1. Considering this patient’s history and physical examination, how precisely can the neurologic lesion be localized in this case?
2. Is there evidence of peripheral nervous system involvement in this case, and, if so, what is the level (s) of the involvement? Is there evidence of spinal cord involvement in this case and, if so, at what level?
Spinal cord involvement. The lesion could be anywhere above the right T4-5 spinal cord.
3. Indicate the level of the neurologic lesion in this case as precisely as possible and the structures involved by the pathologic process. What side of the nervous system was involved?
| Signs or Symptoms Left sensory level at T6, which involved the pain pathways on examination Subtle increased DTRs in the RUE |
Site of Lesion R spinothalamic tract at or above the T4-5 spinal cord R lateral corticospinal tract at or above C5-7 |
Localization R lateral C4-5 spinal cord, involving the sacral, lumbar, & lower thoracic parts of the spinothalamic tract (and adjacent lateral corticospinal tract slightly) |
4. In general, what type of pathologic process do you think is involved in this case?