Transcript Spinal Cord Injury Lesions

Lesions of the Spinal Cord
Learning Module
Click to Begin
Used with permission of the
Academy of Neurologic
Physical Therapy
of the APTA
Do not duplicate without
acknowledging Learning
Activity author
Michael McKeough, PT, EdD
Contents
Overview
Introduction
Learning Objectives
Instructions
Legend
Read these Instructions!
Review of functional systems in the spinal cord
Lateral corticospinal tract
Dorsal column-medial lemniscal system
Lateral spinothalamic tract
Lesion lessons
Dorsal column lesion
Fasciculus gracilis lesion
Fasciculus cuneatus lesion
Lateral corticospinal tract lesion
Lateral spinothalamic tract lesion
Transverse cord lesion
Hemicord lesion
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome
Patient Cases
Case 1
Case 2
Case 3
Contents Functional Systems
Lesions
Patient Cases
Exit
Overview
Introduction
Learning Objectives
Instructions
Legend
Contents Functional Systems
Lesions
Patient Cases
Exit
Introduction
• This module reviews lesions of the spinal cord
• Module organization consists of three components. Review of
functional systems in the spinal cord (lateral corticospinal tract,
DCML, and lateral spinothalamic tract), lesion lessons (9 interactive
lesions with feedback), and patient cases (3 interactive cases with
feedback).
• At the bottom of each page, a navigation bar contains options to
move throughout the module.
• Material is presented at both the behavioral level and the
neuroanatomical level.
• The behavioral level is presented first and depicts a patient’s clinical
presentation.
• The neuroanatomical level depicts the detailed anatomy of firstorder, second-order and third-order neurons.
• The neuroanatomical level accounts for the patient’s behavioral
presentation on examination under normal and lesioned conditions.
Contents Functional Systems
Lesions
Patient Cases
Exit
Learning Objectives
After completing this module you should be able to:
1. describe the signs and symptoms caused by a lesion of the
spinal cord (fasciculus gracilis and fasciculus cuneatus, lateral
corticospinal tract, and lateral spinothalamic tract).
2. given a patient case (examination results and chief complaint),
identify the functional systems causing the sensory and motor
impairments.
3. correlate neurology information between the behavioral and
neuroanatomical levels.
Contents Functional Systems
Lesions
Patient Cases
Exit
Instructions
• This module contains 9 interactive lesion lessons with animation.
• Lesson lessons begin with a question about the symptoms
produced by that particular lesion.
• Clicking the answer button will reveal the answer to the question.
• Clicking the explanation button will lead to both behavioral and
neuroanatomical explanations of the lesion.
• Each presentation is launched by clicking the animation button.
The same button serves to replay the animation if desired.
• Any of the lessons may be accessed by simply clicking on the
lesion title on the Contents page.
• Please refer to the Legend that defines the symbols used
throughout the module.
Contents Functional Systems
Lesions
Patient Cases
Exit
Legend
Mechanism of injury
First-order neuron
Lesion
Second-order neuron
Pain stimulus
Third-order neuron
Light touch stimulus
Sensory impairment
Function intact
Function lost
Contents Functional Systems
Lesions
Patient Cases
Exit
Review of Functional Systems
in the Spinal Cord
Lateral corticospinal tract
Dorsal column-medial lemniscal system
Lateral spinothalamic tract
Contents Functional Systems
Lesions
Patient Cases
Exit
Lateral Corticospinal Tract
Voluntary Knee Extension:
Behavioral Description
Click to animate
Voluntary movement is controlled by a
system of brain and spinal motor centers
linked by neuronal pathways. The primary
motor pathway (Corticospinal tract) is
crossed such that the left hemisphere
controls movement of the right half of the
body and vise versa. Motor pathways
consist of upper and lower motor neurons.
Upper motor neurons originate in the
precentral gyrus, decussate in the medulla,
descend in the lateral column of the spinal
cord, and terminate on lower motor neurons
in the ventral horn. Lower motor neurons
exit the CNS and innervate skeletal muscles
via the peripheral nervous system.
Stimulus
UMN
LMN
Neuroanatomical Explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Lateral Corticospinal Tract
Voluntary Knee Extension:
Neuroanatomical Description
The cell body of the upper motor neuron is
located in he precentral gyrus
(somatotopically organized). The axon
descends through the internal capsule,
decussates in the medulla, descends
through the lateral column of the spinal cord
and terminates in the ventral horn.
