Question

1) Professor Wollschlager was rock climbing at Devil’s Tower in Wyoming. After a very successful climb to the top and back down, she was exhausted and slipped in the last 5 feet. When she hit the ground, a small, sharp twig was forced in between 2 vertebrae and was compressing part of her spinal cord on the left side. On her way to the ER, she noticed that she could no longer feel pain or temperature from specific areas AND she could not move some of her appendicular muscles in other areas. Being the professional that she is, she announced, ”Ha! I know what is wrong and which spinal tracts are affected!” The twig was removed and she made a full recovery. Which specific pathways were affected (2 pts)? What general areas (which side, above or below compression) of her body were pain/temperature lost (2 pts)? What general areas (which side, above or below compression) of her body were loss of appendicular muscle movement lost (2 pts)? How do you know where the loss is in each tract (2 pts)? Compare and contrast the two pathways that are affected by the compression (Note: Don’t restate things you already described in other questions above as repeating information doesn’t count) (2 points for one SPECIFIC similarity, 8 pts for four SPECIFIC differences) When comparing and contrasting, be careful not to count one difference as two. For example, if you are comparing two roses, they are similar in that they are roses and they are different in that they are different colors (one is white and the other is red). That is one similarity and one difference. Saying they are both flowers, is far too vague and NOT specific.Also stating that they are different colors, without explaining the color differences isn’t being specific. 2 pts for essay formatting, grammar, spelling.

Answer 1

Part 1

Specific pathway affected:

1. Lateral spinothalamic tract -
   • because the patient temporarily lost pain and temperature sensation
   • This is a sensory pathway
   • it carries pain and temperature sensation to the thalamus
2. Lateral corticospinal tract -
   • because the patient loss power in the appendicular(limbs) muscle
   • This is a motor pathway
   • it is responsible for carrying out the motor activity of the upper and lower limbs

Part 2

The twig went into the leg side of the patient's spine

The loss of pain sensation will, therefore, be - on the right side and below the level of the lesion

Explanation:

1. The first order neuron (neuron arising from the sensory receptor) synapses with the 2nd order neuron in the posterior horn of the spinal grey matter.
2. The 2nd order neuron decussates (crossover) at the same level or a level above or below to the opposite side.
3. The 2nd order neuron later synapses with the 3rd order neuron in the thalamus
4. Also, the fibers coming from the lower spinal nerves are situated on the outside
5. therefore, outer superficial extraspinal compression tends to injure them first.

Part 3

The loss of appendicular power muscle on the left side (same side of the injury)

Explanation:

• The first order neuron starts from the cerebrum and synapse with the second-order neuron with the medulla
• Second-order neurons with medulla decussate to the opposite side and travel down the spinal cord.
• It synapses with the anterior horn cell. The third order arises from the anterior horn cell and innervates the muscle.
• therefore, as the tract has already decussated in the brainstem, the lesion of the left side will cause muscle weakness of the left side.

Comparison between the lateral corticospinal tract and lateral spinothalamic tract.

Lateral corticospinal tract	Lateral spinothalamic tract.
this is a motor tract	this is a sensory tract
the first-order neuron arises from the cerebrum	the first-order neuron arises from the sensory receptor
the tract decussate in the medulla	the tract decussate at the spinal level
the lesion of this tract cause weakness on the same side as the lesion	The lesion of this tract cause sensation loss on the opposite side
The fibers going towards the sacral region are situated superficially and cervical region deep	The fibers bring sensory impulse from the lower body parts is situated superficially