Diagnosing sites and levels of Spinal Cord Injuries based on Sensory Deficits
Consult Fig. 7-19 p. 201 12th Edition of Widmaier et al. textbook.
Determine 1) whether injury is at high cervical or mid-thoracic level and 2) the regions of white matter damaged.
Case 1.
Patient has normal pain and temperature sensations in hands.
No touch sensations or proprioception in hands and feet.
Case # 2
Normal pain and temperature sensations in hands and feet.
Normal touch and proprioception in hands.
Loss of touch and proprioception in both feet.
Case # 3
All sensations normal except for a loss of touch and proprioception from the left hand and left foot.
Case # 4
All sensations normal except loss of pain and temperature from the right foot.
Case # 5
All sensations normal except loss of pain and temperature sensation from both feet.
Case # 6
Loss of pain and temperature in right hand and right foot.
Loss of touch and proprioception from left hand and left foot.
Case # 7
All sensations normal in both hands.
No touch or proprioception from left foot.
Normal Pain and temperature sensations from left foot.
Normal touch and proprioception from right foot.
No pain or temperature sensitivity in right foot.
Know site of decussation, locations of 1st, 2nd, and 3rd order sensory neurons in pain-temperature & touch/proprioception pathways.
Spinothalamic tract = anterolateral tract for pain and temperature ascends contralaterally in spinal cord.
Dorsal columns carry touch and proprioception ipsilaterally in the spinal cord to the dorsal column nuclei in medulla which have cell bodies of second-order sensory neurons.
For both pathways, it is the second order sensory neurons whose axons cross (decussate) the midline.
Case 1 high cervical or mid thoracic Case 2 high cervical or mid thoracic
Case 3 high cervical or mid thoracic Case 4 high cervical or mid thoracic
Case 5 high cervical or mid thoracic Case 6 high cervical or mid thoracic
Case 7 high cervical or mid thoracic Spare high cervical or mid thoracic