The cell body of the lower motor neuron is
located in the ventral horn. The axon exits
the CNS via ventral rootlets of
spinal nerves and
innervates skeletal muscle
via a peripheral nerve.
Skeletal muscles contract
to produce the force to
extend the knee.
Stimulus
UMN
LMN
Behavioral Explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Lateral Corticospinal Tract
Voluntary Knee Extension:
Neuroanatomical Description
The cell body of the upper motor neuron is
located in he precentral gyrus
(somatotopically organized). The axon
descends through the internal capsule,
decussates in the medulla, descends
through the lateral column of the spinal cord
and terminates in the ventral horn.
The cell body of the lower motor neuron is
located in the ventral horn. The axon exits
the CNS via spinal nerves and
innervates skeletal muscle
via a peripheral nerve.
Skeletal muscles contract
to produce the force to
extend the knee.
Behavioral Explanation
Contents Functional Systems
Stimulus
UMN
LMN
Lesions
Patient Cases
Exit
Primary sensory cortex
Thalamus
Nucleus Gracilis
Nucleus Cuneatus
Dorsal Column-Medial
Lemniscal System
Discriminative touch, vibration,
and position information from the
body is conveyed by the dorsal
column-medial lemniscal system
(DCML). The DCML is a crossed
system. It originates from
mechano-receptors (sensory
receptors sensitive to
mechanical deformation) located
in the body wall and projects to
the contralateral cerebral
hemisphere via a three neuron
projection system. The DCML is
comprised of the fasciculus
gracilis and fasciculus cuneatus.
Fasciculus Cuneatus
Fasciculus Gracilis
Fasciculus gracilis
Fasciculus cuneatus
Stimulus
First-order neuron
Second-order neuron
Third-order neuron
Contents Functional Systems
Lesions
Patient Cases
Exit
Primary sensory cortex
Thalamus
Nucleus Gracilis
Fasciculus Gracilis:
Behavioral Description
Fasciculus gracilis
gracilis: light touch,
vibration, and position sense
from the contralateral leg and
lower trunk
Fasciculus Gracilis
Consists of a 3-neuron
projection system extending
from receptors in the periphery
to the primary somatosensory
cortex (Click neuroanatomical
explanation)
Click to animate
Neuroanatomical Explanation
Stimulus
First-order neuron
Second-order neuron
Third-order neuron
Fasciculus cuneatus
Contents Functional Systems
Lesions
Patient Cases
Exit
Fasciculus Gracilis:
Neuroanatomical Description
First-order neurons
Cell body: dorsal root ganglion (DRG)
Distal axon: innervates mechanoreceptors in
leg and lower trunk via peripheral nerves
Proximal axon: enter dorsal column (fasciculus
gracilis), ascend ipsilaterally and terminate in
the nucleus gracilis
Second-order neurons
Cell body: nucleus gracilis
Axon: decussates in the medulla and projects
to the contralateral thalamus (ventral
posterior lateral nucleus, VPL) via the medial
lemniscus
Third-order neurons
Cell body: VPL of thalamus
Axon: ascends via the posterior limb of the
internal capsule and terminates in the primary
somatosensory cortex
Behavioral Explanation
Click to animate
Contents Functional Systems
Lesions
DRG
Patient Cases
Exit
Fasciculus cuneatus
Primary sensory cortex
Thalamus
Fasciculus Cuneatus:
Behavioral Description
Nucleus Cuneatus
Fasciculus Cuneatus
Fasciculus cuneatus: light
touch, vibration, and position
sense from the contralateral
arm and upper trunk
Consists of a 3-neuron
projection system extending
from receptors in the
periphery to the primary
somatosensory cortex (Click
neuroanatomical explanation)
Click to animate
Neuroanatomical Explanation
Stimulus
First-order neuron
Second-order neuron
Third-order neuron
Contents Functional Systems
Lesions
Patient Cases
Exit
Fasciculus Cuneatus:
Neuroanatomical Description
First-order neurons
Cell body: dorsal root ganglion (DRG)
Distal axon: innervates mechanoreceptors in
arm and upper trunk via peripheral nerves
Proximal axon: enter dorsal column (fasciculus
cuneatus), ascend ipsilaterally and terminate
in the nucleus cuneatus
Second-order neurons
Cell body: nucleus cuneatus
Axon: decussates in the medulla and projects
to the contralateral thalamus (ventral
posterior lateral nucleus, VPL) via the medial
lemniscus
Third-order neurons
Cell body: VPL of thalamus
Axon: ascends via the posterior limb of the
internal capsule and terminates in the primary
somatosensory cortex
Behavioral Explanation
Click to animate
Contents Functional Systems
Lesions
DRG
Patient Cases
Exit
Primary sensory cortex
Thalamus
Lateral Spinothalamic Tract:
Behavioral Description
Information about pain and
temperature from the body is
conveyed via several spinal
tracts collectively known as the
anterolateral system. The
lateral spinothalamic tract
(LSTT) is the most prominent
among these. The LSTT is a
crossed system. It originates
from nociceptors (free nerve
endings and chemo-receptors)
and projects to the opposite
(contralateral) cerebral
hemisphere via a three neuron
projection system.
