Approach to Sensory Loss & Abdominal Reflexes

Dr. Wells presented an interesting case of a man who presented with bilateral, symmetric, progressive, ascending lower extremity numbness that turned out to be secondary to compressive myelopathy from a benign lipomatous growth.

Step one: Localize the lesion:

  • Examine their sensation to light touch, sharp stimuli, proprioception, vibration and temperature

  • Vibration and proprioception live in the DORSAL COLUMN

  • Temperature and pain sensation live in the SPINOTHALAMIC TRACT

Step two: Determine the pattern of sensory loss:

  • If it’s one limb: think peripheral nerves/mononeuropathy, nerve plexus or a spinal root

  • If it’s bilateral or symmetric, think polyneuropathy or spinal cord lesion

  • If only one side is affected, think higher up (ie brainstem and above) and on the contralateral side.

Capture.JPG

Our patient here ended up having compressive myelopathy of T7-T10 which can be very difficult to localize. Dr. Sullivan gave us a pearl about how to test thoracic reflexes #Sullivanpearls: Superficial abdominal reflexes! Here’s a video:

https://www.youtube.com/watch?v=4oo1oDQSfPs

Capture.JPG