Match each patient's clinical history and mechanism of spinal injury with the specific pattern of neurological deficits most likely to be observed on physical examination.
- A 75-year-old man with severe cervical spondylosis who sustains a forceful hyperextension injury during a fall.Disproportionately severe motor impairment in the upper extremities compared to the lower extremities, with variable, patchy sensory loss below the lesion level.
- A 30-year-old man involved in a high-speed motor vehicle collision who sustains a C6 burst fracture with posterior retropulsion of bone fragments.Bilateral complete loss of motor function, pain, and temperature sensation below the lesion, with preserved proprioception and vibratory sense.
- A 24-year-old man who sustains a penetrating knife wound to the right hemisection of the T8 spinal cord.Ipsilateral flaccid paralysis and loss of proprioception, combined with contralateral loss of pain and temperature sensation below the level of the lesion.
- A 35-year-old woman with a history of a Chiari type I malformation who presents with a gradual, progressive neurological decline over several years.Bilateral loss of pain and temperature sensation in a 'cape-like' distribution across the neck, shoulders, and arms, with preserved light touch and proprioception.
- A 42-year-old construction worker who suffers a massive L4-L5 central disc herniation after improperly lifting a heavy steel beam.Asymmetric flaccid paraparesis, saddle anesthesia, absent lower extremity reflexes, and decreased resting rectal sphincter tone.
Cevap
The hyperextension injury matches Central Cord Syndrome (upper extremity-predominant weakness). The burst fracture matches Anterior Cord Syndrome (loss of motor and pain/temperature, preserved proprioception). The hemisection matches Brown-Séquard Syndrome (ipsilateral motor/proprioception loss, contralateral pain/temp loss). The Chiari malformation matches Syringomyelia (cape-like pain/temp loss). The lumbar disc herniation matches Cauda Equina Syndrome (asymmetric weakness and saddle anesthesia).
Each clinical scenario describes a classic mechanism of injury or etiology that correlates directly with the neuroanatomy of the spinal cord and its vascular supply, leading to distinct, predictable patterns of neurological deficits.
Adım Adım Çözüm
Anahtar Kavram
Clinical presentation and neuroanatomical pathophysiology of distinct spinal cord syndromes.