cns q!! - superdoodz

[ArchivalUser]

a 70 year old man with a history of rheumatoid arthritis comes to the physician complaining of weakness 1 day after a motor vehicle accident. physical exam reveals intact sensation and strength in the lower extremities along with bilateral upper extremity weakness. the patient is able to move his arms parallel to gravity but is unable to lift his arms, forearms, or hands upwards against gravity; strength is rated 2/5. A cervical CT scan rules out the presence of a cervical fracture and mri demonstrates traumatic c6 disc herniation , buckling of the ligamentum flavum and edema within the cervical cord in that area.


wut is the most likely diagnosis??

[ArchivalUser]

well i think the herniation of the disc in poterolateral direction has compressed a spinal nerve in the intervertebral foramen

[ArchivalUser]

compression of c6 spinal nerve

what is the answer superdoodz

[ArchivalUser]

Symptoms of a cervical herniated disc

A cervical herniated disc will typically cause pain patterns and neurological deficits as follows:

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C4 - C5 (C5 nerve root) - Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain.
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C5 - C6 (C6 nerve root) - Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
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C6 - C7 (C7 nerve root) - Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation (see Figure 1).
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C7 - T1 (C8 nerve root) - Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.

[ArchivalUser]

wonderful cancer123

[ArchivalUser]

actually the ans. guys is CENTRAL CORD SYNDROME!
this syndrome is ccc by upper extremity weakness that exceeds lower extremity weakness.

a watershed zone is an area between 2 major arteries in which small branches of the arteries form anastomoses. important watershed zones lie between the cerebral arteries(middle and anterior) and in the central spinal cord. these areas are particularly susceptible to infarction during times of hypotension or hypoperfusion. in the above case edema and trauma impair blood flow to the cervical spinal cord and the predominant symptoms result from damage within the central cord watershed zone.
the most medial portions of the corticospinal tracts supply the muscles of the upper limb and becuase they are medial structures motor impairment of the upper extremities can occur following a small central cord lesion.


I FOUND THIS CASE IN FA CASES! I DIDNT FIND IT IN KAPLAN!

[ArchivalUser]

oops
i knew it superdoodz....ur q is not gonna be that easy
uve got some standards dude
keep it up mate
u always help me learn something new

[ArchivalUser]

Central cord syndrome: If the zone of injury lies centrally within the cervical cord and encroaches on the long tracts this will produce weakness of the arms. More common in elderly patients (associated cervical spondylosis).

Anterior cord syndrome: Anterior damage affects the corticospinal and spinothalamic tracts. This leads to weakness and impaired pain and temperature sensation. Usually associated with a fracture or dislocation injury.

Posterior cord syndrome: Posterior damage causes loss of vibration and proprioception. More commonly seen after neurosurgical proceedures where a cyst or intraspinal tumour is removed.

Brown-Sequard Syndrome: Trauma may be confined to one side of the cord producing ipsilateral weakness and impaired contralateral pain and temperature sensation ("hemisection of the cord"). More common in penetrating trauma and blunt rotational injury.