A 56-year-old woman with metastatic breast cancer presents with progressive bilateral leg weakness and hyperreflexia. Vital signs show BP 128/82, HR 88, RR 16, temp 37°C, SpO2 98%. Neurologic exam reveals bilateral Babinski signs and spasticity. Pain and temperature sensation are intact bilaterally. MRI cervicothoracic spine demonstrates T6 spinal cord compression with cord signal abnormality. She takes tamoxifen and recently completed chemotherapy. Which spinal cord tracts are most likely affected?
- A)Spinothalamic tracts bilaterally
- B)Dorsal columns (fasciculus gracilis and cuneatus)
- C)Corticospinal tracts bilaterallyGABARITO
- D)Spinocerebellar tracts
- E)Lateral corticospinal and dorsal column tracts
Explicação
Bilateral leg weakness with hyperreflexia and Babinski sign indicates upper motor neuron involvement, specifically bilateral corticospinal tract compression. Preserved pain and temperature sensation argues against spinothalamic tract involvement. The spinal co... Ver explicação completa e trilha adaptativa →