Question

Answer the following case study:

Emilio is a 19 year-old student who was rock climbing and fell 30 feet to the ground. He became unable to move any extremities and complained of neck discomfort. He was awake, alert, and able to answer questions appropriately. He had no feeling in his arms and legs. On physical examination, Emilio's pupils are equal and reactive to light, his BP is normal (110/72), heart rate 86, respiratory rate 18, unlabored. He has no deep tendon reflex. He has sensation from his head to his chest, at the level of the nipples. He is unable to expand his chest wall. Paramedics applied a cervical collar, placed him on a board and transported him to the medical center.

a- Why is Emilio having no sensation from his arms down?
b- What is the level of the injury?
c- Is the reflex activity from the spine affected by the injury?

Answer 1

1. The symptoms raised due to injury at the spine. This could be due to fracture or silo action of vertebral column which might have lead to compression of nerves transection of the spinal cord at specific levels at the chest. The complete transection led to loss of sensations beyond/below the point of injury as the connection between the brain and the cord is lost.
2. The level of injury is T5. Nipples are supplied by the T4 level and the sensations around this dermatome is normal and lost beyond it, indicating damage just below the T4 level around the T5.
3. There is loss of deep reflexes. This occurred due to damage to the spinal cord, which led to non responsiveness to the sensory potentials. As the cord is non-functioning due to transection, led to loss of sensations and reflexes and development of signs and symptoms.