A Case of Spinal Cord Injury
(Adapted from the Case Study Collection from the National Center for Case
Study Teaching in Science.)
Charles Crosby is a 21-year old senior at the University of Wisconsin-Madison, majoring in biology. While on Spring Break in Florida, Charles was involved in a one-vehicle motorcycle accident. In the accident, Charles was thrown from his bike to the pavement, landing on his back. A police officer witnessed the accident and immediately called for medical assistance. Emergency personnel arrived within minutes, and upon recognizing the seriousness of Charles’ back injury, immobilized his neck and secured him to a back board prior to transporting him to the emergency room of the nearest hospital.
When he arrived at the hospital, Charles was conscious and complained of pain in his lower back. Upon examination by emergency room personnel, Charles was found to have numerous abrasions and contusions and loss of both sensation and motor control of his legs. Charles’ vital signs upon arrival at the emergency room were as follows:
BP: 96/52
Pulse: 108 beats/min
Respiratory rate: 24 breaths/min
Temperature: 96.7 F
After he was stabilized, a complete neurological exam was performed to assess and localize Charles’ injury. The neurological exam revealed the following:
Strength in flexing and extending elbows: Both normal
Extending wrists: Both normal
Flexing middle finger: Both normal
Abducting little finger: Both normal
Flexing hip: Right normal; left abnormal
Extending knee: Right normal; left abnormal
Dorsiflex ankle: Right normal; left abnormal
Stretch reflexes of the biceps, brachioradialis, and triceps muscles were normal in both arms. Stretch reflexes involving the patella and ankle were normal in the right leg but the patellar reflex was elevated in the left leg and the ankle reflex was absent in the left leg. The Babinski sign was present on the left but not the right. The neurological exam also revealed a loss of pain and temperature sensation in the right leg (mostly below the knee). Charles was found to have normal sensitivity to pin prick in areas of his body above the level of his pelvis but not below.
After the exam, Charles was placed on IV methylprednisolone (Solumedrol, 30 mg/kg) for one hour and an MRI was ordered.
Questions:
Are Charles’ vital signs normal? Identify all abnormal values and explain why they
may be abnormal.
Explain what a “Babinski sign” is and what the presence of it says about Charles’
condition.
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