Image Quiz
Pain and Weakness Following Cervical Spine Trauma1
A twenty-two-year-old woman was transferred to our care after she was involved as a restrained driver in a motor-vehicle rollover collision. Her chief symptoms were neck and shoulder pain with bilateral upper-extremity weakness. She had no history of medical problems. The area over the cervical spine was tender to palpation during the physical examination. Bilateral upper-extremity motor strength was graded as 5 of 5 in the triceps, the finger flexors, and the finger abductor muscles according to the classification of the American Spinal Injury Association (ASIA). Deltoid and biceps muscle strength was graded as 1 of 5 bilaterally, and wrist extension strength was graded as 2 of 5 bilaterally. Sensation to light touch and pinprick was intact in all dermatomes. Normal sphincter tone was present. The bulbocavernosus reflex was not checked at the time that the patient presented to our institution because the injury had occurred more than seventy-two hours previously. No motor or sensory deficits were noted in the lower extremities. Lower-extremity reflexes were 2+ and symmetric, and the Babinski test was negative bilaterally. Imaging studies were performed.
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