Case
Study
•29 Rt h
m had diving accident at age 20. C4
quadriplegic with some sensory sparing and some motor function at C4-5. MRI and XR spine: fx
C5 lamina and C6
body w.o. cord compression. RX high dose methyl-prednisolone and halo neck brace.
•Trf
after 10 days to Rehab, still quadriplegic, move R toe. After 1 month of inpatient rehab, he was walking, wearing
halo, and had recovered substantial strength in hands R > L.
•Seen in
Neurology OPD at age 22, c/o mild L hand wkness and stiffness, poor stamina, spasms, throbbing and dysesthesias in legs, neck pain,
partial erectile and
ejaculatory dysfunction. Neuro Exam: nl CN, almost nl motor excpt 4.5/5 L finger abd, sl RAM L fingers, sl vibr toes bilat, sl pin and temp R T2-T8, MRs 2-3 excpt 4 at L ankle, bilat
Hoffmann’s and L Babinski. Gait and
station nl.
•Urologic
w/u and EMG showed only penile
tumescence in snap test.
•RX nortriptyline 75 mg/d improved pain and stiffness but worsened
sexual symptoms.
Sildenafil improved sexual function.
•Went to
medical school and now functioning well socially and professionally.
