Spinal cord injury: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spinal cord injury

Sample item

A man is stabbed on the right side of his back at the T10 level. On examination, he has right leg weakness with loss of vibration and position sense on the right, and loss of pain and temperature sensation on the left from about the T12 level downwards. What explains the sensory findings on the left?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Spinothalamic fibres cross within one or two segments of entering the cord, so a right hemisection affects the contralateral pain pathway below the lesion

Brown-Séquard syndrome is a hemisection of the cord. The ipsilateral side has upper motor neurone weakness and loss of dorsal column function (vibration, proprioception), and the contralateral side loses pain and temperature because spinothalamic fibres decussate in the anterior white commissure close to their level of entry.

Option by option

  • A. Corticospinal tract fibres carry pain sensation from the opposite side

    The corticospinal tract is a motor pathway.

  • B. The posterior columns cross in the cord and carry pain

    The dorsal columns ascend ipsilaterally and decussate in the medulla, and carry fine touch and proprioception.

  • C. Spinothalamic fibres cross within one or two segments of entering the cord, so a right hemisection affects the contralateral pain pathway below the lesion (correct)

    Correct. Fibres carrying pain from the left side cross to the right cord before ascending, and are cut by a right hemisection.

  • D. Spinothalamic fibres ascend uncrossed, so the left side is affected

    Spinothalamic fibres cross rather than ascending uncrossed.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Spinothalamic fibres cross within one or two segments of entering the cord, so a right hemisection affects the contralateral pain pathway below the lesion. Brown-Séquard syndrome is a hemisection of the cord.

Why is "Corticospinal tract fibres carry pain sensation from the opposite side" not the answer?

The corticospinal tract is a motor pathway.

Why is "The posterior columns cross in the cord and carry pain" not the answer?

The dorsal columns ascend ipsilaterally and decussate in the medulla, and carry fine touch and proprioception.

Why is "Spinothalamic fibres ascend uncrossed, so the left side is affected" not the answer?

Spinothalamic fibres cross rather than ascending uncrossed.

What concept does this question test?

It tests Spinal cord injury in Orthopaedics. The ipsilateral side has upper motor neurone weakness and loss of dorsal column function (vibration, proprioception), and the contralateral side loses pain and temperature because spinothalamic fibres decussate in the anterior white commissure close to their level of entry.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spinal cord injury?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.