QuestionSBA
QuestionChoice
This is incorrect. The corticobulbar tracts terminate in the cranial nerves and are not associated with neurological changes in the lower limbs. The patient also shows a severe vitamin B12 deficiency which, in combination with his neurological symptoms, is in keeping with dorsal column damage as a result of subacute combined degeneration of the spinal cord.
10025833
d
Tectospinal tract
QuestionChoice
This is incorrect. The lateral spinothalamic tract is responsible for carrying sensory information relating to pain and temperature. By contrast, lower limb deficits in vibration sensation and proprioception, in combination with the severe vitamin B12 deficiency, are more in keeping with dorsal column damage as a result of subacute combined degeneration of the spinal cord.
10025834
e
Lateral spinothalamic tract
QuestionChoice
This is correct. The dorsal columns carry sensory fibres for vibration and proprioception, which are impaired in the neurological examination of this patient. The patient also shows a severe vitamin B12 deficiency which, in combination with his neurological symptoms, is in keeping with subacute combined degeneration of the spinal cord which affected the dorsal column.
10025830
a
Dorsal column
QuestionChoice
This is incorrect. The corticobulbar tracts terminate in the cranial nerves and are not associated with neurological changes in the lower limbs. The patient also shows a severe vitamin B12 deficiency which, in combination with his neurological symptoms, is in keeping with dorsal column damage as a result of subacute combined degeneration of the spinal cord.
10025831
b
Corticobulbar tracts
QuestionChoice
This is incorrect. The reticulospinal tracts are responsible for voluntary movements and muscle tone, and are not associated with neurological changes in the lower limbs. The patient also shows a severe vitamin B12 deficiency which, in combination with his neurological symptoms, is in keeping with dorsal column damage as a result of subacute combined degeneration of the spinal cord.
10025832
c
Reticulospinal tracts
Concept
Chapter
2693
5864
Subacute combined degeneration of the spinal cord
Topic
141
Neurology
Dorsal column
17564
A 65 year old male presents to A& after a fall, with a 6-month history of general health deterioration, increased fatigue, unsteadiness, and leg tingling.
  

  
 

A neurological examination reveals:
  
 

* Diminished vibration sense in the lower limbs bilaterally
* Diminished proprioception in the lower limbs bilaterally
* Slight weakness of the lower limbs bilaterally (power 3/5)
* Intact pain and temperature sensation throughout
  
 

Some blood tests are done and relevant results are as follows:
  
  
| |  |  |
| -------------- | :-------: | --------------- |
| Haemoglobin | 110 g/L | (M) 130 - 170, (F) 115 - 155  |  
| Mean Cell Haemoglobin (MCH)| 36 pg | 27 - 33  |
| Mean Cell Volume (MCV)  | 104 fL | 80 - 96  |
| Serum Vitamin B12  | 55 ng/L | 160 - 925  |
 

* Intrinsic factor antibody positive
  
 

Which of the following neurological tracts are most likely to be implicated in this pati
a