Neurological Examination of Malingering
Alan R. Hirsch in Neurological Malingering, 2018
Pacinian corpuscles cells transverse throughout the body, especially on the joints and bones, making it possible for a person to know the specific location of their limbs in space. Vibration and position sense are transmitted through the posterior column of the spinal cord. Organic vibratory loss can induce gait disturbances since they are unable to judge the location of their limbs in place, as in long-term vitamin B12 deficiency. Vibration should be felt equally bilaterally if placed within a midline bone which is being tested because Pacinian corpuscles traverse the bone (Gilman, 2002). Since vibration is sensed mainly through bone conduction, presentation of vibration through the midline bone should be felt bilaterally. Thus, splitting of vibration in the midline points toward patients with functional sensory loss. By simply placing a tuning fork to the forehead or sternum of the patient, the Pacinian corpuscles activate widely throughout the periosteum of the forehead or sternum leading to bilateral vibratory sensation. Placing the tuning fork lateral to the middle of the forehead or sternum should not be detected unilaterally, but rather bilaterally. Thus, splitting of the sternum or forehead—feeling it on one side and not on the other—is a sign of functional vibration loss (Daum, Hubschmid, and Aybek, 2014). This examination finding is 95% sensitive and 14% specific for malingers.
Cervical spine injury
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
The classic assessment of instability of an acute traumatic spine injury is based on the three-column spine concept, which was first described in 1984 by Denis.16 This model divides the spine into three columns in the sagittal plane. The anterior column is formed by the anterior longitudinal ligament, the anterior half of the vertebral bodies, and discs. The middle column is formed by the posterior vertebral bodies and discs, the posterior longitudinal ligament, and synovial joints. The posterior column is formed by the laminae, spinous processes, and posterior ligaments of the spine. An injury that disrupts any two or more of these conceptual columns makes the spine unstable.
ENTRIES A–Z
Philip Winn in Dictionary of Biological Psychology, 2003
The nucleus gracilis is a SOMATOSENSORY nucleus in the lower MEDULLA that relays information about discriminative TOUCH and PROPRIOCEPTION. Together with the NUCLEUS CUNEATUS, it forms the posterior column nuclei, with the nucleus gracilis being the smaller and more medially located of the two. Both nuclei receive axons from the first-order sensory neurons in the DORSAL ROOT GANGLIA. The nucleus gracilis receives information from the lower part of the body (the trunk and lower limbs), while information from the upper part is directed to the nucleus cuneatus. The axons of the second-order neurons in these nuclei give rise to the MEDIAL LEMNISCUS which ascends to the THALAMUS.
Posterior cord syndrome associated with postoperative seroma: The case to perform a complete neurologic exam
Published in The Journal of Spinal Cord Medicine, 2020
Meghan Cochrane, Marika Hess, Natalie Sajkowicz
The posterior column transmits the sensations of vibration, position sense, deep pressure and two-point discrimination. Loss of vibration and proprioception below the level of the lesion are hallmarks of posterior cord syndrome which are not routinely tested during the standard ISNCSCI examination.4 Therefore disorders that are limited to the posterior column can easily be missed or overlooked when performing the standard ISNCSCI examination. Dorsal column pathology resulting in posterior cord syndrome causes sensory ataxia and unstable gait, which can have a huge impact on function. Though this patient’s motor examination remained stable, his functional impairments changed significantly from his preoperative baseline. His balance deficits resulted in an inability to stand and remain in his home. With rehabilitation, he was able to return to baseline function and return home.
Total hip arthroplasty, combined with a reinforcement ring and posterior column plating for acetabular fractures in elderly patients: good outcome in 34 patients
Published in Acta Orthopaedica, 2019
Tõnis Lont, Jyrki Nieminen, Aleksi Reito, Toni-Karri Pakarinen, Ilari Pajamäki, Antti Eskelinen, Minna K Laitinen
Acute THA was performed by experienced revision arthroplasty surgeons together with pelvic trauma surgeons. Patients were placed under spinal anesthesia, and a dose of preoperative antibiotic prophylaxis was infused 30 min prior to surgery. A Kocher–Langenbeck approach was used. The posterior column was supported by adding posterior column plating and a GAP II reinforcement ring (Stryker, Mahwah, NJ, USA). Various components were used in both the femur and acetabulum throughout the study period, depending on the implant selected by the hospital (Table 1). In all acute THA cases, morselized autograft bone transplantation from the resected femoral head was performed using an impaction grafting technique (Hosny et al. 2017). In the first acute THA case, anterior column reduction and fixation was performed using an AIP approach. Additional anterior fixation was not applied in any subsequent patients.
The safe use of long screws in L5/S1 stand-alone anterior interbody fusion for olisthesis cases
Published in British Journal of Neurosurgery, 2018
Matthias A. König, Michael P. Grevitt, Nasir A. Quraishi, Bronek M. Boszczyk
Stand-alone anterior lumbar fusion (STALIF) gained popularity among spinal surgeons over the last decade, offering a better access to the anterior column with less morbidity compared to posterior constructs.1–4 The advantage of foraminal height restoration with indirect decompression, restoration of sagittal balance and lumbar lordosis5,6 pushed the indications for stand-alone anterior interbody fusion into complex pathologies like olisthesis.7–10 Depending on the cage design, divergent locking screws are needed to anchor the device into the superior and inferior endplate.11 The divergent locking screws however could perforate the neuroforamen at the sacrum and injuring the S1 nerve root, especially if long screws are used. Due to the pull-out forces at the lumbo-sacral junction, the use of too short screws might lead to sacral fractures.12–14 These risks might be even higher, if the posterior column support is poor like in olisthesis cases.
Related Knowledge Centers
- Central Nervous System
- Nerve Tract
- Parietal Lobe
- Postcentral Gyrus
- Proprioception
- Somatosensory System
- Primary Somatosensory Cortex
- Sensory Nervous System
- Two-Point Discrimination
- White Matter