Question 2#

An upper motor neurone lesion will usually comprise which of the following features?

A. A lesion at T10 or above with an atonic bladder
B. A lesion at T10 or above with neurogenic detrusor overactivity and detrusor-sphincter-dyssynergia
C. A lesion below L2 with an atonic bladder
D. Any lesion with detrusor-sphincter-dyssynergia
E. Cauda equina compression

Correct Answer is B


In spinal cord injuries at or above the level of T10, the patient is most likely to have an upper motor neurone type injury with neurogenic detrusor overactivity and detrusor-sphincterdyssynergia (DSD). DSD is defined as involuntary contraction of the urethral and/or periurethral striated muscle simultaneously with a detrusor contraction. This is the result of loss of co-ordination by the pontine micturition centre. The typical appearance on a pressure-flow trace is drawn as shown in figure below.

Pressure/flow trace and EMG in a spinal cord injured patient with DSD. (From Hussain, M. et al., BJMSU, 5, 192–203, 2012.)