Question

4. A 32 year old patient in her 6th month of pregnancy complains of experiencing tingling and loss of sensation of the first three digits of her right hand. Further examination shows deficits of both pain and touch, a weakening of the muscles and diminished stretch reflexes of the affected area.

What is the site of the injury (include cervical, lumbar, thoracic, or sacral) if located in the spinal cord?

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Is lesion bilateral or unilateral?

Answer 1

If the injury is in the spinal cord , then the site of lesion will be in CERVICAL SEGMENT. and lesion would be BILATERAL

Because the nerve supplying the right hand are coming the brachial plexus which is formed by the C5 to T1 nerve roots , that are orginating from the Cervical part of spinal segment. Except T1 which is orginating from the thoracic segment.

The sensation of the first 3 finger of the right hand is supplied by theright median Nerve.

nerve root of right median nerve isright sided C5 to T1 , so if there is loss of sensation in this area it means that lesion can be in the Right side of the spinal cord.

Here there is motor weakness in the right hand also , it is suggestive of right sided cervical spinal lesion

On examination there is loss of pain and loss of touch, pain and crude touch is carried via the spinothalamic tract.

spinothalamic tract usually decussate into opposite side in the spinal segment.

it means that if there is loss of pain and touch in the right hand , there should be a lesion in the left side of the spinal cord if it is a spinal cord lesion.

There is also loss of reflex in the right hand it is suggestive of a LMN(lower motor neuron ) type of lesion that is lesion can be anywhere in between the anterior horn cell of the spinal cord to muscle supply)

From all this , we can conclude that there is lesion in the right side and left side of teh cervical spinal segment .

so it is a Bilateral cervical spinal cord lesion

Here,