Signs of spinal cord transsection
1. Big picture
Spinal cord transsection means a complete transverse lesion of the spinal cord. Clinically, the examiner wants you to recognize a spinal cord level: below a certain segment there is bilateral motor, sensory, and autonomic failure.
The key exam idea is:
Complete spinal cord lesion = bilateral paralysis + bilateral sensory loss below a level + bladder/bowel/sexual dysfunction.
In the acute phase it may look like a peripheral lesion because of spinal shock: flaccidity, hypotonia, and absent reflexes. Later it becomes a typical upper motor neuron lesion below the level: spasticity, hyperreflexia, clonus, and Babinski sign.
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