Click to animate
Lateral spinothalamic
tract
Stimulus
Neuroanatomical Explanation
Contents Functional Systems
First-order neuron
Second-order neuron
Third-order neuron
Lesions
Patient Cases
Exit
The Lateral Spinothalamic
Tract: Neuroanatomical
Description
First-order neurons
Cell body: dorsal root ganglion
(DRG)
Distal axon: innervates nociceptors
via peripheral nerves
Proximal axon: enter the spinal cord,
diverge 1-3 levels and terminate on
second-order neurons in the dorsal
horn
Second-order neurons
Cell body: dorsal horn
Axon: decussates at or about the
level of entry and projects to the
contralateral thalamus (ventral
posterior lateral nucleus, VPL) via
the lateral spinothalamic tract
Third-order neurons
Cell body: VPL of thalamus
Axon: ascends via the posterior limb
of the internal capsule and
terminates in the primary
somatosensory cortex
Behavioral Explanation
DRG
Click to animate
Contents Functional Systems
Lateral spinothalamic tract
Lesions
Patient Cases
Exit
Lesion Lessons
Dorsal column lesion
Fasciculus gracilis lesion
Fasciculus cuneatus lesion
Lateral corticospinal tract lesion
Lateral spinothalamic tract lesion
Transverse cord lesion
Hemicord lesion
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome
Contents Functional Systems
Lesions
Patient Cases
Exit
R
L
Lesion of the right dorsal
column at L1 produces what
impairment?
Click for answer
Damage to the right dorsal column at L1 causes the
absence of light touch, vibration, and position
sensation in the right leg. Only fasciculus gracilis
exists below T6.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Right Dorsal Column Lesion
Click to animate
DRG
R
L
L1
Dorsal column lesion
Ipsilateral loss of light touch,
vibration, and position sense
generalized below the lesion level
Common causes
include MS,
penetrating injuries,
and compression
from tumors.
Below T6 only the fasciculus gracilis
is present.
Contents Functional Systems
Lesions
Patient Cases
Exit
Lesion of the left fasciculus gracilis
at T8 produces what impairment?
Click for answer
Damage to the left fasciculus gracilis at T8 causes
the absence of light touch, vibration, and position
sensation in the left leg and lower left trunk. Only
the fasciculus gracilis exists below T6.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Primary sensory cortex
Thalamus
Nucleus Gracilis
Nucleus Cuneatus
Lesion of the fasciculus
gracilis on the left:
Behavioral Explanation
Fasciculus Cuneatus
Fasciculus Gracilis
Sensory impairment:
absence of light touch,
vibration, and position
sensation in the left
leg and lower left
trunk.
Sensory impairment:
left leg and lower
left trunk.
Click to animate
Neuroanatomical Explanation
Lesion
Lost function
Impairment
Contents Functional Systems
Lesions
Patient Cases
Exit
Lesion of the fasciculus gracilis
on the left: Neuroanatomical
Explanation
Because the tract has not
yet decussated, impairment
is ipsilateral to the lesion.
Lesion of first-order neurons
interrupts ascending
information so light touch,
vibration, and position
sensation is impaired in the
left leg and lower left trunk.
