QuestionSBA
QuestionChoice
Whilst the pons does contain the spinothalamic tracts responsible for pain and temperature sensation, this is not the most site of the lesion likely given the patient's history of spinal trauma.
10025839
e
Pons
QuestionChoice
This is incorrect. Whilst peripheral neuropathy would be an appropriate differential for bilateral sensory changes in a distal limb for a patient with type 2 diabetes, this is not the most likely explanation. The recent spinal trauma and absence of pain and temperature sensation are consistent with damage to the lateral spinothalamic tracts.
10025836
b
Peripheral nerves
QuestionChoice
This is correct. The lateral spinothalamic tracts are responsible for pain and temperature sensation, both of which are impaired in this patient. They can be damaged following spinal injury, and individuals with spinothalamic tract damage often present with burns.
10025835
a
Lateral spinothalamic tracts
QuestionChoice
This is incorrect. The patient did not present with any cerebellar signs. These can be remembered with the mnemonic DANISH (Dysmetria and dysdiadochokinesia, ataxia, nystagmus, intention tremor, slurred speech, hypotonia). In this case, the recent spinal trauma and absence of pain and temperature sensation are consistent with damage to the lateral spinothalamic tracts.
10025837
c
The cerebellum
QuestionChoice
This is incorrect. The dorsal column tracts are responsible for proprioception and vibration sense, both of which are intact in this vignette. The recent spinal trauma and absence of pain and temperature sensation are consistent with damage to the lateral spinothalamic tracts.
10025838
d
Dorsal column
Concept
Chapter
2693
5828
Spinothalamic tracts
Topic
152
Neuroscience
17565
A 60 year old man presents to A&E after sustaining burns to both of his feet. He had not noticed the temperature of his bath when he got in it. On examination, as well as second-degree burns to the plantar aspects of both feet, he also has impaired sensation of pain bilaterally. His sensation of fine touch, vibration and proprioception is intact.

The patient had a recent hospital admission after sustaining a traumatic spinal cord injury, but was discharged the previous week. Other than the spinal cord injury he has a past medical history of type 2 diabetes mellitus, but takes no regular medications.

Which of the following is the most likely location of the pathology?
a