Case Study: Neurological Assessment

Updated on March 7, 2017
H. P. Loveboat profile image

Vince is a technical writer working in the medical research field. He also enjoys exploring literature in his free time.

The Patient

A patient presents with a tumor on the posterior aspect of the spinal cord at C6. Surgery is performed to remove the tumor. What changes in sensation or motor function, if any, can the patient and the care team expect?

The Gracile and Cuneate Tracts

Depending on the size of the tumor and the specific location along the posterior aspect of the spine where it is located, there are two possible tracts that could be affected on each side of the midline. These are the fasciculus gracilis, which is most posterior, and the fasciculus cuneatus, which is more anterior and lateral. If the tumor is centered, it will affect sensations on both sides of the body. If it is not centered, it will affect sensation on the ipsilateral side of the body since information carried by both the gracile and cuneate tracts decussates at the level of the medullary pyramids (Lundy-Ekman, 2013).

If the gracile tract is the only part affected, the patient will experience sensation loss in the lower trunk and limbs, with ascending sensation loss corresponding to how far laterally the tumor reaches. These dermatomes may include anything from T7 through 12, L1 through 5, and S1 through 5. If the tumor reaches all the way into the cuneate fasciculus, then the upper limbs and trunk will be affected. These dermatomes will be C6 through 8 which involve the hands and the posterior arms and T1 through 6 which covers the majority of the thoracic area. Once again, the vertical level of sensation loss will correspond to how far laterally the tissue damage occurs (Lundy-Ekman, 2013).

Sensory Loss

The type of sensations affected will be primarily deep touch, vibrations, and proprioception. The majority of pain and temperature will not be affected as these are carried along the anterolateral tract. The exception being visceral pain (pain occurring within the body). According to Kansal and Hughes (2016), while the nature of this pain is not entirely known, it is understood that internal nociceptors are much less common than on the surface of the body, and the signals are often confused with surface sensations due to following a similar tract. As such, the patient may have trouble identifying where in space his body parts are located, feeling specifically where he is being touched, and identifying internal pain that may be indicative of illness (Lundy-Ekman, 2013).

If the tumor has indeed affected both the gracile and cuneate fasciculi, than the patient may experience difficulty in receiving feedback needed from the body for any fine motor movement such as using his hands and walking. While his motor neurons are still able to function completely, he will not be able to feel how hard he is gripping an object or where his feet are in relation to each other. It is likely that the patient will be able to learn how to use a wheelchair as he can be taught to perform the gross motor movements of gripping the wheels, pushing forward, and releasing the wheels and would not require fine motor skills for this. Once again, it is important to note that the patient will not be numb as he will not have lost all forms of sensation. He will still be able to feel when he has gripped something or that his is activating his muscles. It is only the level of precision with which he can sense these things that is affected.


Lundy-Ekman, L. (2013). Neuroscience: fundamentals for rehabilitation. (4th ed.). Philadelphia, PA: WB Saunders. ISBN: 978-1455706433.

Kansal, A. & Hughes, J. (2016). Visceral pain. Anesthesia and Intensive Care Medicine, 17(11), 543-547.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


    0 of 8192 characters used
    Post Comment

    No comments yet.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)
    ClickscoThis is a data management platform studying reader behavior (Privacy Policy)