Akua Kakarika, a menopausal woman in her late seventies was admitted to the hospital a week ago because of her increasing difﬁculty with walking. Two weeks prior admission, she had been able to walk with the help of a stick. Since that time, walking had become increasingly difﬁcult, and for the past 2 days, she could not walk at all. She had complete control of micturition and defecation. Her examination reveal the handgrip was weak on both sides, but power was normal in the proximal segments of the upper extremities. The tendon reflexes of the upper limbs and the sensory function were normal. Both lower limbs showed muscular weakness with increased muscle tone, especially on the left side. The knee jerks and ankle jerks (tendon reﬂexes) in both lower limbs were grossly exaggerated, and there were bilateral extensor plantar responses. The patient had a loss of sensation of pain below the fifth thoracic dermatome on both sides of the body. Postural sense was impaired in both great toes, and vibration sense was absent below the ﬁfth thoracic segmental level. Radiologic examination, including an MRI, of the vertebral column showed nothing abnormal. A myelogram in the lumbar region revealed a complete block at the lower border of the fourth thoracic vertebra. Suggest a possible diagnosis using your knowledge in neuroanatomy. Discuss a treatment measure for this patient? What is the position of these tracts in the spinal cord? Name the tracts responsible for the conduction of postural sense and vibration sense from the spinal cord to the brain. Why did the patient have increasing difficulty in walking? Name the tracts in the spinal cord that are responsible for conduction of the sensation of pain. Why the tendon reﬂexes in the lower limbs were exaggerated, and why did the patient exhibit bilateral extensor plantar responses?

Human Anatomy & Physiology (11th Edition)

11th Edition

ISBN:9780134580999

Author:Elaine N. Marieb, Katja N. Hoehn

Publisher:Elaine N. Marieb, Katja N. Hoehn

Chapter1: The Human Body: An Orientation

Section: Chapter Questions

Problem 1RQ: The correct sequence of levels forming the structural hierarchy is A. (a) organ, organ system,...

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Akua Kakarika, a menopausal woman in her late seventies was admitted to the hospital a week ago because of her increasing difﬁculty with walking. Two weeks prior admission, she had been able to walk with the help of a stick. Since that time, walking had become increasingly difﬁcult, and for the past 2 days, she could not walk at all. She had complete control of micturition and defecation. Her examination reveal the handgrip was weak on both sides, but power was normal in the proximal segments of the upper extremities. The tendon reflexes of the upper limbs and the sensory function were normal. Both lower limbs showed muscular weakness with increased muscle tone, especially on the left side. The knee jerks and ankle jerks (tendon reﬂexes) in both lower limbs were grossly exaggerated, and there were bilateral extensor plantar responses. The patient had a loss of sensation of pain below the fifth thoracic dermatome on both sides of the body. Postural sense was impaired in both great toes, and vibration sense was absent below the ﬁfth thoracic segmental level. Radiologic examination, including an MRI, of the vertebral column showed nothing abnormal. A myelogram in the lumbar region revealed a complete block at the lower border of the fourth thoracic vertebra.

Suggest a possible diagnosis using your knowledge in neuroanatomy.
Discuss a treatment measure for this patient?
What is the position of these tracts in the spinal cord?
Name the tracts responsible for the conduction of postural sense and vibration sense from the spinal cord to the brain.
Why did the patient have increasing difficulty in walking?
Name the tracts in the spinal cord that are responsible for conduction of the sensation of pain.
Why the tendon reﬂexes in the lower limbs were exaggerated, and why did the patient exhibit bilateral extensor plantar responses?

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