Localization of Lesions in the Nervous System (original) (raw)

Clinical Approach and Lesion Localization in Patients with Spinal Diseases

Veterinary Clinics of North America: Small Animal Practice, 2010

In most cases, it is the owner's complaint that raises the suspicion of vertebral column disease. The history is taken to collect information about time of onset and progression of clinical signs as it relates to the reason of presentation. The physical and ophthalmologic examinations provide information about the general health of the animal and about the presence of systemic signs that could be related or compound the neurologic disease. The neurologic examination brings into light the neurologic deficits and leads to lesion localization. Once these steps have been completed, the differential diagnosis is established based on lesion localization, history, and the animal's signalment. The diagnostic workup is then planned, keeping in mind the most probable causes. Minimum database and ancillary laboratory diagnostic tests, imaging, cerebrospinal fluid (CSF) analysis, electrodiagnostics, and biopsies may all be necessary to reach the final diagnosis. 1 Each of these steps are covered in more detail in the following paragraphs. OWNER'S COMPLAINT A complaint of back or neck pain, difficulty or inability walking, and incoordination or presence of lameness that does not respond to medical treatment should all alert the clinician to a possible spinal/vertebral problem. Incoordination, wobbliness, and drunken gait all relate to neurologic gait. Dragging of the rear paws and assistance to get into the car or up the stairs may harbor rear-end weakness related to a vertebral/spinal disorder. A lameness in which no abnormality is found on radiographs or joint aspiration and that fails to respond to symptomatic treatment should be investigated for spinal nerve/nerve root disease and secondary spinal cord involvement.

‘Thumb localizing test’ for detecting a lesion in the posterior column–medial lemniscal system

Journal of the Neurological Sciences, 1999

A proprioception examination, called the 'thumb localizing test' (TLT), is described as a technique for testing 'limb localization'. With the patient's eyes closed, the examiner positions one of the patient's upper limbs (fixed limb) and asks him to pinch the thumb of that limb with the opposite thumb and index finger (reaching limb). The findings for 221 patients (423 limbs) show that: there were TLT deficits when the limb contralateral to the cerebral lesion or ipsilateral to the peripheral nerve lesion was the fixed limb, but not when the fixed limb became the reaching limb; that the deficits of limb localization found by the TLT were strongly correlated with deficits of deep or discriminative perceptions such as sense of joint position and movement and tactile cutaneous localization, but uncorrelated with sensory deficits of pain and temperature; that deficits of limb localization were apt to arise from lesions in the posterior column-medial lemniscal system at various levels in the peripheral nerves, cervical cord, brainstem, thalamus or parietal lobe; and that impairment of limb localization and other deep or discriminative sensations were occasionally dissociated. The TLT is easily done at the patient's bedside and can detect a lesion in the posterior column-medial lemniscal system. Moreover, it provides the means to examine the perceptual deficits using a motor task of the opposite limb.

Strategies for resection of lesions in the motor area

In recent years considerable technological advances have been made with the purpose of i m p roving the surgical results in the treatment of eloquent lesions. The overall aim of this study is to evaluate the postoperative surgical outcome in 42 patients who underwent surg e ry to remove lesions aro u n d the motor cortex, in which preoperative planning by using neuroimaging exams, anatomical study, appropriate micro s u rg e ry technique and auxiliary methods such as cortical stimulation were perf o rmed. Tw e n t ytwo patients (52.3%) presented a normal motor function in the preoperative period. Of these, six developed transitory deficit. Twenty patients (47.6%) had a motor deficit pre o p e r a t i v e l y, nevertheless 90% of these improved postoperatively. Surg e ry in the motor area becomes safer and more effective with pre o perative localization exams, anatomical knowledge and appropriate micro s u rg e ry technique. Cortical stimulation is important because it made possible to maximize the resection reducing the risk of a motor deficit. Stereotaxy method was useful in the location of subcortical lesions.

Thoracic sensory level as a false localizing sign in cervical spinal cord and brain lesions

Clinical Neurology and Neurosurgery, 2013

Background: In rare cases of cervical myelopathy, there may be a discrepancy between the sensory level and the site of cord lesion. This phenomenon is not well recognized. This study sought to investigate the characteristics of patients presenting with a false localizing thoracic sensory level. Methods: The databases of the neurology clinics of two major tertiary medical centers were reviewed for all patients who presented in 2000-2010 with a main complaint of paraparesis and a thoracic sensory level. Those whose initial thoracic magnetic resonance scan showed no spinal cord pathology were included in the study. Results: Twelve patients (mean age, 52 ± 31 years) met the study criteria. In all cases, the pathological lesion was visualized on magnetic resonance imaging of the cervical spine or brain. Eight patients had a compressive lesion of the spinal cord and 4 had demyelinating lesions. The difference between the false localizing sensory level and the level of the cervical lesion ranged from 6 to 11 segments. Conclusion: Patients with a sensory thoracic level and normal findings on thoracic magnetic resonance imaging should be further evaluated with cervical spinal cord and, sometimes, brain imaging to search for potentially treatable lesions.

