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A 55-year-old woman with known metastatic breast cancer presents to the emergency department complaining of new-onset weakness and numbness. The symptoms involve both arms and legs. She also has developed urinary incontinence over the past 24 hours. On physical examination, strength is 3/5 in the lower extremities and 4/5 in the upper extremities. Anal sphincter tone is decreased. Babinski sign is positive. Sensation is decreased in the extremities, but not in the face. Cranial nerves are symmetric and intact, and mental status is normal. Based on this information, what is the most likely site of the lesion causing the patient's symptoms?
1:Brainstem
2:Cerebrum
3:Cervical spinal cord
4:Lumbar spinal cord
5:Neuromuscular junction
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thanks for this q!!
its 3.
no cranial n. involvement = no brainstem, autonomic fibers affected = no cerebrum and nm juntion
and upper limbs would be only affected on cervical involvement so 3.
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@interferon....thanks for explanation. answ is 3 as you said.
could you pl explain...." autonomic fibers affected= no cerebrum and nm junction" thanks
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correct answer 3
The patient's symptoms are bilateral with sparing of the cranial nerves and normal mental status, localizing the lesion below the level of the brainstem and cerebrum. The patient demonstrates mixed upper and lower motor neuron signs with decreased sphincter tone and a positive Babinski sign, placing the lesion at the level of the spinal cord. As the weakness is involving both the arms and legs, this would indicate a lesion in the lower cervical or upper thoracic spine.
