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  #1  
Old 06-13-2011
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Question Can you locate this spinal cord lesion!

A man was severely hypotensive following major blood loss in a car accident two years ago. Today, this 50-year-old man goes to see his physician because he has had multiple infections of his left foot. On exam, he is noted to have decreased pain and temperature sensation in his left leg. Vibration and proprioception in all four extremities are normal, leading his physician to suspect a spinal cord lesion. What is the likely location of this man’s lesion?

A. Left anterolateral spinal cord
B. Left lateral spinal cord
C. Left posterior column
D. Right anterolateral spinal cord
E. Right lateral spinal cord
F. Right posterior column
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Old 06-13-2011
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Default D

D : right anterolateral lesion
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Old 06-13-2011
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Default where is the lesion

D. rt. antereolateral spinal cord
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Old 06-13-2011
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This seems like a Spinothalamic Tract injury and since these fibers cross right away (or at least within 2 spinal cord levels), the injury should be to the opposite side of the spinal cord.

I'll go with D) Right Anterolateral
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Old 06-13-2011
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yup, the answer is D)

sPinoThalamic = Pain & Temperature
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Old 06-13-2011
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D for sure..
spinothal tracts are the only ones to produce contraltersal signs since the cross ovr in the spinal cord unlike dorsal column which do so in the medulla.
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Old 06-15-2011
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I agree its a spinothalamic lesion. But decussation of spinothalamtic tract happens all the way up in pyramidal tract, why can't it be any of the options of Left sided? What if the accident involved a section that was lower than the pyramidal tract? Wouldn't that be ipsilateral lesion?
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Old 06-15-2011
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Quote:
Originally Posted by patelMD View Post
I agree its a spinothalamic lesion. But decussation of spinothalamtic tract happens all the way up in pyramidal tract, why can't it be any of the options of Left sided? What if the accident involved a section that was lower than the pyramidal tract? Wouldn't that be ipsilateral lesion?
The spinothalamic pathway decussates at the level of the spinal cord, rather than in the brainstem like the posterior column-medial lemniscus pathway and corticospinal tract

Can you locate this spinal cord lesion!-st_tract.jpg
click image to enlarge
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