NEUROANATOMY

CASES
 KASUS 1 (1,2)

A 45 year old man, laborer, coming to the clinic reporting a trauma in his right feet due to sharp object penetrating the skin 2 hours
ago and unable to removed it by himself. He said that the sharp object penetrating the medial side of his feet. Explain in detailed
about:
A. Neuroanatomy of the peripheral nerve from the distal portion of the affected part to the posterior root before spinal cord
B. Neuroanatomy of the central nervous system related to the tract affected
C. What is the function of:
A. Anterior corticospinal tract
B. Lateral corticopsinal tract
C. Anterior spinothalamic tract
D. Lateral spinothalamic tract
E. Tectospinal tract
F. Vestibulospinal tract
G. Reticulospinal tract
H. Rubrospinal tract
 KASUS 2 (3,4)

A 20 year old man, athlete, coming to the clinic reporting a trauma in his right feet due to blunt object in which pain sensation is felt
“through the bone” from 2 hours ago and unable to walk normally. He said that the blunt object hit the heel side of his feet. Explain in
detailed about:
A. Neuroanatomy of the peripheral nerve from the distal portion of the affected part to the posterior root before spinal cord
B. Neuroanatomy of the central nervous system related to the tract affected
C. What is the function of:
A. Anterior corticospinal tract
B. Lateral corticopsinal tract
C. Anterior spinothalamic tract
D. Lateral spinothalamic tract
E. Tectospinal tract
F. Vestibulospinal tract
G. Reticulospinal tract
H. Rubrospinal tract
 KASUS 3 (5,6)

A 45 year old man, laborer, coming to the clinic reporting a trauma in his right hand due to sharp object penetrating the skin 2 hours
ago and unable to removed it by himself. He said that the sharp object is penetrating the thumb. Explain in detailed about:
A. Neuroanatomy of the peripheral nerve from the distal portion of the affected part to the posterior root before spinal cord
B. Neuroanatomy of the central nervous system related to the tract affected
C. What is the function of:
A. Anterior corticospinal tract
B. Lateral corticopsinal tract
C. Anterior spinothalamic tract
D. Lateral spinothalamic tract
E. Tectospinal tract
F. Vestibulospinal tract
G. Reticulospinal tract
H. Rubrospinal tract
 KASUS 4 (7,8)

A 20 year old man, MMA Athlete, coming to the clinic reporting a trauma in his right hand due to hitting 10 pile of woods in which pain
sensation is felt “through the bone” from 2 hours. He said that the blunt object hit the lateral side of his hand. Explain in detailed about:
A. Neuroanatomy of the peripheral nerve from the distal portion of the affected part to the posterior root before spinal cord
B. Neuroanatomy of the central nervous system related to the tract affected
C. What is the function of:
A. Anterior corticospinal tract
B. Lateral corticopsinal tract
C. Anterior spinothalamic tract
D. Lateral spinothalamic tract
E. Tectospinal tract
F. Vestibulospinal tract
G. Reticulospinal tract
H. Rubrospinal tract
 KASUS 5 (9,10)
A 30 year old man, police, just came to the emergency department due to gun wound that penetrate from the posterior aspect of the back at the level of axilla,
paravertebra line, dextra. This trauma that he got make him having many symptoms and clinical manifestation as following:

• Right arm: No percepetion of fine touch, vibration and unable to mention where the location of his right arm is. He is unable to feel crude touch, pain sensation
and temperature. This unability affect the entire right arm and hand. He is also unable to move his right arm and hand. During physical examination, inspection
of the right arm appearance seem that there is a muscle wasting, percussion on the right arm exhibit a fasciculation. There is a flaccid paralysis indicating that
there is a hypotonia. No reflex can be inititiate during examination.

• Left arm: He still has the ability of sensing all things that his right arm unable to feel, but at the begining at the trunk of the body just at the lower part from the
axilla, the perception of pain and temperature along with the crude touch is none. Meanwhile, the perception of fine touch, and vibration is still working well. He
has no problem in moving his left arm AND the left trunk of his body.

• Right leg: His right leg is unable to feel the sensation of fine touch, vibration, and he also cannot tell where the location of his right leg is. In contrast to his right
arm however, he can feel crude touch, pain sensation and temperature. During physical examination, inspection of the right leg appearance seem a mild to none
muscle wasting but it is found that there is a hypertonia (rigidity) and findings of “clasp-knife phenomenon”. There is also hyper-reflexia on examination and (+)
Babinski sign.

• Left leg: Consistent with the left trunk findings just below the axilla, his left leg is ABLE to feel the sensation of fine touch, and vibration, while unable to feel the
sensation of pain and temperature. He still able to move his left leg and there is no other abnormal findings.

• Other Findings: There is anhidrosis, ptosis, miosis of the pupil affecting the right side of the face

QUESTION:

1. At what level of spinal cord did the injury takes place?

2. What tracts are affected on right arm, left arm, right leg, left leg?

3. What did the “Other Findings” suggest? Why can this happen?
 KASUS 6 (11,12)
A 30 year old man, police, just came to the emergency department due to gun wound that penetrate from the posterior aspect of the back at the level of axilla,
paravertebra line, sinistra. This trauma that he got make him having many symptoms and clinical manifestation as following:

• Left arm: No percepetion of fine touch, vibration and unable to mention where the location of his left arm is. He is unable to feel crude touch, pain sensation and
temperature. This unability affect the entire left arm and hand. He is also unable to move his left arm and hand. During physical examination, inspection of the left arm
appearance seem that there is a muscle wasting, percussion on the left arm exhibit a fasciculation. There is a flaccid paralysis indicating that there is a hypotonia. No
reflex can be inititiate during examination.

• Right arm: He still has the ability of sensing all things that his left arm unable to feel, but at the begining at the trunk of the body just at the lower part from the axilla,
the perception of pain and temperature along with the crude touch is none. Meanwhile, the perception of fine touch, and vibration is still working well. He has no
problem in moving his right arm AND the right trunk of his body.

• Left leg: His left leg is unable to feel the sensation of fine touch, vibration, and he also cannot tell where the location of his left leg is. In contrast to his left arm
however, he can feel crude touch, pain sensation and temperature. During physical examination, inspection of the left leg appearance seem a mild to none muscle
wasting but it is found that there is a hypertonia (rigidity) and findings of “clasp-knife phenomenon”. There is also hyper-reflexia on examination and (+) Babinski
sign.

• Right leg: Consistent with the right trunk findings just below the axilla, his right leg is ABLE to feel the sensation of fine touch, and vibration, while unable to feel the
sensation of pain and temperature. He still able to move his right leg and there is no other abnormal findings.

• Other Findings: There is anhidrosis, ptosis, miosis of the pupil affecting the left side of the face.

QUESTION:

• At what level of spinal cord did the injury take place?

• What tracts are affected on left arm, right arm, left leg, right leg?

• What did the “Other Findings” suggest? Why can this happen?