Case Studies
Case 13: A young man with neck pain, collapse and a quadriparesis
A 28-year-old man “working out” in the gym suddenly develops severe neck pain and collapses to the ground. He cannot move any limbs and goes into respiratory arrest. He is resuscitated and moved to an intensive care unit where he is found to have normal cranial nerves, but no movement of any limb. He is unable to breath on his own, he has a loss of pin-prick and temperature sensation to the shoulders, but good preservation of joint position sense and vibration perception threshold.
Your Answer:
Correct answer: The site of the lesion given the sensory level and the involvement of all four limbs is the upper cervical cord above C4 given that he is unable to breath. It can’t involve the brainstem given the absence of any cranial nerve signs.
Your Answer:
Correct answer: The likely cause of the lesion is a vascular one given the acute onset and with the dissociated sensory loss, it implied that he has had an anterior spinal artery occlusion.
Your Answer:
Correct answer: It is well described in some people “working out” in gyms that they can have a fibrocartilaginous embolus of the anterior spinal artery. The occlusion of the anterior spinal artery in the cervical cord will lead to infarction of the anterior two-thirds of the spinal cord, resulting in a flaccid quadraparesis in the first instance with sensory loss to pinprick and temperature with relative preservation of dorsal column function namely joint position sense and vibration.
Your Answer:
Correct answer: The significance of the sensory loss is that this is very characteristic of anterior spinal artery occlusion.