Clinical Neuroscience Week 6 – Ascending Pathways (Hard)

A patient presents with impaired conscious proprioception in their right leg, but normal pain and temperature sensation. Where is the most likely location of a lesion?

A lesion restricted to the left half of the spinal cord at the T10 level would result in which of the following sensory deficits?

Which statement accurately describes the path of the Dorsal Column-Medial Lemniscus (DCML) tract?

A patient reports a loss of fine touch and vibration sense on the left side of their body. Imaging reveals damage to a specific ascending pathway. Which structure is most likely affected?

Following a spinal cord injury, a patient has lost the ability to perceive pain and temperature on the right side of their body below the level of the injury. Which pathway is most likely affected, and where did the injury likely occur?

A patient exhibits loss of pain and temperature sensation on the right side of their body, while also experiencing loss of light touch and proprioception on the left side. Which spinal cord syndrome is MOST likely present?

A patient reports a diminished ability to perceive the position of their left leg in space. Assuming a lesion affecting conscious proprioception, which neural structure is MOST likely implicated?

Following a spinal cord injury, a patient demonstrates loss of motor function, pain, and temperature sensation below the level of the injury. However, light touch and proprioception remain relatively intact. Which incomplete spinal cord syndrome ALIGNS with these findings?

A physical therapist assesses a patient's vibratory sense using a 128 Hz tuning fork. If the patient demonstrates impaired vibration sense in the left foot, where along the sensory pathway is a lesion MOST likely located?

A patient presents with disproportionately greater motor deficits in the upper extremities compared to the lower extremities, along with some sensory deficits. Which spinal cord syndrome BEST fits this presentation?

Which sensory tract does NOT decussate (cross the midline) in the spinal cord or brainstem?

During a proprioception assessment, a clinician passively moves a patient's toe up and down, asking the patient to identify the direction of movement. What SPECIFIC aspect of proprioception is being evaluated?

Damage to the cauda equina is MOST likely to result in which set of impairments?

A patient presents with diminished sensation in the left upper extremity following a stroke. Assuming the stroke affected a major ascending sensory pathway, where is the most likely lesion location?

A clinician is assessing a patient's proprioception in the right index finger. The clinician passively moves the finger up and down and asks the patient to identify the direction of movement. Which ascending pathway is primarily being tested?

A patient reports loss of pain and temperature sensation on the right side of their body below the neck. Where is the most likely location of the lesion?

Following a spinal cord injury, a patient exhibits loss of light touch sensation on the left side of the body and loss of pain and temperature sensation on the right side of the body, both below the level of the injury. This pattern is most consistent with damage to which structure(s)?

A patient is unable to perceive sharp versus dull touch on their lower extremities, but vibration and proprioception remain intact. Which ascending pathway is most likely affected?

Which of the following best describes the primary function of the spinocerebellar tracts?

A patient demonstrates impaired stereognosis (ability to recognize objects by touch) but has normal light touch sensation. Which area of the brain is most likely affected?

A patient with damage to the gracile fasciculus on the right side of the spinal cord would most likely exhibit which sensory deficit?

Which fiber type is responsible for transmitting fast, sharp pain signals?

After a complete spinal cord transection at the T10 level, which sensory modalities would be completely lost bilaterally below the level of the lesion?

Which of the following is a key difference between the dorsal column medial lemniscus (DCML) pathway and the spinothalamic tract?

A patient has difficulty perceiving the difference between hot and cold temperatures but can still feel the pin prick of a sharp object. Which specific nerve fibers are most likely impaired?

A patient has damage to the anterior spinocerebellar tract. How will this most likely present?

Which structure is responsible for the emotional response to pain?

A patient has a lesion in the postcentral gyrus. What sensory deficit would you expect?

A patient demonstrates difficulty coordinating fine motor movements, particularly when attempting to maintain balance. Lesions in which ascending pathway are MOST likely contributing to these deficits?

Following a spinal cord injury, a patient exhibits an inability to perceive pain and temperature on the left side of the body, while also experiencing a loss of light touch and proprioception on the right side. This pattern of deficits is MOST consistent with which spinal cord syndrome?

A patient with damage to the spinothalamic tract exhibits an inability to perceive pain and temperature. Which of the following scenarios would MOST directly assess the impact of this damage on the patient's sensory perception?

A patient presents with disproportionately greater motor impairment in the upper extremities compared to the lower extremities, accompanied by sensory deficits. Their MRI reveals damage primarily in the central portion of the spinal cord. Which of the following is the MOST likely diagnosis?

Following a traumatic injury, a patient exhibits loss of motor function and pain/temperature sensation below the level of the injury, while retaining proprioception and light touch sensation. Which vascular event is MOST likely associated with these findings?

A patient with damage to the superior colliculus would MOST likely have difficulty with which of the following tasks?

During a neurological examination, a physical therapist observes that a patient exhibits dysmetria in the lower extremities, characterized by excessive and uncontrolled movements when attempting to tap their foot on a target. The therapist suspects damage to an ascending pathway. Which of the following pathways is MOST likely involved?

A clinician is evaluating a patient with suspected spinal cord damage. Upon examination, it is noted that the patient has areflexic bowel and bladder function. Which of the following conditions is MOST likely to be associated with these findings?

A researcher is investigating the effects of a novel drug on sensory pathways in animal models. The drug is found to selectively inhibit the function of second-order neurons in the spinothalamic tract. Which of the following outcomes would MOST likely be observed in the treated animals?

A therapist is working with a patient who has impaired proprioception due to damage in an ascending spinal cord pathway. Which exercise would be MOST effective in helping the patient compensate for this sensory loss?

Which of the following BEST describes the anatomical organization of sensory information as it ascends from the periphery to the somatosensory cortex?

A patient has a lesion affecting the tectum of the midbrain. Which resultant deficit would MOST likely correlate with this lesion?

In a research study investigating the neural mechanisms of proprioception, researchers selectively lesion the inferior olivary nucleus in animal subjects. Which of the following outcomes would MOST likely be observed?

A previously healthy patient reports a sudden onset of bowel and bladder dysfunction, accompanied by lower back pain and bilateral leg weakness. Which condition should be of GREATEST concern to the clinician?

A patient has damage to the ventral root of spinal cord. How is motor function impacted?

Afferent/Sensory Input

Dorsal Column-Medial Lemniscus (DCML)

Spinothalamic Tract

Spinocerebellar Tract

Conscious Proprioception

DCML Tract Functions

Lateral Spinothalamic Tract (LST)

Cauda Equina Syndrome Impairment

Anterior Cord Syndrome Impairments

Central Cord Syndrome Impairments

Brown-Sequard Syndrome Impairments

Assessing Light Touch

DCML Pathway

Gracile Fascicle

Cuneate Fascicle

1st Order Neuron (DCML)

2nd Order Neuron (DCML)

3rd Order Neuron (DCML)

Light Touch Assessment

Proprioception Assessment

Ventral Spinothalamic Tract (VST)

1st Order Neuron (Spinothalamic)

2nd Order Neuron (Spinothalamic)

A-beta Fibers

A-delta Fibers

C Fibers

Spinotectal Tract

Spinoolivary Tract

Corticospinal Tracts

Extrapyramidal Tracts

DCML (Dorsal Column Medial Lemniscus)

Brown-Sequard Syndrome

Ipsilateral Loss (Brown-Sequard)

Contralateral Loss (Brown-Sequard)

Central Cord Syndrome

Motor Impairment (Central Cord)

Anterior Cord Syndrome

Motor/Sensory Loss (Anterior Cord)

Cauda Equina Injury