Receptors and reflex
connections below the
lesion level remain intact.
Click to animate
Behavioral Explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
R
L
Lesion of the right fasciculus
cuneatus at C3 produces what
impairment?
Click for answer
Damage to the right fasciculus cuneatus at C3
causes the absence of light touch, vibration, and
position sensation in the right arm and upper trunk.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Right Fasciculus Cuneatus Lesion
Click to animate
DRG
R
L
C3
Fasciculus cuneatus lesion
Ipsilateral loss of light touch,
vibration, and position sense
In the right arm and upper trunk
Common causes
include MS,
penetrating injuries,
and compression
from tumors.
Contents Functional Systems
Lesions
Patient Cases
Exit
R
L
Lesion of the right lateral
corticospinal tract at L1
produces what impairment?
Click for answer
Damage to the right lateral corticospinal tract at L1
causes upper motor neurons signs (weakness or
paralysis, hyperreflexia, and hypertonia) in the right leg.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Right Lateral Corticospinal Tract Lesion
UMN
Click to animate
R
L
L1
Lateral corticospinal tract lesion
Ipsilateral upper motor neurons signs
generalized below the lesion level
UMN signs
Weakness (Spastic paralysis)
Hyperreflexia (+ Babinski, clonus)
Hypertonia
Common causes
include penetrating
injuries, lateral
compression from
tumors, and MS.
Contents Functional Systems
Lesions
Patient Cases
Exit
R
L
Lesion of the right lateral
spinothalamic tract at L1
produces what impairment?
Click for answer
Damage to the right lateral spinothalamic tract at L1
causes the absence of pain and temperature
sensation in the left leg.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Right Lateral Spinothalamic Tract Lesion
Click to animate
DRG
R
L
L1
Lateral spinothalamic tract lesion
Contralateral loss of pain
and temperature sense
Common causes
include MS,
penetrating injuries,
and compression
from tumors.
Contents Functional Systems
Lesions
Patient Cases
Exit
Lesion of the anterior gray and
white commissures (central
cord syndrome) at C5-C6
produces what impairment?
R
L
Click for answer
Damage to the anterior gray and white commissures at
C5-C6 causes the absence of pain and temperature
sensation in the C5 and C6 dermatomes in both upper
extremities.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Central Cord Syndrome
Click to animate
C5-C6
DRG
R
L DRG
Lateral
Spinothalamic
Tract
Common causes
include posttraumatic
contusion and
syringomyelia, and
intrinsic spinal cord
tumors.
Impaired pain and temperature
sensation, C5-C6 dermatomes,
bilaterally
Contents Functional Systems
Lesions
Patient Cases
Exit
R
Complete transection of the right
half the spinal cord (Hemicord or
Brown-Sequard syndrome) at L1
produces what impairments?
L
Click for answer
Damage to the right dorsal columns at L1 causes the
absence of light touch, vibration, and position sense in
the right leg. Damage to the lateral corticospinal tract
causes upper motor neuron signs in the right leg
(Monoplegia), and damage to the lateral spinothalamic
tract causes the absence of pain and temperature
sensation in the left leg.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Hemicord Lesion (Brown-Sequard Syndrome)
Click to animate
R
L
L1
Hemicord lesion
Common causes
include penetrating
injuries, lateral
compression from
tumors, and MS.
Build the lesion
Dorsal column lesion
Ipsilateral loss of light touch,
vibration, and position sense
Lateral corticospinal tract lesion
Ipsilateral upper motor neurons signs
Lateral spinothalamic tract lesion
Contralateral loss of pain
and temperature sense
Hemicord Lesion (Brown-Sequard Syndrome)
UMN
Click to animate
DRG
R
L
DRG
L1
Dorsal column lesion
Ipsilateral loss of light touch,
vibration, and position sense
Lateral corticospinal tract lesion
Ipsilateral upper motor neurons signs
Lateral spinothalamic tract lesion
Contralateral loss of pain
and temperature sense
Hemicord lesion
Contents Functional Systems
Lesions
Patient Cases
Exit
R
Complete transection of the
spinal cord (Transverse cord
lesion) at L1 would produce
what impairments?
