A 24-year-old male mountain bike rider crashes into a tree, resulting in a severe hyperextension neck injury, and fractured lower left ribs. He now presents to hospital with shock and a painful distending abdomen.
After another 24 hours it is apparent that he has a complete spinal cord lesion at C4. What signs of this lesion are likely to be present?
College Answer
Tone may well still be decreased (though with time this will increase, with posturing developing in an upper motor neurone distribution). Anal tone would be lax with a complete lesion. Quadriparesis would be expected, with no movement below deltoid. Respiratory muscles may be significantly compromised. Reflexes may still be absent, though with time will increase. The plantar reflex should be upgoing. A sensory level is expected between C2 to C6, and to all modalities (eg. touch, pain, temperature, JPS and vibration).
Discussion
This question is identical to Question 14 from the second paper of 2005.