The Sensory Super Highway Clinical Challenge

Scenario 1:

A 50-year-old man was involved in a car accident and sustained a spinal cord injury at the T8 level. On clinical examination, the patient exhibits the following findings:

• Loss of fine touch and proprioception in his right leg

• Intact pain and temperature sensation in the right leg

• Intact fine touch and proprioception in the left leg

Question 1:

1. Which specific tract of the spinal cord is affected in this patient?

• Left dorsal column at T8
• Right lateral corticospinal tract at T8
• Left anterior spinothalamic tract at T8
• B. Right dorsal column at T8
• 1. Right anterior spinothalamic tract at T8

1. Question 2:

2. Why does the loss of fine touch and proprioception occur on the same side of the lesion?

• The dorsal column fibers decussate immediately at the level of the spinal cord

• The spinothalamic tract carries fine touch and proprioception

• 1. The injury affects both dorsal and spinothalamic tracts

• The fibers remain ipsilateral until they decussate in the medulla

• 1. Sensory input from the periphery is processed in the spinal cord

Question 3:

Which part of the dorsal column carries sensory information from the lower limb, including the affected right leg?

• Fasciculus Cuneatus

• Medial lemniscus
• Dorsal spinocerebellar tract
• Fasciculus Gracilis

• Lateral leminiscus

Scenario 2: A 60-year-old woman complains of burning pain in her left leg and foot. MRI reveals a tumor compressing the right anterolateral quadrant of the spinal cord at the L2 level.

Question1:

1. Which sensory modalities are primarily affected by this lesion?
   

• Muscle strength and coordination
• Touch and pressure
• Vibration and balance
• Fine touch and pain
• A. Pain and temperature

1. Question 2: Why does the patient experience burning pain in the left leg if the lesion is on the right side of the spinal cord?
   
   

• 1. Tumor compresses both sides of the spinal cord

• Spinothalamic fibers decussate at the level of the spinal cord

• Pain signals are transmitted through the dorsal columns

• Pain perception bypasses the spinothalamic tract

• Spinothalamic fibers cross in the Medulla

Scenario 3: A 45-year-old man presents with a loss of pain and temperature sensation on the right side of his body below the level of T10. He also reports a loss of proprioception and vibration sense on the left side. Motor examination is normal.

Question 1:

1. What type of lesion is this patient most likely experiencing?
   

• Anterior cord syndrome

• Posterior cord syndrome

• Brown-Séquard syndrome

• Complete spinal cord transection

• Central cord syndrome

Question 2: Which sensory deficit is typically observed on the opposite side (contralateral) to the lesion in Brown-Séquard Syndrome?

• C. Loss of pain sensation
• Loss of fine touch sensation

• Loss of vibration sensation

• Loss of crude touch sensation

• Loss of prorioception

1. Question 3: Which sensory deficit is typically observed on the same side (ipsilateral) as the lesion in Brown-Séquard Syndrome?

• Loss of pain sensation

• Loss of balance sensation
• Loss of fine touch

• Loss of temperature sensation

• B. Loss of proprioception

draw the dorsal column