A 5-year-old girl was hit by a slow moving car when she ran into the street while
playing tag. She hit her head and had a brief period of loss of consciousness along
with a few superficial scrapes and bruises. She was placed in cervical spine
precautions and brought to the ED where cervical spine radiographs were read as
negative. What transient symptoms immediately after injury suggest the presence of
spinal cord injury without radiographic abnormality?
Answer Choices
1 Burning hands syndrome
2 A see-saw respiratory pattern
3 Weakness in the arms greater than that in the legs
4 Lightning sensation down the spine with neck movement
5 Complete paralysis with loss of pain sensation
ANS:4
Give this one a try later!
, 4 Lightning sensation down the spine with neck movement
Spinal cord injury without radiographic abnormality (SCIWORA) occurs
almost exclusively among children younger than 8 years of age. Increased
elasticity of the pediatric spine allows injury to the cord without obvious
bony disruption. Up to 27% of these children may experience delayed
onset of neurological signs. This delayed period may range from 30
minutes to 4 days, with a mean of 1.4 days. Clues to this condition may be
the presence of certain transient symptoms immediately after the injury.
These include, in addition to a lightning sensation down the spine
associated with neck movement, paresthesia in the hands and legs or a
subjective feeling of generalized weakness. The chief measures to improve
outcome include injury prevention, prompt recognition through
examination, search for such transient symptoms, use of MRI with
electrophysiological verification, and timely bracing of SCIWORA patients.
A burning sensation in the hands, fingertips, and occasionally feet after an
injury, also known as burning hands syndrome, is probably due to
hyperextension of the cervical cord with contusion of the spinothalamic
tract. It is more commonly seen in football players.
A see-saw respiratory pattern where the chest retracts and the abdomen
distends may indicate paralyzed intercostal muscles due to cervical spine
injury.
Incomplete injuries include the central cord syndrome in which there is
weakness in the arms that is greater than that in the legs, as well as variable
bladder involvement.
Another incomplete injury is the anterior cord syndrome that leads to
complete paralysis below the level of injury, as the voluntary motor
impulses carried by the corticospinal tracts are anteriorly located. There is
also loss of pain sensation and /or temperature sensation. Preserv
A 37-year-old woman presents with a history of right-sided facial weakness and
periauricular discomfort since she awoke this morning. She is afebrile.
Question
What is the most likely diagnosis?
Answer Choices
1 Trigeminal neuralgia
,2 Bell's Palsy
3 Multiple sclerosis
4 Myasthenia gravis
5 Primary lateral sclerosis
ANS: 2
Give this one a try later!
Bell's Palsy
The correct answer is Bell's palsy, which is a condition with typically sudden
onset that affects the facial nerve, causing unilateral facial weakness.
Trigeminal neuralgia presents with sharp pain on 1 side of the mouth that
radiates to the ipsilateral ear, eye, or nostril.
Multiple sclerosis is a demyelinating disorder; it causes a multitude of
symptoms that typically includes diplopia or blurred vision early on,
followed by an insidious onset of progressive weakness, numbness, and/or
tingling in the extremities.
Myasthenia gravis commonly presents with ptosis and diplopia, as well as
difficulty swallowing, fatigue, and muscle weakness.
Primary lateral sclerosis is an upper motor neuron disease that causes limb
weakness, stiffness, and fasciculations.
A 54-year-old woman has suffered a stroke that has resulted in dramatic changes to
her personality, left leg and foot weakness, loss of sensation in the left leg, and
apathy. Which of the following arteries was most likely affected by the stroke?
A left anterior cerebral
B left middle cerebral
C right anterior cerebral
D right middle cerebral
E right posterior cerebral
ANS C
Give this one a try later!
, C. the RAC
The anterior cerebral arteries supply the frontal lobes as well as the medial
aspects of the parietal and occipital lobes rostral to the parietooccipital
sulcus. The prefrontal cortex of the frontal lobe is concerned with a
person's personality, depth of feeling, and initiative. Hence, occlusion of an
anterior cerebral artery can cause neuronal injury to this area, leading to
feelings of apathy and personality changes. The paracentral lobule
represents the medial aspects of the precentral gyrus (frontal lobe) and
postcentral gyrus (parietal lobe), which are responsible for motor control
and somatosensory perception, respectively, of the leg and foot. Hence,
occlusion of an anterior cerebral artery can produce contralateral
hemiparesis and hemisensory loss involving the leg and foot. With the 54-
year-old patient, the symptoms were occurring on the left side, which
points to a right anterior cerebral artery occlusion.
A 62-year-old man presents with vision problems and difficulty swallowing. Over the
past week, he has had a constellation of symptoms, beginning with numbness and
tingling in his feet that progressed to weakness that now affects both lower and upper
extremities. Within the past day, he has started to notice difficulty swallowing and
double vision. He also feels it is difficult for him to take a big breath. His past medical
history is noncontributory, and he takes no medications. Exam reveals bilateral
absence of patellar and ulnar reflexes.
Question
What is the most likely prognosis for this patient?
