A patient presents with bilateral loss of pain and temperature sensation across the upper limbs and shoulders in a 'cape-like' distribution, with preservation of fine touch and proprioception. Motor function is intact. Where is the lesion most likely located?
- A Anterior commissure of cervical spinal cord ✓
- B Posterior columns at cervical level
- C Bilateral spinothalamic tracts in the lateral funiculi
- D Posterior horns bilaterally
Correct answer: A. Anterior commissure of cervical spinal cord
Explanation
The anterior (ventral) white commissure carries decussating spinothalamic fibers from both sides; a central cord lesion at cervical levels interrupts these crossing fibers, producing bilateral loss of pain and temperature in a cape-like distribution. Fine touch and proprioception, carried in posterior columns, are spared — this dissociated sensory loss is classic for syringomyelia. The posterior columns or lateral funiculi would not produce this pattern.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.