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A 73-year-old man slipped in the bathroom, falling, and striking his forehead on the toilet. In the emergency room he complains of neck pain and subjective weakness of his upper extremities. Examination reveals 3/5 strength to elbow flexion, elbow extension, and grip. Examination of his lower extremity shows he is able to straight leg raise against gravity bilaterally, with 4+/5 strength to knee extension bilaterally. The patient reports prior to the fall he was active, playing doubles tennis, and had no problems with dexterity in his hands. Figure A is the sagittal MRI of the cervical spine. What is the likely pathogenesis for the patient's symptoms?
Disruption of the anterior spinal artery
Chronic cord compression secondary to diffuse spondylotic changes.
Herniation of intervertebral disc
Transient cord compression with central cord edema affecting longitudinal motor tracts
Pathologic ossification of the posterior longitudinal ligament resulting in cord compression
Select Answer to see Preferred Response
A 78-year-old woman is seen in the emergency department after a fall. She has a significant bruise on her forehead and complains of mild neck pain. Her MRI is shown in Figure A. Which of the following is NOT associated with the spinal cord injury most commonly seen in this presentation?
Hyperextension mechanism in setting of pre-existing cervical stenosis
Motor weakness more pronounced in upper extremity than lower extremity
Dyesthesias in the lower extremities
Motor weakness more pronounced in hands than arms
Selective injury to the lateral corticospinal tract
A 73-year-old man falls forward from standing height and sustaining a hyperextension injury to his neck. Physical exam of his lower extremities shows he has 4+ of 5 strength to hip flexion, knee extension, and ankle plantar flexion. Physical exam of his upper extremities shows 4 of 5 deltoid and triceps strength, with 3 of 5 wrist flexion and finger flexion strength. A CT scan and MRI are shown in Figures A and B. Which of the following neurologic pathways was most likely affected?
Lateral corticospinal tract
Central Gray matter
Lateral spinothalamic tract
Ventral spinothalamic tract
A 79-year old man falls sustaining a hyperextension injury to his neck. A lateral radiograph, CT scan and MRI are seen in Figures A through C. On motor examination, he has 3/5 strength in his deltoids, elbow and wrist flexors and extensors. He has 4/5 strength in his hip flexors, knee flexors, extensors, ankle dorsiflexors and plantarflexors. Sensation is preserved in both his upper and lower extremities as well as his sacral segments. Injury to which of the following tracts contributes greatest to his motor function deficits?
A 35-year-old male is involved in a motor vehicle accident and sustains the neck injury shown in Figures A and B. The patient's physical exam is consistent with a Brown-Sequard spinal cord injury. Which of the following likely represents the motor and sensory findings?
Bilateral upper extremity loss of motor function and unilateral lower extremity loss of pain and temperature sensation
Bilateral loss of motor function and unilateral loss of pain and temperature sensation
Ipsilateral loss of motor function and contralateral loss of pain and temperature sensation
Bilateral loss of pain and temperature sensation and unilateral loss of motor function
Ipsilateral loss of pain and temperature sensation and contralateral loss of motor function
A 78-year-old female slips and falls in the bathroom. In the emergency room she is found to have a laceration on her forehead. On physical exam she has new onset Grade 3 weakness in her upper extremities, more pronounced in her hands, making it difficult for her to hold objects. In her lower extremities she has Grade 4 weakness, but is able to walk with assistance. She has new onset urinary dysfunction. A radiograph and MRI are shown in Figure A and B respectively. History reveals that prior to the fall she was living independently, was able to go on daily walks, and had normal function of her hands. Which of the following most accurately describes her prognosis with nonoperative treatment.
The patient will continue to deteriorate in a step-wise manner.
The patient will most likely regain full function in her hands.
More likely than not she will regain her ability to ambulate independently.
There is a less than a 10% chance the patient will regain her bowel and bladder function.
The patient will continue to deteriorate in a rapid and progressive manner.
Which of the following clinical scenarios would be an indication for surgical intervention of the spine?
18-year-old male with T12 burst fracture, 25% loss of vertebral body height, 30% encrouchment of the spinal canal due to retropulsion, no evidence of injury to the posterior ligamentous complex, and no neurologic deficits.
25-year-old male with trans-colonic gun shot wound and cord hemi-transection without retained bullet fragment.
80-year-old female with global upper extremity weakness but preserved lower extremity function following a fall with an extension mechanism to the cervical spine and imaging showing diffuse spondylitic changes but no current focal spinal cord compression.
37-year-old male with type III odontoid fracture who is neurologically intact.
18-year-old male with incomplete sensory and progressive motor deficits after gun shot wound with retained bullet fragment and radiographic evidence of neural compression of the cauda equina region.
In patients with incomplete spinal cord injuries what is the most important prognostic variable relating to neurologic recovery?
Severity of neurologic deficit
Mechanism of injury
Administration of spinal dose steroids within 8 hours
Early definitive surgery