Physical Examination of the Peripheral Nerves and Vasculature

A thorough physical examination begins with a detailed history followed by inspection, palpation, and testing of muscle strength, tone, reflexes, and sensation. This systematic approach to the physical examination is useful for the peripheral nervous system and vascular system so pertinent details are not missed. When inspecting neurovascular structures, the physical examination is the primary initial clinical assessment. In addition to these fundamental aspects of the physical examination, many “special” provocation or relief tests and signs have been developed. The clinician then forms an impression from the information gathered during the history and physical examination and may use more advanced diagnostic tests to rule in or rule out a diagnosis.

Diagnosis of compression syndromes in neurological practice

Medical Studies

Compression syndromes are a multidisciplinary issue. Many specialists are involved in the problem of peripheral nerve injury, but it is the neurologist's task to identify the nerve and locate the level of its damage. The nerve damage occurs in the anatomic isthmus and in the area of the nerves' course under the surface of the skin. Compression syndromes manifest themselves with muscle weakness and sensory ailments such as paraesthesia, numbness, and pain. Symptoms occur in the sensory and motor supply of a given nerve. In diagnostics, we use clinical evaluation, provocative tests, electrophysiological diagnostics, and imaging examinations. Treatment is divided into conservative and operational. The increased availability of electrophysiological research in recent years allows for precise differential diagnosis of individual compression syndromes and the selection of optimal treatment. In this study, a clinical picture of the most frequent syndromes of compression syndromes and the role of electrophysiological research in their diagnosis and treatment are presented. Streszczenie Zespoły z ucisku są zagadnieniem wielodyscyplinarnym. Z problemem uszkodzenia nerwów obwodowych spotyka się wielu specjalistów, jednak to zadaniem neurologa jest identyfikacja nerwu i lokalizacja poziomu jego uszkodzenia. Do uszkodzenia nerwów dochodzi w cieśniach anatomicznych oraz w miejscach przebiegu nerwów pod powierzchnią skóry. Zespoły z ucisku objawiają się niedowładami mięśni oraz dolegliwościami czuciowymi, takimi jak parestezje, drętwienia i bóle. Objawy występują w zakresie zaopatrzenia czuciowego i ruchowego danego nerwu. Diagnostyka obejmuje ocenę kliniczną, testy prowokacyjne, diagnostykę elektrofizjologiczną i badania obrazowe. Leczenie dzieli się na zachowawcze i operacyjne. Większa dostępność badań elektrofizjologicznych w ostatnich latach umożliwia precyzyjną diagnostykę różnicową poszczególnych zespołów i wybór optymalnego leczenia. W pracy przedstawiono obraz kliniczny najczęstszych zespołów z ucisku i rolę badań elektrofizjologicznych w ich rozpoznawaniu i leczeniu.

Clinico Pathological Study of Parenchymal Lesions of Spinal Cord

Annals of Pathology and Laboratory Medicine, 2018

Background: Spinal parenchymal lesions are rare with a wide spectrum of clinical and histological presentation.The aims and objectives was to study the incidence and histopathological features of parenchymal lesions of spinal cord in relation to age,sex,clinical features, radiological findings and topographical distribution. Methods: We studied spinal lesions over a period of ten years in a tertiary care hospital. Our study comprised a total number of 241 surgical resection specimens of lesion of spinal cord out of which 73 cases of spinal cord parenchymal lesions were found. Primary vertebral tumors and paraspinal soft tissue lesions were excluded. Descriptive cross-sectional study of cases including detailed clinical data of age, sex, duration of disease, type of lesion, and radiological findings of the patients was obtained. All cases were analyzed by examining Hematoxylin and Eosin stained slides with use of special stains and immunohistochemistry, as needed. Results: Male predominance was seen in spinal cord parenchymal lesions and 3rd and 4th decade age group was most commonly affected. These lesions were more common in thoracic region followed by cervical region .Neoplastic lesion of spinal cord parenchyma are more frequently encountered than nonneoplastic lesions. Astrocytomas (24.63 %) were commonest neoplastic spinal cord lesions with preponderance of low grade astrocytoma. Ependymomas and PNET accounted for 20.53 % and 4.10 % respectively Conclusion: The histopathological diagnosis of spinal parenchymal lesions can be extremely challenging, the difficulty exaggerated by small size of the specimen. In such situation a multidisciplinary approach including neurosurgeons, neuroradiologist and neuropathologist is highly recommended.