Question

A 19-year-old man hyperextended his neck in an auto accident. He lost consciousness for a short time, and when he awoke he could not move any of his limbs, nor could he feel any sensations in his trunk or limbs. After a month he could move his shoulders to some extent, but otherwise all four extremities remained paralyzed. At this time he developed increased muscle tone and hyperactive stretch reflexes in both arms and legs. Also, when either foot was sharply dorsiflexed, sustained clonus of the ankle occurred. (Ankle clonus is a rapid back and forth movement of the foot.) Signs of Babinski could readily be elicited bilaterally. Stimulation of one foot caused withdrawal of that foot and also flexion of the other leg. He had to be catheterized to allow for drainage of the urinary bladder.

At what level was the spinal cord functionally transected?

Answer 1

The presence of UMN signs like a positive Babinski sign points to a high cervical lesion between the C4 and C5 vertebrae as the likely site of spinal transection in the quadriplegic patient.

Step-by-step explanation:

The presence of symptoms such as increased muscle tone, hyperactive stretch reflexes, sustained clonus, and a positive Babinski sign all point to damage in the upper motor neurons (UMNs). Given that the patient developed quadriplegia following the accident but retained some shoulder movement, the spinal cord lesion likely involves the cervical region which innervates both the upper and lower limbs. Based on the provided information, the most likely location of the functional transection of the spinal cord would be at or above the cervical level but below the region that innervates the shoulders, suggesting a high cervical lesion possibly between the C4 and C5 vertebrae.