shirish_sss
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Topics: 32
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A 75 YEAR OLD AFRICAN AMERICAN MAN WITH LONG STANDING HISTORY OF DIABETES AND HYPERTENSION CAME TO THE EMERGENCY DEPT. WITH CHIEF COMPLAINTS OF------
1) LOSS OF SENSATION AND PROGRESSIVE WEAKNESS OF BOTH LOWER EXTRMETIES
2) LOSS OF BLADDER AND BOWEL CONTROL
PATIENT'S NEUROLOGICAL EXAMINATION SHOWS DISTURBANCES BELOW THE T-1 TO T-3 SPINAL CORD SEGMENTS.
CRANIAL NERVE EXAMINATION AND REST OF THE NEUROLOGICAL EXAMINATION IS NORMAL.
MRI BRAIN AND BRAIN STEM IS NORMAL.
THERE IS ALSO NO MASS OR SPACE OCCUPYING LESION IN VERTEBRAL CANAL.
A NEUROLOGICAL REFERENCE WAS DONE FOR ASSESSMENT OF THIS PATIENT.
WHAT SHOULD BE THE MOST LIKELY ACCURATE CONCLUSION OF THE EXAMINING NEUROLOGIST ?
1) SYRINGOMYELIA
2) VERTIBRO-BASILAR INSUFFIENCY
3) DRUG TOXICITY
4) OCCLUSION OF POSTERIOR SPINAL ARTERIES
5) BREAKDOWN IN THE RADICULAR ARTERY DISTRIBUTION AT T-1 TO T-3 LEVEL
6) OCCLUSION OF THE ENTIRE ANTERIOR SPINAL ARTERY
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| smitha
Forum Elite
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HMMMMMM ....that's another good mind blowing/working q shirish............but i guess iam not very sure this time.......
all i can put in here is, this person, with involvement of bowel & bladder early,weakness & loss of sensation in lower xtremeities, is having something which is intrinsic cord ds., with involvement of post. columns, and a spinal level..........but otherwise normal neuro & imaging.....
Is it 5.....breakdown of radical artery distribution at T1-T3 level???? :roll: :roll:
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| smitha
Forum Elite
Topics: 53
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sorry, i meant radicular artery, not radical.... :lol:
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| shirish_sss
Forum Senior
Topics: 32
Posts: 134
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THAT WAS A GOOD ANSWER SMITHA...
ANTERIOR SPINAL ARTERY SUPPLIES MOST OF THE SPINAL CORD EXCEPT THE DORSAL COLUMNS...
THIS FACT IS WORTH REMEMBERING...
ANOTHE FACT IS THAT ANTERIOR SPINAL ARTERY NEEDS HELP OF RADICULAR ARTERIES TO DO IT'S JOB......
IF THE ENTIRE ANTERIOR SPINAL ARTERY IS OCCLUDED THEN THE PATIENT WILL HAVE ALL SIGNS AND SYMPTOMS EXCEPT OF THOSE RELATED TO DORSAL COLUMNS i.e. THE PATIENT WILL HAVE PARALYSIS, BOWEL AND BLADDER INVOLVEMENT, AUTONOMIC TRACT INVOLVEMENT AND ALSO LOSS OF PAIN AND TEMPERATURE i.e. IN SHORT EVERYTHING EXCEPT THAT WHICH IS RELATED TO DORSAL COLUMNS.
BUT IN OUR CASE THE PT. DID NOT HAVE ANY SENSORY SYSTEM INVOLVEMENT.
SO THE ENTIRE ANTERIOR SPINAL ARTERY IS NOT OCCLUDED.
BUT HERE WE DO HAVE SYMPTOMS RELATED TO ANTERIOR SPINAL ARTERY OCCLUSION.
WELL THEN THE ONLY OPTION LEFT IS THE RADICULAR ARTERY SYSTEM...
YES SMITHA.... IN THIS PATIENT THE RADICULAR ARTERIAL SYSTEM IS MOST LIKELY AFFECTED.....
AND SO YOUR ANSWER IS CORRECT....... :lol: :lol:
NOW ONE MORE THING.....
THE THICKEST PORTION OF THE ENTIRE SPINAL CORD IS BETWEEN T-1 AND T-3.
THIS IS THE PART WHICH IS MOST SUSCEPTIBLE TO ISCHEMIA.....
AND REST YOU CAN GUESS.........
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| smitha
Forum Elite
Topics: 53
Posts: 236
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YES SHIRISH....... i can guess, with this pt. having long standing HTN & DM..........risk for his ishemia etc...... 
Thanx a lot for the gr8888 piece of info again................and the q was simply good........
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| polona
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My father has ishemia of brain. Is there a drug you know?
He is taking ketonal temorary.
Thanks
Polona
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