Case 180 Answers

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case 180 Answers

1. Is there evidence of peripheral nerve involvement in this case, and, if so, what nerve(s) is involved?

2. Is there evidence of dorsal or ventral root involvement or spinal nerve involvement in this case, and, if so, what is the level(s) of the involvement?

3. Is there evidence of spinal cord involvement in this case and, if so, at what level? Indicate the structures involved by the pathologic process.

Cervical spinal cord, probably involving the posterior columns. The level is at C2-3 because the pain occasionally radiated up onto the occipital region of the head.

4. The symptoms experienced by this patient in the three months prior to consultation constitute a classic neurologic symptom complex. What is the name of this phenomenon?

Lhermitte’s sign (of course, this is a symptom, not a sign)

5. What is thought to be the underlying mechanism producing this symptom complex?

Increased sensitivity of demyelinated or damaged axons to stretch of, or pressure on, the cervical spinal cord (especially involving the posterior columns) by neck flexion or extension.

6. Name the two most common conditions associated with this symptom complex.

Multiple sclerosis and cervical spondylosis (others include: vitamin B12 deficiency, foramen magnum mass lesions, radiation myelopathy)

7. In general, what type of pathologic process do you think is involved in this case?

Demyelinating disease
(Differential Dx: tumor, Arnold-Chiari Malformation, cervical spondylosis, vitamin B12 deficiency)

8. What diagnostic procedure(s) would you undertake at this point?

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