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PT 7326 Neuroanatomy Case Study

PT 7326 Neuroanatomy Case Study. Paige Perriraz, SPT David Middaugh, SPT. Examination. Sally Reddy 53 y/o female Pt has difficulty dressing Pt has difficulty brushing hair Concerned with her lack of sensation in UE after a burn from cooking. Examination continued. Physical Examination

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PT 7326 Neuroanatomy Case Study

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  1. PT 7326 NeuroanatomyCase Study Paige Perriraz, SPT David Middaugh, SPT

  2. Examination • Sally Reddy • 53 y/o female • Pt has difficulty dressing • Pt has difficulty brushing hair • Concerned with her lack of sensation in UE after a burn from cooking

  3. Examination continued • Physical Examination • HR 75, BP 110/75, RR 15, temp 98.9°F • Pulses intact – checked cubital fossa, brachial, radial, and carotid • Well nourished • Pt appeared worried

  4. Examination continued • Neurologic Examination • Cranial nn intact • Normal cognitive function • A&O x 3 • Sensory & Motor explored more closely

  5. Examination continued • Sensory Testing • Inability to discriminate hot and cold bilaterally in C4-C6 dermatomes • Sharp/dull and two point discrimination tests of UE showed bilateral absent sensation in C4-C6 dermatomes • Testing revealed that the sensory deficits were cape-like

  6. Examination Continued • Motor Testing • Bilateral UE mm tests were identical • Deltoid – 3/5 • Biceps – 3+/5 • Triceps – 4+/5 • Normal biceps, triceps, brachioradialis reflexes at this time. • Both LE reflexes and mm strength WNL

  7. Follow-Up Visit • Same • Results of hot/cold, sharp/dull, and two-point discrimination test • Level of UE strength • Different • Hypereflexive Biceps and brachioradialis • Possible corticospinal tract involvement • Normal triceps reflex

  8. Involved Tracts (Quiz Time!) • Corticospinal – motor tract • Spinothalamic – sensory tract • Dorsal Column – sensory tract

  9. Sniffing out the Problem • Bilateral involvement reveals central canal involvement • Hot/Cold, Sharp/Dull - Spinothalamic tract • Tract decussates at the SC level • Two-point discrimination - Dorsal Column • Muscle Strength testing, Reflexes – Cortiospinal Tract • Diminished mm strength

  10. Syringomyelia • Syrinx (cyst) + myelo (spinal cord)* • Fluid filled cavitation central canal • Typically lower cervical/upper thoracic regions • Gradual progression from anterior white commissure to anterior horn cells • Bilateral loss of pain & temp, weakness/atrophy at level(s) of lesion ONLY • Typically capelike sensory loss with weakness in the hands *Pathology: Implications for the Physical Therapist 2nd edition. Goodman, Fuller, Boissonnault

  11. Syringomyelia continued… • Typically symptoms appear acutely • Most cases are related to a past injury • Important to get a complete PMH • MVA, falls, SCI, head trauma,

  12. Evaluation • Per Nagi Model • Pathology – Syringomyelia (SC cyst) at C4-C6 dermatome • Impairment – loss of sensation, decreased mm STR, hypereflexia in UE • Functional Limitation – difficulty dressing and brushing hair • Disability – pt cannot return to work as a restaurant chef, and cannot go to church

  13. Prognosis • If left untreated, the pt can deteriorate in STR and sensory function. • Surgery is usually done to remove the cyst in hopes of alleviating sensory and motor losses, but recovery is usually modest. • The prognosis is good for the pt who receives a surgery.

  14. PT Goals • LTG – pt will be able to fully dress and undress, brush her hair, brush teeth and apply make-up without assistance. • STG 1 – pt will undergo surgery in 3 days • STG 2 – pt will be able to maintain a 2 lb wt in hand with 45° elbow flexion, 45° shoulder flexion in both UE. This will replicate pt’s job with handling kitchenware.

  15. Intervention • Surgery to remove the cyst • Post Op • ROM • MM Strengthening • Overhead exercises (for dressing and brushing hair) • Sensation should return with time upon the removal of the syrinx • Random hot/cold, sharp/dull, two point discriminative touch, etc. testing should be performed throughout rehabilitation process

  16. APTA Practice Pattern • 5E – Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System

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