12/5/2023 0 Comments Post void residual cauda equinaLoss of bowel/bladder/sexual function (especially: acute urinary retention).Gram-positive bacteremia (especially endocarditis) unexplained fever.Known malignancy (especially metastatic).This may be harder than it sounds, because spinal cord disease is uncommon and not generally high on our list of considerations. The first step towards diagnosis and therapy is recognizing that the patient has some sort of spinal cord pathology. Autonomic nerves run within the grey matter, near the center of the cord.Thus, diseases affecting the anterior horn of the spinal cord cause flaccid paralysis. The ventral (anterior) horns of the grey matter contain lower motor neurons.Most of the additional pathways shown here cannot be tested clinically, so they cannot assist in lesion localization. The figure below shows more anatomic detail.Thus, a central spinal cord lesion may cause neurologic deficits in a descending order. Nerves to the cervical cord are located closest to the middle of the cord, whereas nerves to the sacrum are located farthest towards the edges of the spinal cord.Different involvement of these three tracts explains the major patterns of spinal cord injury (e.g., hemicord injury causing Brown-Sequard syndrome more on this below). Three major tracts run through the spinal cord, as shown below.Great toe dorsiflexion (movement towards the shin).īasic functional anatomy of the spinal cord.Toe: Metacarpal and interphalangeal extension.Hip extension, abduction, internal rotation.Thumb: Opposition, adduction and abduction perpendicular to palm.Thumb: Flexion, extension, and abduction in plane of thumb.Finger: Flexion at proximal joint, extension.Shoulder flexion, extension, abduction (deltoids), adduction, internal/external rotation.Muscles corresponding to various spinal levels are listed below: ( 27907952) Motor weakness may be used to evaluate the level of a spinal lesion that involves the corticospinal tract. Patients with partial cord involvement may fail to display a sensory level. ![]() ![]() ![]() Evaluating for a sensory level using a pin to detect pain sensation is more sensitive to detect a spinal level originating from a lesion in the spinothalamic tract.Therefore, a sensory level to light touch may be absent unless both of these are involved (e.g., a complete injury that involves all spinal cord tracts). Light touch is perceived by both the spinothalamic tract and the dorsal columns.Note that the spinal cord level doesn't line up precisely with the corresponding vertebrae, especially caudal to the thoracic spine.ĭefining the level of a spinal cord lesion Spinal nerves and corresponding sensory dermatomes are shown above.
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