Thursday, March 12, 2009

Spinal cord-bhg 2







What is the name of the syndrome if there is a lesion as shown in the picture
Brown sequard syndrome

State the probable clinical feature you would expect in the patient with the above lesion/syndrome ( hemisection of spinal cord )

BELOW THE LEVEL OF LESION
Same side: sensory changes
Sensation from uncrossed tract are lost (post column tract affected)
Sensation from crossed tract not lost –ok (Spinothalamic tract-ok)
Same side : Motor changes
UMN lesion manifestation

Opposite side : sensory changes
sensation carried by crossed tract are lost (spinothalamic tract affected)
sensation from uncrossed tract-ok (post column tract-ok)
Opposite side : Motor changes
No paralysis -if it occur very mild and resembles UMN lesion type

AT THE LEVEL OF LESION

Same side : sensory changes
Complete anaesthesia (post column and spinothalamic tract affected)
Same side : Motor changes
LMN lesion manifestation


Opposite side : Sensory changes
Sensation carried by crossed tract are lost (spinothalamic tract affected )
sensation carried by uncrossed tract –ok (post column tract –ok)
Opposite side : Motor changes
No paralysis - if it occur very mild and may resembles LMN lesion type

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*Post column tract affected : loss of Vibration, Position ,Two-point discrimination,Deep touch
*Spinothalamic tract affected : Loss crude touch,pain, temperature sensation

7 comments:

Ibnu Shaukani on March 12, 2009 at 11:15 PM said...

anis dhuha, thanks! sangat mantap!

Miss Independent on March 12, 2009 at 11:23 PM said...

biasa la.....tgk la stdy group sape..haha (giler riak kan? =p)

ainaa ismail on March 16, 2009 at 10:22 AM said...

sokong!

Anonymous said...

anis...utk below level of lesion.. ko state that on the same side... crossed spinothalamic tract will not affected(mksdnya..tract tu dh crossed p opposite site..so x kena la...kan??huhu)tapi.. utk spinothalamic tract on the same side(below the lesion) yg crossed at the site of lesion cmne?? affected x??

anis dhuha on March 26, 2009 at 7:44 AM said...

to anonymus..
soalan 1st tu kalu yg sy faham betullah mcm tu.

for below lesion:
spinal cord kat bawah tu ok..xde masalah. tract yg masuk kat spinal cord tu cth spinothalamic tract dia akan cross ke opposite site pastu baru dia ascend. maknanya masa dia ascend dia akn lalu kat atas tu sebelah bhg spinal cord yg ok. jd dia tak affected

sori, yg 2nd soalan tu sy xberapa clear dgn soalan yg ditanya tu.(samada below/at the site lesion)... yg sy boleh explain dan apa yg sy fhm:

"...utk spinothalamic tract on the same side(below the lesion) yg crossed at the site of lesion cmne?? affected x??..

at the level of the spinal cord yg lesion:

cth STT tu masuk kat sebelah hemisphere spinal cord yg ok (opposite side>>at the level of lesion) .. dia akan cross ke opposite yg mana bhg tu yg lesion. sbb lesion kat situ.. dia tak boleh ascend so maksudnya dia affected.

kalu STT tu awal2 dah masuk ikut sebelah yg lesion (ipsilateral>>at the site of lesion).. memang dia affected jg sbb dah tak boleh nk cross dan ascend.

kesimpulannya:
utk STT at the site of lesion sama ada dia come from same side or opposite side of lesion, dia akan affected

utk STT below the lesion kalau dia come from opposite side dia akan affected, kalau dia come from same side dia not affected

harap menjawab soalan..kalau ada salah sila betulkan..

Anonymous said...

oooo thanks 4 the answer...i will sure digest it slowly.. :)
just 1 more... x perlu statekn ke anterior or lateral STT??
then... (ada g 1..huhu) anterior white commisure sign in dr's note tu cmne?? sorry 4 taking ur time for the Q

anis dhuha on March 27, 2009 at 12:23 PM said...

kalu nak specifikan boleh lah kot kalu nak statekan..

based on lect note, Ant commisure sign is a bilateral sign. Apa yang saya faham, (tak taulah betul ke salah).

lost pain,temp (lateral STT) in 1 or 2 segment below lesion tu..

cth lesion of spinal cord at T10.
at level T8 and T9 on both side, kiri dan kanan badan akan loss of pain, temp.

mengikut apa yg sy tahu.. few fibers of lateral STT may ascend one or two segment then baru akan cross to opposite side and ascend in lateral column.(but most, in 2nd order neuron, lepas masuk post column akan cross to oppsite on same segment )

sbb tu kot dia ada bilateral sign for just one/two segment below lesion.

(dia masuk post column, few fiber ascend dulu 1,2 segment tp xsempat nak naik ada lesion, so impair kat same side. yg fiber yg dah cross frm opposite side, bila nak ascend tak dpt jg sbb ada lesion. so impair yg sebelah opposite side..kesimpulannya impair dua2 belah.. just 1,2 segment below lesion)

maaf.. sy xreti sgt..kalau salah sila betulkan ye..

 

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