Case C2653 - New Case Smoke

200 / M - There is no time for History here! only Science!! Medical Science

1) once again this poll title is completely wrong
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2) This is the second terrible looking poll
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3) this is the 3rd question
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4) this is number 4
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5) and this is the final 5th question
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QID: 3432

(OBQ11.9) A 23-year-old man falls down a flight of stairs while intoxicated and is brought to the emergency room the following morning. On physical exam he has no motor function in his upper and lower extremities. Sensory exam shows diminished but present sensation in the perianal area and in the lower extremities. Reflex exam shows his bulbocavernosus reflex is intact. The inital CT and MRI are seen in Figures A and B. According to the American Spinal Injury Association (ASIA), how would this injury be classified? Topic Review Topic

QID:3432
FIGURES:
1

ASIA 1

5%

(188/3573)

2

ASIA 2

83%

(2970/3573)

3

ASIA 3

4%

(158/3573)

4

ASIA 4

6%

(201/3573)

5

ASIA 5

1%

(47/3573)

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

This patient has some sensory function but no motor function below the injury level. His bulbocavernosus reflex is intact so we know he is no longer in spinal shock. Therefore, he would be classified as an ASIA B.

The imaging studies show a type II odontoid fracture, a congenital fusion at C2/3 and C4/5, and a large soft disc herniation at C3/4 with spinal cord compression and myelomalacia.

The ASIA system describes the exam below the level of the injury.
ASIA A: Complete. No motor or sensory
ASIA B: Incomplete. No motor function but some remaining sensory
ASIA C: Incomplete. 50% or more of muscles below injury are less than Grade 3.
ASIA D: Incomplete. 50% or more of muscles below injury are equal to or greater than Grade 3.
ASIA E: Normal

Furlan et al reviewed the ASIA classification in the assessment of motor and sensory function in patents with spinal cord injury (SCI). Although many studies suggest convergent and divergent construct validity, they determined that the ASIA classification is an adequate instrument to evaluate patients with SCI.

Illustration A outlines the ASIA classification. The complete ASIA assessment chart is in Illustration B.

ILLUSTRATIONS:
  • A
  • B
  • C
  • D
  • E
  • F
  • V

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