Neuroanatomy Draw It To Know It

124 Neuroanatomy: Draw It to Know It

Spinal Cord Disorders (Cont.)

Case VII

Patient presents with a several-month course of weak-
ness that began in the left arm and has since spread
to both arms and legs. Exam reveals asymmetric but
diff use upper and lower extremity weakness. Th ere is
mixed hyperrefl exia and arefl exia throughout the bilat-
eral upper and lower extremities. Th ere are bilateral
pathologic (ie, positive) Babinski’s. Sensory exam is
normal.

Show that the presence of motor weakness in con-

junction with mixed hyperrefl exia and arefl exia with

bilateral pathologic Babinski’s and a normal sensory

exam suggests both corticospinal tract and anterior

motor horn involvement.

Indicate that this constellation of defi cits is oft en

found in amyotrophic lateral sclerosis (aka ALS or Lou

Gehrig’s disease).^18 – 21

Case VIII (Advanced)

Patient presents with muscle pains and slowly progres-
sive muscle wasting. Exam reveals asymmetric lower
extremity weakness; hyporefl exia in the lower extremi-
ties; the absence of pathologic Babinski’s (ie, negative
Babinski's); and normal sensation.
Show that the weakness in conjunction with hypore-
fl exia and a normal sensory exam suggests anterior motor
horn involvement, only.

Many illnesses cause select anterior horn cell loss.

Indicate that two common illnesses that cause this pathol-

og y are polio syndrome and spinal muscular atrophy.^18 – 21

Case IX ( Advanced )

Patient presents with slowly progressive lower extremity
weakness. Exam reveals spastic weakness of the lower
extremities more so than the upper extremities; hyper-
refl exia; bilateral pathologic (ie, positive) Babinski’s; gait
ataxia; and a normal sensory exam.

Show that the weakness in conjunction with spasticity,

hyperrefl exia, bilateral pathologic Babinski’s, and a normal

sensory exam suggests corticospinal tract involvement.

Indicate that select corticospinal tract involvement

suggests a diagnosis of primary lateral sclerosis.^18 – 21