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| | Neuroexam.com - Cortical Sensation, Including Extinction |
 | | Note that graphesthesia, stereognosis, and extinction cannot reliably be tested for unless primary sensation is intact bilaterally. |
 | | Somatosensory deficits can be caused by lesions in peripheral nerves, nerve roots, the posterior columns or anterolateral sensory systems in the spinal cord or brainstem, the thalamus, or sensory cortex. |
 | | Recall that position and vibration sense ascend in the posterior column pathway and cross over in the medulla, while pain and temperature sense cross over shortly after entering the spinal cord and then ascend in the anterolateral pathway (see Neuroanatomy through Clinical Cases, Figures 2.13, 2.18 and 2.19). |
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