Answer Choices
1 Complete resolution of symptoms
2 Gradual resolution of paralysis and residual paresthesias
3 Gradual resolution of paresthesias and residual lower extremity weakness
4 Progressive paralysis and premature death most likely due to respiratory failure
5 Waxing and waning polyarticular weakness and pares
Give this one a try later!
playing tag. She hit her head and had a brief period of loss of consciousness along
with a few superficial scrapes and bruises. She was placed in cervical spine
precautions and brought to the ED where cervical spine radiographs were read as
negative. What transient symptoms immediately after injury suggest the presence of
spinal cord injury without radiographic abnormality?
Answer Choices
1 Burning hands syndrome
2 A see-saw respiratory pattern
3 Weakness in the arms greater than that in the legs
4 Lightning sensation down the spine with neck movement
5 Complete paralysis with loss of pain sensation
ANS:4
Give this one a try later!
, 4 Lightning sensation down the spine with neck movement
Spinal cord injury without radiographic abnormality (SCIWORA) occurs
almost exclusively among children younger than 8 years of age. Increased
elasticity of the pediatric spine allows injury to the cord without obvious
bony disruption. Up to 27% of these children may experience delayed
onset of neurological signs. This delayed period may range from 30
minutes to 4 days, with a mean of 1.4 days. Clues to this condition may be
the presence of certain transient symptoms immediately after the injury.
These include, in addition to a lightning sensation down the spine
associated with neck movement, paresthesia in the hands and legs or a
subjective feeling of generalized weakness. The chief measures to improve
outcome include injury prevention, prompt recognition through
examination, search for such transient symptoms, use of MRI with
electrophysiological verification, and timely bracing of SCIWORA patients.
A burning sensation in the hands, fingertips, and occasionally feet after an
injury, also known as burning hands syndrome, is probably due to
hyperextension of the cervical cord with contusion of the spinothalamic
tract. It is more commonly seen in football players.
A see-saw respiratory pattern where the chest retracts and the abdomen
distends may indicate paralyzed intercostal muscles due to cervical spine
injury.
Incomplete injuries include the central cord syndrome in which there is
weakness in the arms that is greater than that in the legs, as well as variable
bladder involvement.
Another incomplete injury is the anterior cord syndrome that leads to
complete paralysis below the level of injury, as the voluntary motor
impulses carried by the corticospinal tracts are anteriorly located. There is
also loss of pain sensation and /or temperature sensation. Preserv
A 37-year-old woman presents with a history of right-sided facial weakness and
periauricular discomfort since she awoke this morning. She is afebrile.
Question
What is the most likely diagnosis?
Answer Choices
1 Trigeminal neuralgia
,2 Bell's Palsy
3 Multiple sclerosis
4 Myasthenia gravis
5 Primary lateral sclerosis
ANS: 2
Give this one a try later!
Bell's Palsy
The correct answer is Bell's palsy, which is a condition with typically sudden
onset that affects the facial nerve, causing unilateral facial weakness.
Trigeminal neuralgia presents with sharp pain on 1 side of the mouth that
radiates to the ipsilateral ear, eye, or nostril.
Multiple sclerosis is a demyelinating disorder; it causes a multitude of
symptoms that typically includes diplopia or blurred vision early on,
followed by an insidious onset of progressive weakness, numbness, and/or
tingling in the extremities.
Myasthenia gravis commonly presents with ptosis and diplopia, as well as
difficulty swallowing, fatigue, and muscle weakness.
Primary lateral sclerosis is an upper motor neuron disease that causes limb
weakness, stiffness, and fasciculations.
A 54-year-old woman has suffered a stroke that has resulted in dramatic changes to
her personality, left leg and foot weakness, loss of sensation in the left leg, and
apathy. Which of the following arteries was most likely affected by the stroke?
A left anterior cerebral
B left middle cerebral
C right anterior cerebral
D right middle cerebral
E right posterior cerebral
ANS C
Give this one a try later!
, C. the RAC
The anterior cerebral arteries supply the frontal lobes as well as the medial
aspects of the parietal and occipital lobes rostral to the parietooccipital
sulcus. The prefrontal cortex of the frontal lobe is concerned with a
person's personality, depth of feeling, and initiative. Hence, occlusion of an
anterior cerebral artery can cause neuronal injury to this area, leading to
feelings of apathy and personality changes. The paracentral lobule
represents the medial aspects of the precentral gyrus (frontal lobe) and
postcentral gyrus (parietal lobe), which are responsible for motor control
and somatosensory perception, respectively, of the leg and foot. Hence,
occlusion of an anterior cerebral artery can produce contralateral
hemiparesis and hemisensory loss involving the leg and foot. With the 54-
year-old patient, the symptoms were occurring on the left side, which
points to a right anterior cerebral artery occlusion.
A 62-year-old man presents with vision problems and difficulty swallowing. Over the
past week, he has had a constellation of symptoms, beginning with numbness and
tingling in his feet that progressed to weakness that now affects both lower and upper
extremities. Within the past day, he has started to notice difficulty swallowing and
double vision. He also feels it is difficult for him to take a big breath. His past medical
history is noncontributory, and he takes no medications. Exam reveals bilateral
absence of patellar and ulnar reflexes.
Question
What is the most likely prognosis for this patient?
Answer Choices
1 Complete resolution of symptoms
2 Gradual resolution of paralysis and residual paresthesias
3 Gradual resolution of paresthesias and residual lower extremity weakness
4 Progressive paralysis and premature death most likely due to respiratory failure
5 Waxing and waning polyarticular weakness and pares
Give this one a try later!
