Locate neurological signs

Introduction Neurological localization refers to longitudinal positioning, ie, neurological signs of different segmental lesions. It is one of the clinical manifestations of myeloma. Spinal cord tumor is one of the important reasons for the compression of the spinal cord and cauda equina. In addition to the spinal cord itself, the tumors that occur in the spinal canal and the adjacent tissue structure of the spinal cord can also compress the spinal cord, causing physical dysfunction. The clinical manifestations of the neck, neck and neck 4 high spinal cord injury diaphragm and intercostal muscle paralysis, dyspnea. Upper motor neuron. Impaired plane below sensory disturbance, urinary retention.

Cause

Etiology and pathology:

1, lumbar 2 2 spinal cord injury can lead to lower extremity pain, the lower limbs in the corresponding lesions of the lower segment of the branch of the nerves, the level of damage below the sensory dysfunction is the iliac crest line, accompanied by urinary retention.

2, 3 tail cone damage: saddle-shaped sensory dysfunction area (anal line) in the back of the thigh, perianal and perineum. Both lower limbs are innocent, but the perineal muscles are paralyzed. Peripheral dysuria and urinary incontinence.

3, the pony tail damage the lower extremity to shoot sputum, the lower limbs under the motor neuron, lower limbs and perineal sensory disturbance, urinary incontinence.

an examination

Related inspection

Spinal MRI examination of brain MRI

(1) Cranial-cervical junction area: Tumors in this area may involve the 11th and 12th cranial nerves, causing the posterior column to be compressed, causing positional sensation, tremor and light tactile dysfunction. The extremities are characterized by no damage to the upper motor, and the C2 dominating area may Have a feeling of disability.

(B) cervical spinal cord area: upper cervical spinal cord lesions may have occipital, neck pain and paresthesia. There may be spastic quadriplegia below the lesion segment, and the biceps tendon is hyperreflexive. The fifth cervical spinal cord lesion can cause deltoid muscle, biceps brachii, and atrophic tendon of the supinator muscle. The sensory disturbance extends to the outside of the arm, and the biceps and supinator muscles disappear. The sixth cervical spinal cord disease caused triceps and wrist extensor tendon, partial scapular wrist, corresponding dermatomes and sensory disturbances. In the seventh cervical spinal cord lesion, the wrist flexor and the flexor digitorum extensor tendon appear, and the sensory disturbance involves the lateral midline of the arm. The eighth cervical spinal cord lesion caused by atrophic spasm of the hand, claw-shaped hand deformity, may have Horner sign, sensory disturbance involving the inside of the arm, 4th and 5th fingers.

(C) the thoracic region: clinical positioning usually depends on the level of sensory impairment, difficult to judge by the intercostal muscle strength. The lower abdomen tendon, the upper abdominal muscles can be normal, the Beevor sign, that is, the patient, lying on the back, when the resistance is increased against the chest, the umbilicus moves upward. The lower abdominal wall reflection disappeared.

(4) Lumbar region: The lesion can be located horizontally by sensory and motor impairment. Involving the first and second lumbar pith causes loss of cremaster reflex. In the third and fourth lumbar medullary lesions, when the cauda equina nerve root was not involved, the quadriceps muscle was weakened, the knee reflex disappeared, and the Achilles tendon reflexes, and the sputum sputum appeared. This level of cauda equina nerve involvement caused the calf to relax and the knee reflex disappeared. If the spinal tail is involved at the same time, it can be expressed as a calf on one side and a slow on the other side.

(5) Cone and horsetail area: early symptoms may have low back pain, pain or numbness in the saddle area and lower limbs, often diagnosed as sciatica. Sphincter dysfunction occurs earlier. There may be lower extremity relaxation, muscle atrophy, foot drop, lumbosacral skin, especially in the saddle area, there may be sensory loss, occasionally lumbosacral, hip, hip or heel ulcer.

Differential diagnosis

1. Cervical spondylosis: The clinical manifestations of spinal cord tumors are very similar to cervical spondylosis, and spinal cord tumors are often overlooked due to the high incidence of spinal degenerative diseases. In this regard, clinicians should pay great attention to it. Spinal cord tumors often manifest as root pain and gradual spinal cord compression symptoms. It has a fixed site, severe pain, persistence, and increased coughing. At the same time or later, accompanied by stimulation or compression of the long spinal cord. Therefore, such patients should be routinely performed neurological examinations and corresponding imaging studies.

2, extramedullary tumors: common clinical pathological types are neurofibroma, meningioma. Nerve root pain is more common and has the value of localization diagnosis. Feeling changes The sensory changes in the distal extremities are obvious, and develop from the bottom up, without sensory separation. The pyramidal tract sign appeared earlier and significantly, the symptoms of lower motor neurons were not obvious, and the spinal cord hemisection syndrome was more common. Early or obvious spinal canal obstruction, cerebrospinal fluid protein increased significantly, after the release of cerebrospinal fluid due to extramedullary tumors moved down and the symptoms worsened. Spinal processes are more common, especially epidural tumors, and spinal bone changes are more common.

3, syringomyelia: slow onset. Common in the lower neck and upper thoracic segments of adults aged 20 to 30. Most segments on one or both sides have sensory separation and lower motor neuron spasm. If the cavity extends downward, invading the lateral horn cells is often accompanied by horner's syndrome and upper limb skin dystrophy. Early spinal canal obstruction, late can lead to spinal canal obstruction. The mri examination can be clearly diagnosed and differentiated from intramedullary tumors.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.