'Duplicate limbs' sensation in acute traumatic quadriplegia

A 64-year-old man sustained acute quadriplegia due to a traffic accident, while in the midst of a petit mal seizure. After recovery from the initial medical complications he developed a duplicate limb phenomenon. The patient felt that another pair of upper and lower limbs had grown from his body, parallel to the paralysed limbs. To the best of our knowledge this duplicate phenomenon in all limbs has not been described before in a traumatic quadriplegic patient. It is our impression that this phenomenon is a rare example of preoccupation with the paralytic limbs, of sensory deprivation with a (possible) unusual drug reaction.     

Injury zone denervation in traumatic quadriplegia in humans

In order to obtain an electrophysiological characterization of the injury zone in traumatic quadriplegia, we performed electromyography and nerve conduction studies on the upper limbs of 15 patients with cervical cord trauma. Evidence of significant axonal loss was found in multiple myotomes of all patients. In most cases, the level of the most severe denervation, as determined by the absence or diminution of the compound motor action potential and the density of fibrillation potentials, was 2–5 spinal segments below the clinically and radiologically defined injury levels. In patients with injuries, the rostral extent of which is at C5 or higher, the most obvious clinical and electromyographic denervation was seen in the intrinsic hand muscles (C8/T1), with complete loss of C8/T1 motor axons in a subset of these patients. Our results document that spinal cord trauma can cause loss of motor axons in regions several segments caudal to the rostral level of injury. This finding may have implications for the pathophysiology of secondary injury, for recovery potential, and for the design of rehabilitation strategies. © 1996 John Wiley & Sons, Inc.     

Myotonic dystrophy and traumatic quadriplegia: case report

A thirty-year-old man with traumatic quadriplegia, was also found to have weakness above the level of the injury. He had facial weakness, difficulty in swallowing, and recurrent respiratory problems. A diagnosis of myotonic dystrophy was supported by examination of his sister. The problems of diagnosis, and the implications of the diagnosis on the management of the patient with myotonic dystrophy and a spinal injury are discussed.     

Spinal cord potentials in traumatic paraplegia and quadriplegia.

Cortical, cervical and lumbar somatosensory evoked potentials were recorded following median and tibial nerve stimulation in patients with traumatic paraplegia and quadriplegia. The isolated cord was able to produce normal potentials even during spinal shock if the vertical extent of the lesion did not involve the generator mechanisms. The cervical potentials showed subtle changes in paraplegia at Th5 levels and below. In high cervical lesions the early cervical potentials may still be present but the later potentials were absent or, in partial lesions, delayed.     

Anterior cervical arachnoid cyst presenting with traumatic quadriplegia

Introduction Intradural spinal arachnoid cysts are rare. Rarer still are cysts located anterior to the cervical spinal cord. To date, only 10 such cases have been reported in the English-language literature.Case report Two cases of anterior cervical arachnoid cysts that presented as traumatic quadriplegia are reported.     

Sudden quadriplegia after acute cervical disc herniation

BACKGROUND: Acute neurological deterioration secondary to cervical disc herniation not related to external trauma is very rare, with only six published reports to date. In most cases, acute symptoms were due to progression of disc herniation in the presence of pre-existing spinal canal stenosis. CASE REPORT: A 42-year-old man developed weakness and numbness in his arms and legs immediately following a sneeze. On physical examination he had upper motor neuron signs that progressed over a few hours to a complete C5 quadriplegia. An emergent magnetic resonance imaging study revealed a massive C4/5 disc herniation. He underwent emergency anterior cervical discectomy and fusion. Postoperatively, the patient remained quadriplegic. Eighteen days later, while receiving rehabilitation therapy, he expired secondary to a pulmonary embolus. Autopsy confirmed complete surgical decompression of the spinal cord. CONCLUSIONS: Our case demonstrates that acute quadriplegia secondary to cervical disc herniation may occur without a history of myelopathy or spinal canal stenosis after an event as benign as a sneeze.     

