04-04-2015, 11:14 AM
A 18 y/o man is brought in to the emergency department after being stabbed in a fight. The knife wound is located in the center of the patient's back at about the T5 IeveI. After assuring that the patient is hemodynamically stable, a neurologic examination is preformed. The patient is alert, oriented, and fluent.
His cranial nerves are intact and the motor and sensory examinations of his upper extremities are within normal limits. However, the patient is unable to move his right leg. Sensory examination of his lower extremities reveals a complete loss of tactile discrimination, proprioception, and vibratory sensation in his right leg and a complete loss of pain and temperature sensation in his left leg. Which of the following is the most likely diagnosis?
A. Anterior spinal artery disruption
B. Complete transection of the spinal cord
C. Hemisection of the left half of the spinal cord
D. Hemisection of the right half of the spinal cord
E. Syringomyelia
F. Tabes dorsalis
His cranial nerves are intact and the motor and sensory examinations of his upper extremities are within normal limits. However, the patient is unable to move his right leg. Sensory examination of his lower extremities reveals a complete loss of tactile discrimination, proprioception, and vibratory sensation in his right leg and a complete loss of pain and temperature sensation in his left leg. Which of the following is the most likely diagnosis?
A. Anterior spinal artery disruption
B. Complete transection of the spinal cord
C. Hemisection of the left half of the spinal cord
D. Hemisection of the right half of the spinal cord
E. Syringomyelia
F. Tabes dorsalis