A 72-year-old female presents with a complete right sided hemiparesis. She is conscious and alert. Cranial nerves are normal. She has had a non-contrast CT scan of her brain which is normal. Clinical examination reveals loss of pain sensation in her left arm, with intact light touch.
a) What is the site of the lesion? (25% marks)
Right half of cervical cord.
Important features to process here are:
Now, for some localisation, showing the working:
In case it helps, here is a crude diagram of these decussations:
Oh's Manual: Chapter 78 (pp. 795) Spinal injuries by Sumesh Arora and Oliver J Flower
Wagner, Robert, and Andy Jagoda. "Spinal cord syndromes." Emergency medicine clinics of North America 15.3 (1997): 699-711.
Lin, Vernon W., et al. "Spinal Cord and Cauda Equina Syndromes." (2003).
Maynard, Frederick M., et al. "International standards for neurological and functional classification of spinal cord injury." Spinal cord 35.5 (1997): 266-274.
Hayes, Keith C., et al. "Classifying incomplete spinal cord injury syndromes: algorithms based on the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients." Archives of physical medicine and rehabilitation 81.5 (2000): 644-652.
McDonald, John W., and Cristina Sadowsky. "Spinal-cord injury." The Lancet 359.9304 (2002): 417-425.