From the Guidelines
The Upper Motor Neuron (UMN) spinal lesion would most likely be located in the cervical or thoracic spine, specifically in the lateral or dorsal columns, given the patient's symptoms and the absence of lesions in the brain, C1, C2, C3, or C4 [ 1 ].
Key Considerations
- The patient's symptoms, such as a positive Babinski sign, heavy leg sensation, intentional tremor of hands, finger weakness, and full-body muscle tics, are consistent with an UMN lesion [ 1 ].
- The absence of lesions in the brain, C1, C2, C3, or C4, and the presence of moderate connective tissue laxity, suggest a spinal lesion [ 1 ].
- The patient's family history of Multiple Sclerosis (MS) and the presence of a positive Babinski sign, which is a common sign of MS, support the likelihood of a spinal lesion [ 1 ].
- The MRI criteria for the diagnosis of MS, as outlined in the MAGNIMS consensus guidelines, suggest that spinal cord lesions can be used to support the diagnosis of MS [ 1 ].
Lesion Characteristics
- The lesion is likely to be focal, with a clearly demarcated border, and cigar-shaped on sagittal images, and wedge-shaped on axial images [ 1 ].
- The lesion may be small, covering less than two vertebral segments, and usually less than half of the cord area [ 1 ].
- The lesion may be located in the periphery of the spinal cord, mainly in the lateral or dorsal columns, and may affect the anterior white matter and the central grey matter [ 1 ].
From the Research
Clinical Presentation
The patient presents with a positive Babinski sign, heavy leg sensation, intentional tremor of hands, finger weakness, preserved vision, and full-body muscle tics. These symptoms are consistent with an Upper Motor Neuron (UMN) lesion.
Possible Location of the Lesion
Given that there are no lesions in the brain, C1, C2, C3, or C4, the lesion is likely to be located in the spinal cord below the level of C4. The presence of a positive Babinski sign and heavy leg sensation suggests a lesion affecting the corticospinal tract, which is consistent with a spinal cord lesion [ 2, 3 ].
Association with Multiple Sclerosis (MS)
The patient's family history of MS and the presence of intentional tremor, a common symptom in MS [ 2, 3, 4 ], suggest a possible association with MS. However, the diagnosis of MS should be considered in the context of other potential causes, including connective tissue disorders [ 5 ].
Connective Tissue Laxity
The patient's moderate connective tissue laxity may be a contributing factor to their symptoms, but it is not directly related to the location of the UMN lesion.
Potential Diagnosis
Based on the patient's symptoms and family history, a potential diagnosis could be MS with a spinal cord lesion below the level of C4. However, further evaluation and testing would be necessary to confirm this diagnosis [ 2, 3, 4 ]. The presence of full-body muscle tics and other symptoms may also suggest other potential diagnoses, such as a movement disorder [ 2, 3, 6 ].