An unconscious patient is brought to the Emergency Depament with suspected cervical cord injury. Which of the following clinical signs is not suggestive of cervical spinal cord injury.
**Core Concept**
Cervical spinal cord injury can result in a range of clinical manifestations due to the disruption of descending and ascending tracts. The key to diagnosing cervical cord injury lies in identifying the characteristic signs and symptoms that occur as a result of this disruption.
**Why the Correct Answer is Right**
The clinical signs of cervical spinal cord injury include loss of sensation and motor function below the level of the lesion, as well as the presence of reflexes or their absence. The Brown-Séquard syndrome, for example, is characterized by hemiplegia, loss of proprioception, and ipsilateral loss of pain and temperature sensation due to a unilateral lesion in the spinal cord.
*Option A: Upper motor neuron signs such as spasticity and hyperreflexia are suggestive of cervical spinal cord injury.* This is because the disruption of the corticospinal tracts in the cervical spine leads to the loss of inhibition on the spinal reflexes, resulting in increased muscle tone and reflexes.
*Option B: Loss of bladder and bowel control is a common feature of cervical spinal cord injury due to the disruption of the autonomic pathways.* The inability to maintain continence is a critical sign that requires prompt recognition and management.
*Option C: The presence of a sensory level, such as the loss of sensation to pinprick or temperature, is a classic sign of cervical spinal cord injury.* This is due to the disruption of the spinothalamic tracts, which transmit pain and temperature sensation.
*Option D: The absence of a sensory level on examination is not suggestive of cervical spinal cord injury.* This is because a sensory level is a hallmark sign of spinal cord injury, and its absence suggests that the injury may not be located in the cervical spine.
**Clinical Pearl / High-Yield Fact**
It is essential to remember that the presence of a sensory level on examination is a critical diagnostic feature of cervical spinal cord injury. This sign can be used to localize the level of the lesion and guide further management.
**Correct Answer:** D. The absence of a sensory level on examination is not suggestive of cervical spinal cord injury.