Diverse sensory functions with an almost totally divided spinal cord. A case of spinal cord transection with preservation of part of one anterolateral quadrant

Abstract

The spinal cord of a patient was completely and cleanly cut across at the Th3 segment except for part of 1 anterolateral quadrant. The extent of the lesion was clearly verified at an open surgical inspection. There was complete paralysis below the level of the lesion. The classical expectations of her sensory status were confirmed in only 2 ways: temperature could be identified only on the side opposite the intact quadrant, and pin prick could be only identified on this contralateral side. The following findings were against classical expectations. Localization of touch and pressure stimuli was reasonably accurate on both sides. Passive movement could be detected on the homolateral side. Pain could be evoked by stimulation of both sides. Von Frey hair stimuli could be identified on both sides. Repeated subthreshold stimulation markedly lowered the threshold for detecting von Frey hairs. This case implies that there must be a revision of the traditional labeling of the function of the spinal cord afferent systems.