164 Emergency Medicine
hypovolemia persists in a patient with a major pelvic fracture, despite con-
trol of hemorrhage from other sources. Since angiography typically takes
place in the angiography suite, patients should have a pelvic binding device
applied, prior to being transferred to angiography.
147.The answer is c.(Rosen, p 349.)Anterior cord syndromeresults
from cervical flexion injuries(eg, diving in shallow water) that cause cord
contusion or protrusion of a bony fragment or herniated intervertebral disk
into the spinal canal. It may also occur from vascular pathology, such as
laceration or thrombosis of the anterior spinal artery. The syndrome is
characterized by different degrees of paralysis and loss of pain and temper-
ature sensation below the level of injury. Its hallmarkis the preservation
of the posterior columns, maintaining position, touch, and vibratory
sensation.
SCIWORA(a)is reserved for the pediatric population because the
spinal cord is less elastic than the bony spine and ligaments. The diagnosis
is associated with paresthesias and generalized weakness. This syndrome is
coming under scrutiny since the advent of the magnetic resonance imaging
(MRI) where spinal cord lesions are being identified in patients who other-
wise had normal CT scans. Central cord syndrome (b)is often seen in
patients with degenerative arthritis of the cervical vertebrae, whose necks
are subjected to forced hyperextension. This is seen typically in a forward
Syndrome Neurologic DeficitsAnterior cord B/L paralysis below lesion, loss of pain and tempera-
ture, preservation of proprioception and vibratory
function
Central cord Lower extremity paralysis > upper extremity paralysis,
some loss of pain and temperature with upper
> lower
Brown-Séquard Ipsilateral:paresis, loss of proprioception, and
vibratory sensation
Contralateral:loss of pain and temperature
Cauda equina Variable motor and sensory loss in lower
extremities, bowel/bladder dysfunction, saddle
anesthesia