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We are starting to focus on tracts, and clinical presentations of their lesions. ¬†This can take a few attempts at revision to get right – so don’t be discouraged. ¬†Neurophobia is real, but not permanent! ¬†Best of luck!¬†

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Clinical Neuroanatomy: Part Three

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Question 1

Stem 1 of 4

A patient has notable MR spine results as follows:
T1 MR shows hypodensity region corresponding to syrinx of the central canal at the C5 level only.

What is the inferior-most level of changes to thermoception given this rare, isolated site?
A
C4
B
C5
C
C6
D
C7
E
C8
Question 2

Stem 2 of 4

On which side would you expect theroception to be most attenuated?
A
Left side neck
B
Right side thorax
C
Right side ncek
D
Right sided upper limb
E
None of the above
Question 2 Explanation: 
A classic syrinx presentation, commonly in the cervical region as a result of trauma or an arteriovenous malformation, would present with bilateral loss of spinothalamic-conveying sensory modalities.
Question 3

Stem 3 of 4

Study the relevant image below. Given the somatotopic organisation, which coloured pin represents the area of T5 nociceptive fibre afferent flow?
A
Blue
B
Red
C
Yellow
D
Green
E
None of the above
Question 4

Stem 4 of 4

In regards to the previous schematic, what is the function of the tract marked by the pink pin?
A
Conscious vibrational sense
B
Fine touch
C
Crude touch
D
Pain transmission
E
Unconscious proprioception
Question 4 Explanation: 
The above demonstrates the spinocerebellar tracts, an amalgamation of the ventral/dorsal variants.
Question 5
The dorsal spinocerebellar tract conveys ...
A
Ipsilateral stretch receptor information
B
Contralateral stretch receptor information
C
Ipsilateral tendon tension information
D
Contralateral tendon tension information
E
All of the above
Question 6
The Golgi tendon organ receptor subclass sends afferent information through the
A
Ventral spinocerebellar tract
B
Dorsal spinocerebellar tract
C
Anterior spinothalamic tract
D
Dorsal column medial lemniscus system
E
Trigeminothalamic tract
Question 6 Explanation: 
It is not confirmed that the trigeminothalamic tract sends head and neck tendon tension information via the TTT, thus the ventral spinocerebellar tract is the only one confirmed histologically to be definitively connected to the Golgi tendon organ system.
Question 7
How many neurons are present in the system transmitting unconscious proprioception and movement, of a coarse degree, for the hallux?
A
One
B
Two
C
Three
D
Four
E
Five
Question 7 Explanation: 
This is a tough question. First of all, what is it asking us? The hallux (big toe in anatomic terminology) is lower limb based. The modality is conveyed in the rostral and ventral spinocerebellar tract. So we then have to decide which spinocerebellar tract conveys lower limb sensation, and that is the remit of the ventral spinocerebellar tract. Now the second order is to conceptualise the neuronal pathway and count the synapses. There are two synapses and two neurons.
Question 8
Which of the following best describes Clarke's column?
A
A group of interneurons in the middle lamina of the spinal cord grey matter
B
Part of the crude touch transmission pathway
C
The decussation point of the dorsal column
D
The tract through which pain fibres ascend 1/2 levels on entry into the spinal cord before decussation
E
None of the above
Question 9
How many times does the tract, responsible for crude positional sense conveyed to the cerebellum, decussate ordinarily?
A
It does not decussate and remains ipsilateral
B
Once
C
Twice
D
Three times
E
None of the above
Question 9 Explanation: 
The ventral spinocerebellar tract double-decussates thus actually results in ipsilateral synapsing at the deep cerebellar nuclei as the modality origin.
Question 10
Study the image below. NB: The red shaded schematic indicate a total infarcted region second to penetrating trauma.

Which of the following vignettes are most appropriate to describe a classic presentation?
A
Ipsilateral dorsal column and spinothalamic loss
B
Contralateral loss of crude touch, ipsilateral loss of vibration
C
Contralateral loss of conscious proprioception, contralateral loss of pain
D
Contralateral loss of vibration, ipsilateral loss of pain
E
None of the above
Question 10 Explanation: 
Study Brown-Séquard syndrome if you remain unsure of the consequence of a hemisection cord.
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With thanks to: 

  • Hapugoda, S et al. (2018). Incomplete spinal cord syndromes (illustrations). Available: https://radiopaedia.org/cases/incomplete-spinal-cord-syndromes-illustrations?lang=gb. Last accessed 24th October 2019.

  • Fpjacquot. (2009). Incomplete lesions of the spinal cord. Available: https://en.wikipedia.org/wiki/File:Cord-en.png. Last accessed 24th October 2019.