Chapter 56C. Spinal Cord Trauma Flashcards
Question 56C-1:
A young man is in a high-speed MVA and has total paralysis below the C6 level lmaging shows cord contusion without transection. Four hours later, there still is no return of function. Which of the following statements is true?
A. He is in spinal shock, so some improvement is expected
B. He is beyond the time of spinal shock so recovery is not expected
C. He is beyond the time when motor functions are returning from spinal shock, so the prognosis for recovery is low
Answer 56C-1: C.
Spinal shock involves motor, sensory, and
autonomic features. Although there is a
variable duration of the spinal shock.,
generally motor loss resolves within one hour,
therefore, weakness after this point indicates
physical cord injury rather than spinal shock..
(p1154)
Question 56C-2:
A 74-year-old man with PD falls onto his face while walking. He presents with weakness of all four limbs, but much more prominent in the arms. As reflexes return in the legs and become brisk, they are persistently depressed in the arm. Which is the most likely diagnosis?
A. Central cord syndrome
B. Cervicomedullary syndrome
C. Decompensation ofChiari malformation with syrinx
D. Hematomyelia
Answer 56C-2: A.
This patient has a typical central cord
syndrome, typically occurring from traumatic
hyperextension of the neck. This is common
in an elderly patient with a forward fall.
Cruciate paralysis, from damage in the
cervicomedullary junction, would produce
upper motor neuron findings in both the arms
and legs, although the remainder of the
presentation would be similar to that described
here. (p1155)
Questions 56C-3 through 56C-6: The following disorders represent important syndromes affecting the spinal cord. For the subsequent questions, select the best syndrome from the list. A. Anterior cord syndrome B. Brown-Sequard syndrome C. Cauda equina syndrome D. Central cord syndrome E. Cervicomedullary syndrome F. Conus medullaris syndrome G. Posterior cord syndrome Question 56C-3: A patient presents following an MVA with flaccid leg weakness, loss of bowel and bladder sphincter control, with some preservation of sensory function. Over the next few hours ankle reflexes return and are brisk.
Answer 56C-3: F.
The patient has a lesion of the conus
medullaris. which is at about the level ofTl2
and L I in the spine. The combination of upper
and lower motor neuron dysfunction suggests
a higher lesion than the cauda equina. (p 1157)
Questions 56C-3 through 56C-6: The following disorders represent important syndromes affecting the spinal cord. For the subsequent questions, select the best syndrome from the list. A. Anterior cord syndrome B. Brown-Sequard syndrome C. Cauda equina syndrome D. Central cord syndrome E. Cervicomedullary syndrome F. Conus medullaris syndrome G. Posterior cord syndrome Question 56C-4: A patient presents with leg weakness following MVA with complete paralysis below approximately T9. Sensory examination shows preservation of position sense and vibration in the legs.
Answer 56C-4: A.
The preservation of the posterior column
sensation indicates anterior cord syndrome.
While this can be traumatic, we see this more
prominently with anterior spinal artery
infarction. (p 1157)
Questions 56C-3 through 56C-6: The following disorders represent important syndromes affecting the spinal cord. For the subsequent questions, select the best syndrome from the list. A. Anterior cord syndrome B. Brown-Sequard syndrome C. Cauda equina syndrome D. Central cord syndrome E. Cervicomedullary syndrome F. Conus medullaris syndrome G. Posterior cord syndrome
Answer 56C-5: B.
The Brown-Sequard syndrome is
characterized by ipsilateral corticospinal
weakness and loss of posterior column
function with contralateral loss of
spinothalamic tract function. This would be
unusual for blunt trauma, but can occur with
penetrating trauma or with recovery from a
more extensive cervical spine injury. (p1157)
Questions 56C-3 through 56C-6: The following disorders represent important syndromes affecting the spinal cord. For the subsequent questions, select the best syndrome from the list. A. Anterior cord syndrome B. Brown-Sequard syndrome C. Cauda equina syndrome D. Central cord syndrome E. Cervicomedullary syndrome F. Conus medullaris syndrome G. Posterior cord syndrome Question 56C-5: A man presents with GSW to the mid-cervical spine, and is found on examination to have left-sided weakness below the level of the lesion, with loss of pain and temperature sensation on the right side of the body.
Answer 56C-6: C.
Cauda equina lesion is suggested by the.
saddle anesthesia and urinary retention, these
being salient features which help to
differentiate this from conus medullaris
syndrome. along with the level of the lesion.
(p1158)
