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Neurology Exam: Sensory Loss Questions

(1) Your patient is an 18 year old man who sustained a spinal cord injury following a motorcycle accident. He is unable to move his left lower extremity and demonstrates the following sensory deficits:

L LE: absent kinesthesia of hip, knee, ankle, greater toe
L side below L2 Level: absent 2 point discrimination and pallesthesia
R LE below L4: absent temperature sensation, cannot distinguish between sharp/dull stimuli.
L L2 Dermatome: diminished sensation

Intact sensation observed in:
All sensations above L2 level
L LE: can distinguish temperature sensation and sharp/dull stimuli
R LE: can distinguish 2-point discrimination, can report direction of passive motion testing of joints, can detect vibration sensation.

Explain the PATTERN of sensory loss in this patient.

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So far I have drawn out my stick man and I have come up with a couple of choices of what it is, I was wondering if I was right or not. Also I am not sure what "pattern" refers to, so I was hoping you could explain it to me here.

Spinalthalamic Tract
Leminscal (dorsolateral) pathway
since it is L2 dermatome the injury could be at L1-L2 region on the Left side.
but I do not know how to explain the R LE below L4 that is absent with temp and sharp/dull unless there was something else going on.

Can you help me??

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(2) A 32 y/o woman is unable to work because of weakness and altered sensation in her right (dominant) hand. She is an officer manager who spends a substantial part of her day at her computer station. She presents with the following SYMPTOMS:

1. diminished sensation of the thumb, index and middle fingers, and 1/2 of the ring finger.
2. tingling sensations, especially at night (7 weeks duration)
3. she is unable to use her hand for longer than 5 minutes without numbness and tingling.
4. thumb muscles ar visibly atrophied
5. strength, reflexes, and sensation WNL throughout remainder of RUE.

What is the location and probable etiology of the lesion?

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I want to say the Median Nerve - Carpal Tunnel syndrome
Location: R volar retinaculum and carpal bones
Etiology: overuse syndrome of R wrist

I feel I am missing something here? What do you think??

Solution Preview

Explain the pattern of sensory loss in this patient.

Your patient is an 18 year old man who sustained a spinal cord injury following a motorcycle accident. He is unable to move his left lower extremity and demonstrates the following sensory deficits:

L LE: absent kinesthesia of hip, knee, ankle, greater toe
L side below L2 Level: absent 2 point discrimination and pallesthesia
R LE below L4: absent temperature sensation, cannot distinguish between sharp/dull stimuli.
L L2 Dermatome: diminished sensation

Intact sensation observed in:
All sensations above L2 level
L LE: can distinguish temperature sensation and sharp/dull stimuli
R LE: can distinguish 2-point discrimination, can report direction of passive motion testing of joints, can detect vibration sensation.

Explain the PATTERN of sensory loss in this patient.

I'm going to go through the symptoms one at a time.

Since he is unable to move his left leg, we suspect that he has damage on the left side of his thoracic or lumbar spinal cord (if it was higher up, then his arms might be affected as well and if it was bilateral, both legs would be affected). The motor damage means his corticospinal tract was affected.

He lost ...

Solution Summary

This problem set has two questions regarding the cause of symptoms found during a neurology exam.

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