TABLE 12

PBL 2
Mrs Amadi Juliana is a 52 year old widow and volunteer health worker who had been working in a beggars colony in Kano for 12 years. She had noticed a white scaly patch over her chest area 5 years ago which she dismissed as mild eczema. Over time she noticed some bumps on her arms and some difficulty in holding her tea cup. She became alarmed when she noticed that her fingers got burned over the gas flame while cooking on 3 occassions without her feeling it.

 On seeing a physician, he discovered more whitish patches on her skin and that over such areas she did not percieve pin pricks. He also noticed that putting her fingers in water at 70o C she did not respond in any way. The doctor ordered that sample of her skin over the patches been obtained for laboratory investigations With your knowledge in Anatomy, discuss what pathway that may be affected and responsible for her fingers to be burnt without her feeling it?

 With your knowledge in Anatomy, discuss what pathway that may be affected and responsible for her fingers to be burnt without her feeling it? What disease can possibly give rise to this condition Is the physician in any possible danger?

KEY WORDS
52 YEARS OLD WORKING IN BEGGARS COLONY FOR 12YEARS DICOVERED WHITE SCALY PATCHES ON CHEST AREA 5 YEARS AGO BUMPS ON HAND DIFFICULTY IN HOLDING HER CUP NOT FEELING HER FINGERS GET BURNT ON THREE DIFFERENT OCCASION MORE WHITISH SCALY PATCHES ON SKIN THAT HAS LOST SENSATION NO RESPONSE WHEN HER HAND WAS PUT IN WATER AT 70oC

KEY WORDS
ANATOMY OF PATHWAY THAT IS AFFECTED AND RESPONSIBLE FOR HER FINGERS TO BE BURNT WITHOUT HER FEELING IT WHAT DISEASE CAN POSSIBLE GIVE RISE TO THIS CONDITION IS THE PHYSICIAN IN ANY POSSIBLE DANGER?

QUESTIONS
ANATOMY OF PATHWAY THAT IS AFFECTED AND RESPONSIBLE FOR HER FINGERS TO BE BURNT WITHOUT HER FEELING IT? THE PATHWAY RESPONSIVE FOR HER HANDS TO BE BURNT IS THE PAIN AND TEMPERATURE PATHWAY KNOWN AS THE LATERAL SPINOTHALAMIC TRACT

LATERAL SPINOTHALAMIC TRACT

THE LATERAL SPINOTHALAMIC TRACT Brief Illustration of the Lateral Spinothalamic Tract

THE LATERAL SPINOTHALAMIC TRACT

The LATERAL SPINOTHALAMIC TRACT is the pain and temperature pathways The lateral spinothalamic tract (or lateral spinothalamic fasciculus), is a bundle of sensory axons ascending through the white matter of the spinal cord, carrying sensory information to the brain. It carries pain and temperature sensory information to the thalamus of the brain. It is composed primarily of slow-conducting, sparselymyelinated A axons and slow-conducting, unmyelinated C axons.

LATERAL SPINOTHALAMIC TRACT

Normally, ascending pathway have three neurons. The FIRST ORDER NEURON It has two parts; the peripheral processes which connects the sensory receptor ending. the central processes which enters the spinal cord through the posterior root to synapse on the second order neuron.

THE LATERAL SPINOTHALAMIC TRACT

The first order neuron entering the spinal cord from the posterior root ganglion proceed to tip of the posterior gray horn. Divides into ascending and descending branches This branches travel for a distance of one or two segments of the spinal cord to form Posterolateral Tract of Lissauer The first order neuron synapse with cells in the posterior gray column

LATERAL SPINOTHALAMIC TRACT

The second order neuron The axons of the second order neuron now cross obliquely to the opposite side in the anterior gray and white commissure within the one spinal segment of the cord. These neurons are situated in the dorsal horn, specifically in the Lamina of Rexed regions I, II, and V. Region II is primarily composed of Golgi type II interneuron, are primarily for the modulation of pain, and largely project to regions I and V. Regions I and V decussate across the anterior commissure and ascend in the (now contralateral) lateral spinothalamic tract. These fibers will ascend through the medulla and through the Pons and midbrain as the spinal lemniscus until synapsing in the Ventroposteriorlateral (VPL) nucleus of the thalamus.

LATERAL SPINOTHALAMIC TRACT

The third order neuron The third order neurons in the thalamus will then project through the internal capsule and corona radiata to various regions of the cerebral cortex, primarily the main somatosensory cortex SI, Brodmann's Areas 3, 1, and 2.

LATERAL SPINOTHALAMIC TRACT

The ROLE of the CEREBRAL CORTEX is to interpret the quality of the sensory information at the level of consciousness

WHAT DISEASE CAN POSSIBLE GIVE RISE TO THIS CONDITION LEPROSY

LEPROSY
Leprosy or Hansen's disease (HD) is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; Granulimatous in the sense that it is characterized by granulomas (Granuloma - Granulomas are macrophages that form when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate.)

LEPROSY
It is not very contagious and it has a long incubation period (time before symptoms appear), which makes it hard to know where or when someone caught the disease. Leprosy has two common forms: tuberculoid lepromatous. (Both forms produce sores on the skin.) The lepromatous form is most severe. It causes large lumps and bumps (nodules).

LEPROSY
Symptoms Symptoms include: Skin lesions that are lighter than your normal skin color
Lesions have decreased sensation to touch, heat, or pain Lesions do not heal after several weeks to months

Muscle weakness Numbness or lack of feeling in the hands, arms, feet, and legs

 Lesions are the primary external sign. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs and eyes. Body parts become numb or diseased as a result of secondary infections; these occur as a result of the body's defences being compromised by the primary disease. Secondary infections, in turn, can result in tissue loss causing fingers and toes to become shortened and deformed, as cartilage is absorbed into the body.

LEPROSY
A syringomyelia-like syndrome has been infrequently reported in neurological disorders lepromatous leprosy. This study reports a syringomyelia-like syndrome in four adult male patients, which we have termed facial onset sensory and motor neuronopathy, or FOSMN syndrome, that appears to have a neurodegenerative aetiology. S. Vucic et al, 2006

SYRINGOMYELIA
Syringomyelia is a generic term referring to a disorder in which a cyst or cavity forms within the spinal cord. This cyst, called a syrinx, can expand and elongate over time, destroying the spinal cord. The damage may result in pain, paralysis, weakness, and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. The disorder generally leads to a cape-like loss of pain and temperature sensation along the back and arms. Each patient experiences a different combination of symptoms. These symptoms typically vary depending on the extent and, often more critically, to the location of the syrinx within the spinal cord. Syringomyelia with symptoms usually beginning in young adulthood. Signs of the disorder tend to develop slowly, although sudden onset may occur with coughing, straining, or myelopathy.

IS THE PHYSICIAN IN ANY POSSIBLE DANGER?

THE ANSWER IS YES Leprosy can be contacted through *prolong contact with infected persons * leprosy is transmitted from one person to another in infected respiratory droplets

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