Thick filament degeneration in a case of acute quadriplegia

Absence of thick filaments from the A bands in tissue giving apparently normal histochemical reactions for myosin ATPase, was seen in a case of acute onset muscle weakness progressing rapidly to quadriplegia with cerebral involvement. There was also widespread degeneration of interstitial structures and much phagocytosis. The dissociation of structure and function of the thick filaments suggests that a selective injury occurred within the myosin molecule. The etiology of the condition although clinically suggestive of a polyneuropathy remains pathologically uncertain. Toxic, immunological or viral causation may be responsible.     

Localization of sensory levels in traumatic quadriplegia by segmental somatosensory evoked potentials

We studied the usefulness of cortical somatosensory evoked potentials (SEPs) elicited by segmental sensory stimulation in traumatic quadriplegia. By stimulating sensory branches of musculocutaneous (C5, C6), median (C7, C8), and ulnar nerves (C8), we studied 10 chronic traumatic quadriplegics and compared them with age-matched controls. In all traumatic quadriplegics tested, the SEP abnormalities provided a direct linear relationship with clinical localization of posterior column sensory levels. Our findings suggest that segmental SEPs can enhance the clinical assessment of posterior column sensory levels in chronic traumatic quadriplegia. Further studies may find this technique useful in acute quadriplegia, particularly during surgical monitoring.     

Immediate endocrine and metabolic consequences of traumatic quadriplegia in a young woman.

Onset of paralysis by cervical spinal cord injury led immediately to temporary adrenocortical activation and, within 2 days, to sustained skin and bone breakdown. Urine cAMP was increased, blood parathyroid hormone, renin activity, and electrolytes were normal, and fluid and electrolytes balance became negative during the initial 6 days of paralysis.     

A case of acute quadriplegia complicating Mediterranean spotted fever

Mediterranean spotted fever is a rickettsiosis caused by Rickettsia conorii. Mediterranean spotted fever is considered to be a benign disease, however, approximately 10% of patients present with a severe systemic manifestation in which neurologic involvement occurs. We present a case of an 80-year-old man with a R. conorii infection who developed an acute quadriplegia secondary to an axonal polyneuropathy. The characteristic tache noire was observed on the lateral region of the thigh and elevated IgM antibody titres against R. conorii were detected by an indirect immunofluorescence test.     

Focal magnetic coil stimulation reveals motor cortical system reorganized in humans after traumatic quadriplegia

A figure of ‘8’ magnetic coil (MC) was used to stimulate focally the motor cortex of two adult, traumatic quadriplegics and three normal adults. The two patients were injured approximately 2 years previously and had intensive physiotherapy, including biofeedback training of biceps and deltoid muscles, respectively, which were the most caudal muscle spared. The focal MC elicited compound motor action potentials (CMAPs) from these muscles from a much wider area of scalp than in the normal subjects. Latency of biceps and deltoid CMAPs were inversely related to CMAP amplitude. A reorganization of the motor cortical projection system is inferred, in which areas normally eliciting digit movements instead activate muscles in quadriplegics just above the spinal level. The reorganization applies also to the central sense of movement normally elicited by focal frontal cortex stimulation. Possible mechanisms of the reorganization and an implication for rehabilitation are discussed.     

Shoulder pain relieved by root canal.

The authors report a 73-year-old man with moderately severe shoulder pain of 6 months' duration. The pain resolved suddenly and completely with root canal in a premolar tooth ipsilateral to the shoulder, and the patient has remained pain-free over the ensuing 6 months.     

Arteriovenous shunting in quadriplegia

Arterio-venous shunting has been demonstrated in the limbs of ten subjects with traumatic quadriplegia, as shown by increased venous oxygen concentration and a Doppler sonogram pattern indicative of continuous forward flow. This phenomenon is similar to that seen in the diabetic neuropathic foot, suggesting that autonomic dysfunction is a major factor in the development of foot ulceration in the quadriplegic and in the diabetic.