1. Considering this patient’s initial history and examination five years prior to consultation, how precisely can the neurologic lesion be localized at that time? If precise localization is not possible, list as many levels and/or structures as you can that might produce the same clinical picture.
2. What is the localizing significance of the findings on the examination of the motor system and the reflexes?
3. What is the anatomical basis of the "suspended sensory level" involving pain sensation?
4. Indicate the level of the neurologic lesion in this case and the structures involved by the pathologic process. Is a single restricted level or segment of the nervous system involved or does the pathologic process span a few segments? Indicate the side(s) of the lesion and its extent. A diagram may be helpful in this instance.
| Signs or Symptoms Initial decreased pain, RUE Weakness, atrophy, decreased DTRs, RUE>LUE Weakness, increased tone, increased DTRs, extensor R plantar reflex, RLE>LLE Suspended pain deficit, BUE |
Site of Lesion See #1 above R>L anterior horn, C5-T1 (LMN lesion) R>>L lateral corticospinal tracts (UMN lesion) White commissure, C2-T1 |
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5. In general, what type of pathologic process do you think is involved in this case?
Pathologic Dx
Syringomyelia (Differential Dx: Ependymoma)
6. What diagnostic procedure(s) would you undertake at this point?