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Cauda equina syndrome
10%
17/174
Central cord syndrome
65%
113/174
Conus medullaris syndrome
8%
14/174
Intracerebral hemorrhage
9%
16/174
Ischemic stroke
5%
8/174
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This patient is presenting after a motor vehicle collision and possible hyperextension injury with weakness of his upper extremities > lower extremities, loss of temperature sensation in his upper extremities, and urinary retention, which is concerning for central cord syndrome. Central cord syndrome can occur secondary to a hyperextension injury to the cervical spine, disruption to the blood flow of the spinal cord, cervical spinal stenosis, or in cases of syringomyelia. After a traumatic injury, patients can present initially (or sometimes the presentation is delayed days to weeks later) with quadriparesis. The weakness and possible decreased pain/temperature sensation may affect the upper extremities more than the lower extremities. Occasionally, there can be bladder dysfunction and urinary retention. MRI is the most appropriate confirmatory test for this diagnosis with possible neurosurgery if a correctable injury exists on MRI. Incorrect Answers: Answer 1: Cauda equina syndrome presents after trauma with flaccid paralysis and areflexia of the lower extremities with saddle anesthesia, urinary retention, and loss of rectal tone. It would not present with symptoms in the upper extremities. Answer 3: Conus medullaris syndrome presents similarly to cauda equina syndrome but occurs secondary to compression of the tip of the spinal cord leading to lower extremity weakness, hyperreflexia, and more symmetric weakness and sensation loss. Answer 4: Intracerebral hemorrhage presents with initial focal neurologic deficits with progressive obtundation and a hyperdense lesion seen on head CT. It is possible in this anticoagulated patient (given he has atrial fibrillation); however, symmetric neurologic deficits that are stable after a collision are less likely to be a head bleed. Answer 5: Ischemic stroke presents with sudden onset and focal neurologic deficits in a patient with atrial fibrillation as in this patient. Usually, there would be sudden-onset, unilateral weakness rather than symmetric weakness with upper extremities > lower extremities in terms of weakness. Bullet Summary: Central cord syndrome presents after a hyperextension injury with weakness and loss of sensation with the upper extremities affected more than the lower extremities.
5.0
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