L
Click for answer
Damage to the dorsal columns, bilaterally, causes the
absence of light touch, vibration, and position sense in
the both legs. Damage to the lateral corticospinal tracts,
bilaterally, cause upper motor neuron signs in the both
legs (Paraplegia), and damage to the lateral
spinothalamic tracts, bilaterally, cause the absence of
pain and temperature sensation in the both legs.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Transverse Cord Lesion
Click to animate
R
L
Transverse cord lesion
Dorsal column lesion
Common causes
include trauma,
tumors, transverse
myelitis, and MS.
Bilateral loss of light touch,
vibration, and position sense
Lateral corticospinal tract lesion
Bilateral upper motor neurons signs
Lateral spinothalamic tract lesion
Build the lesion
Bilateral loss of pain and
temperature sense
Contents Functional Systems
Lesions
Patient Cases
Exit
Transverse Cord Lesion
UMN
UMN
Click to animate
DRG
DRG
R
L
Dorsal column lesion
Ipsilateral loss of light touch,
vibration, and position sense
Lateral corticospinal tract lesion
Ipsilateral upper motor neurons signs
Lateral spinothalamic tract lesion
Contralateral loss of pain
and temperature sense
Transverse cord lesion
Contents Functional Systems
Lesions
Patient Cases
Exit
R
Complete transection of the
dorsal columns, bilaterally,
(posterior cord syndrome) in
the cervical region would
produce what impairments?
L
Click for answer
Damage to the dorsal columns (fasciculus gracilis
and cuneatus), bilaterally, causes the absence of
light touch, vibration, and position sense, bilaterally,
from the neck down (below the lesion level).
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Posterior Cord Syndrome
Click to animate
DRG
DRG
R
Common causes
include trauma,
compression from
posteriorly located
tumors, and MS.
L
Dorsal column lesion (bilateral)
Bilateral loss of light touch,
vibration, and position sense,
generalized below lesion level
Contents Functional Systems
Lesions
Patient Cases
Exit
Complete transection of the lateral
corticospinal and lateral spinothalamic
tracts with sparing of the dorsal
columns, bilaterally, (anterior cord
syndrome) in the cervical region would
produce what impairments?
R
L
Click for answer
Damage to the lateral corticospinal tracts cause upper motor
neuron signs, bilaterally, below the lesion level. Damage to
lower motor neurons in the ventral horns cause lower motor
neuron signs, bilaterally, at the lesion level. Damage to the
lateral spinothalamic tracts cause absence of pain and
temperature sensation, bilaterally, below the lesion level.
Sparing of the dorsal columns leaves light touch, vibration,
and position sense intact throughout.
Click for explanation
Contents Functional Systems
Lesions
Patient Cases
Exit
Anterior Cord Syndrome
UMN
UMN
Click to animate
DRG
DRG
R
L
Anterior cord lesion
Common causes
include anterior
spinal artery
infarct, trauma,
and MS.
Lateral corticospinal tract lesion
Ipsilateral upper motor neurons signs
Lateral spinothalamic tract lesion
Contralateral loss of pain
and temperature sense
Contents Functional Systems
Lesions
Patient Cases
Exit
Patient Cases
Read these instructions!
Patient Case 1
Patient Case 2
Patient Case 3
Contents Functional Systems
Lesions
Patient Cases
Exit
Case Instructions
• These patient cases are intended to facilitate the integration and
clinical application of information about lesions of the spinal cord
by coupling the findings on examination and patient interview
with their neuroanatomical correlates.
• Each case begins with the patient’s chief complaint and
significant examination findings. Then, the question is asked,
Damage to what system(s) is causing this patient’s problems?
Clicking the Answer button will reveal the answer and clicking
the Show lesion button will reveal the neuroanatomic lesion
along with the patient’s behavioral impairments.
• Cases are presented from two perspectives. What lesion would
account for a given set of examination results and patient
history? For a given lesion, what signs and symptoms would be
expected on examination?
• Click on a case number to begin the exercise.
Contents Functional Systems
Lesions
Patient Cases
Exit
Case 1
The patient complains of “clumsiness” of her left leg due to uncertainty of the
limb’s position in space. Active and passive ROM and strength are within
normal limits (WNL) throughout. Light touch, two-point discrimination,
proprioception, and vibration sense are intact in the right lower extremity but
absent in all dermatomes below the umbilicus in the left lower extremity. She
is able to distinguish sharp from dull WNL in lower extremities, bilaterally.
