Central lesions affect the decussating nociceptive fibres first, then the anterior horn cells and corticospinal tracts; the dorsal columns are usually spared
Clinical findings
Inspection
Wasting at the level of the lesion
Spasticity below the level of the lesion
Reflexes
Increased below the level of the lesion (if large enough to affect corticospinal tract)
May be absent at the level of the lesion
Plantars may be extensor
Power
Flaccid weakness at the level of the lesion (anterior horn cell)
Pyramidal below the level of the lesion (corticospinal tract)
Sensation
Bilateral pain and temperature loss around the level of the lesion
Normal pain and temperature above and below the level of the lesion
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