Chapter 14, Problem 6CCS

10-Year-Old Boy with Spinal Injury

On arrival at Holyoke Hospital, Jimmy Chin, a 10–year-old boy, is immobilized on a rigid stretcher so that he is unable to move his head or trunk. The paramedics report that he was awake and alert after his accident at the skateboard park, but crying and complaining that he couldn't get up and that he had a “wicked headache." He has severe bruises on his upper back and head, and lacerations of his back and scalp. His blood pressure is low, body temperature is below normal, lower limbs are paralyzed, and he is insensitive to painful stimuli below the nipples. Although still alert on arrival, Jimmy soon begins to drift in and out of unconsciousness.

Jimmy is immediately scheduled for a CT scan, and an operating room is reserved.

Relative to Jimmy's condition:

Two days after his surgery, Jimmy is alert and his MRI scan shows no residual brain injury, but does show pronounced swelling and damage to the spinal cord at T₄. On physical examination, Jimmy shows no reflex activity below the level of the spinal cord injury. His blood pressure is still low.

6. Over the next few days, his reflexes return in his lower limbs and become exaggerated. He is incontinent. Why is Jimmy hyperreflexive and incontinent?

On one occasion, Jimmy complains of a massive headache and his blood pressure is far above normal. On examination, he is sweating intensely above the nipples but has cold, clammy skin below the nipples and his heart rate is very slow.