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Question 1

bulbocavernous reflex

Answer 1

The bulbocavernous reflex is a reflex contraction of the anal sphincter with either a squeeze of the glans penis, tapping the mons pubis or pulling on a urethral catheter. The bulbocavernous reflex is absent in spinal shock and its return signals the end of spinal shock.

Question 2

Neurogenic shock

Answer 2

Neurogenic shock occurs secondary to temporary shutdown of sympathetic outflow from the cord from T1 to L2, usually due to injury in the cervical or upper thoracic cord leading to hypotension and bradycardia which usually resolves within 24‐48 hours. Priapism from unopposed parasympathetic stimulation may be present. Neurogenic shock is treated with IV fluid therapy. Neurogenic shock must be differentiated from other forms of shock (hypovolaemic shock is much more common in trauma cases and should respond to fluid replacement therapy).

Question 3

The presence of sacral sparing indicates what?

Answer 3

Sacral sparing with preservation of perianal sensation, voluntary anal sphincter contraction and big toe flexion (FHL muscle, S1/2) indicates some continuity of the corticospinal (motor) and spinothalamic (course touch, pain, temperature) tracts. The presence of sacral sparing indicates an incomplete cord injury with a better prognosis than a complete injury.