine touch and discrimination, vibration and joint position on both sides with pain and temp okay

Answer 28

posterior cord syndrome

Question 29

posterior cord syndrome affects

Answer 29

dorsal columns

Question 30

caues of post. cord syndrome

Answer 30

``` tabes dorsalis (demyl or degen from syphalis) -tumor in dorsal area trauma ```

Question 31

Central cord syndrome: small lesion: usually cervicle ressults in

Answer 31

bilateral loss of pain and temp in derms of spinal levels WITH THE LESION and sparing of dorsal columns and tactile sense as well as sparing anterolateral tracts below lesion

Question 32

bilateral loss of pain and temp in derms of spinal levels WITH THE LESION and sparing of dorsal columns and tactile sense as well as sparing anterolateral tracts below lesion

Answer 32

Central cord syndrome

Question 33

central cord syndrome affects where?

Answer 33

2nd order anterolateral fibers that are crossing

Question 34

Syringomyelia causes

Answer 34

central cord syndrome loss of pain and temp on level of lesion bilaterally only cyst in the central canal

Question 35

bilateral loss of fine discrimination, joint position below lesion can affect motor neurons in ventral horn so loss of motor control can affect anterolateral tracts--> bilateral loss of pain/temp below lesion may bet sacral sparin

Answer 35

large central cord syndrome

Question 36

why are sacral regions spared in large central cord syndrome

Answer 36

because they are on the periphery

Question 37

Hemisection of cord called

Answer 37

brown-sequard syndrome

Question 38

fine discriniation and pain/temp lost on atlernating sides ipsi loss of fine touch/discrimination contra loss of pain/temp w/in 2-3 segments below lesion loss of ALL sensation at level of lesion ipsilateral paralysis and loss of muscle control

Answer 38

Brown-sequard syndrome or hemisection of cord

Question 39

hemisection of cord

Answer 39

fine discriniation and pain/temp lost on atlernating sides ipsi loss of fine touch/discrimination contra loss of pain/temp w/in 2-3 segments below lesion loss of ALL sensation at level of lesion ipsilateral paralysis and loss of muscle control

Question 40

contralateral loss of fine discriminiation AND | contralateral loss of pain/temp must be lesion in

Answer 40

VPL of thalamus

Question 41

face intact | loss of pain/temp/fine touch on contralateral side of body means

Answer 41

VPL of thalamus lesion | VPM spared

Question 42

contralateral loss of fine discrimination pain/tem in face and head while sesnation in body intact

Answer 42

VPM lesion

Question 43

lesion slightly lateral to the middle of the SI cortex results in

Answer 43

loss of fine touch/pain/temp on contralateral side of body on HAND AND WRIST

Question 44

lesion very laterally of the SI cortex results in

Answer 44

loss of fine touch/pain/temp on contralateral side of FACE/tongue

Question 45

Brainstem lesion in lateral medulla results in

Answer 45

interuption of anterolateral pathways and spinal trigeminal tract or nucleus

Question 46

loss of pain/temp body on CONTRA side loss in pain/temp face IPSlateral loss loss of pain/temp on Contralateral side too

Answer 46

lesion in lateral medulla | the fine touch on face is spared bc that doesn't descend to the spinal tract like the pain fibers do

Question 47

If entire 1/2 of medulla is lesioned (opposed to just the lateral portion)

Answer 47

loss in fine touch in body on contralateral side in addition to: loss of pain/temp body on CONTRA side loss in pain/temp face IPSlateral loss loss of pain/temp on face Contralateral side too

Question 48

if you see olives and pyramids we know we are in

Answer 48

rostral medulla

Question 49

Lesion in the medial lemniscus on the rostral medulla on left side of body results in

Answer 49

loss of vibration on right side of body below level of neck - -face doesn't come in until level of pons - -the fibers have already crossed by this pont

Question 50

GSW interupts the entire left half of sp cd at thoracic C6, we see loss of

Answer 50

loss of pain and temp on right | loss of fine touch and discrimination on left

Question 51

Pt with loss of pain and temp sensation on right half of body below level of neck and loss of fine discrmination on right half of body from neck below.. Pt has infarct where

Answer 51

left VPL