Damage to what system(s) is causing this patient’s problems?
Answer
Lesion of the left dorsal column (fasciculus gracilis) at approximately T10.
Lateral corticospinal tracts are intact, bilaterally: AROM and strength are WNL
Lateral spinothalamic tracts are intact, bilaterally: sharp/dull is WNL
Dorsal column is intact on the right: light touch, two-point discrimination,
proprioception, and vibration are WNL
Dorsal column is absent on the left: light touch, two-point discrimination,
proprioception (limb position in space), and vibration are absent in all
dermatomes below the umbilicus
Lesion level, T10: the umbilicus is located in the T10 dermatome
Contents Functional Systems
Lesions
Patient Cases
Exit
Show lesion
Left Dorsal Column Lesion
Click to animate
DRG
R
L
T10
Dorsal column lesion
Ipsilateral loss of light touch,
vibration, and position sense
Contents Functional Systems
Lesions
Patient Cases
Exit
Case 2
After a fall from his horse, the patient was alert and oriented but unable to move
anything but his head. He was unable to sense light touch or pain from the neck
down. He could turn his head but shoulder shrug was weak. Speech was
normal but respiration was labored and required a respirator.
Damage to what system(s) is causing this patient’s problems?
Answer
Complete transection of the spinal cord (transverse lesion ) at approximately C3
(Tetroplegia, Christopher Reeve)
Lateral corticospinal tracts absent, bilaterally, below C3: unable to move any
body part except head and shoulder shrug (C3-5)
Dorsal columns absent , bilaterally, below C3: unable to sense light touch below
neck
Lateral spinothalamic tracts absent, bilaterally, below C3: unable to sense pain
below neck
Lesion level, C3: patient was alert and oriented (cortex and reticular activating
system intact), he could turn his head (spinal accessory nerve), shoulder shrug
and respiration were weak (shoulder elevator and respiratory muscles C3-5)
Contents Functional Systems
Lesions
Patient Cases
Exit
Show lesion
Transverse Cord Lesion
UMN
UMN
Click to animate
DRG
DRG
R
L
C3
Dorsal column lesion
Ipsilateral loss of light touch,
vibration, and position sense
Lateral corticospinal tract lesion
Ipsilateral upper motor neurons signs
Lateral spinothalamic tract lesion
Contralateral loss of pain and
temperature sense
Transverse cord lesion
Contents Functional Systems
Lesions
Patient Cases
Exit
Case 3
Following surgical repair of a knife wound the patient is unable to stand or walk because
he is unable to move or bear weight on his right leg. Light touch, position and vibration
sense are WNL in the left lower extremity but absent in the right below the crest of the
ilium. Active range of motion and strength are normal in the left lower extremity but
absent in the right (hip, knee, and ankle). Pain and temperature sensation are intact in
the right lower extremity but absent in the left below T12.
Answer
Damage to what system(s) is causing this patient’s problems?
Hemisection of the spinal cord on the right at approximately L1
Dorsal column is intact on the left but absent on the right: light touch, position
and vibration sense are WNL in the left lower extremity but absent in the right
Lateral corticospinal tract is intact on the left but absent on the right: active
range of motion and strength are normal in the left lower extremity but absent in
the right
Lateral spinothalamic tract is intact on the left but absent on the right: pain and
temperature sensation are intact in the right lower extremity but absent in the
left
Lesion level, approximately L1: hip flexion absent on right (L2), pain and
temperature sense absent below T12
Contents Functional Systems
Lesions
Patient Cases
Exit
Show lesion
Hemicord Lesion (Brown-Sequard Syndrome)
UMN
Click to animate
DRG
R
L
DRG
T12
Dorsal column lesion
Ipsilateral loss of light touch,
vibration, and position sense
Lateral corticospinal tract lesion
Ipsilateral upper motor neurons signs
Lateral spinothalamic tract lesion
Contralateral loss of pain and
temperature sense
Hemicord lesion
Contents Functional Systems
Lesions
Patient Cases
Exit
The End
D. Michael McKeough, PT, EdD
 2015