Electrodiagnostic / Neuromuscular Medicine
Anish A. Rana, BA
Medical Student
University of Rochester Medical Center, Strong Memorial Hospital
Glen Mills, Pennsylvania, United States
David Jevotovsky, MD
Resident physician
NYU
Rochester, New York, United States
Nicholas Thornton, MD
Sports Medicine Fellow
Burke
White Plains, New York, United States
Brandon Burg, DO
Resident Physician, PGY-4
NYU
Syosset, New York, United States
Chun Maung, DO
Resident Physician
NYU
Elmhurst, New York, United States
Hasan Entwistle, MD
Resident Physician, PGY-4
NYU
New York, New York, United States
Robert Petrucelli, MD
Clinical Assistant Professor
NYU Grossman School of Medicine
New York, New York, United States
Richard G. Ellis, MD
Director of Inpatient Rehabilitation
Metroplitan Hospital
New York, New York, United States
Mark Ragucci, DO
Clinical Assistant Professor
NYU Langone
New York, New York, United States
Shailaja Kalva, MD
Clinical Associate Professor
NYU School of Medicine
Whitestone, New York, United States
Anish A. Rana, BA
University of Rochester School of Medicine and Dentistry
Glen Mills, Pennsylvania, United States
A 37-year-old right-handed male private chef with a history of polysubstance use and depression/anxiety presented after a psychotic episode involving multiple self-inflicted stab wounds and a fall down stairs with the knife embedded in his neck. He sustained injuries to the neck, left anterior forearm, and left distal thigh. On admission, he exhibited 1/5 strength in left-sided muscle groups except 3/5 strength in left elbow flexion/extension, with preserved right-sided strength. His temperature and light touch sensation was impaired bilaterally, with more prominent right-sided numbness. He noted the same object felt “hot” on his right thigh and “cool” on the left, reflecting altered thermal perception. MRI revealed C3-C6 cord edema with left lateral hyperintensity at C4. Electrodiagnostic studies showed left median neuropathy with positive sharp waves and reduced recruitment distal to pronator teres. He was diagnosed with C5 ASIA D spinal cord injury, reflective of BSS with concomitant peripheral nerve injury.
Discussions:
BSS is an incomplete spinal cord injury (SCI) usually characterized by ipsilateral motor weakness and contralateral sensory deficits. This presentation is atypical due to the co-occurrence of left-sided motor deficits, bilateral sensory impairment, and evidence of superimposed median mononeuropathy, complicating localization. While a C5 hemicord injury would explain proximal upper extremity weakness, the patient demonstrated disproportionate weakness in distal left upper extremity muscles innervated by lower cervical roots (C7–T1). The patient's unique mechanism of injury, whereby he sustained multiple penetrating traumas with blunt cervical cord injury, demonstrates the importance of utilizing neuroimaging and electrodiagnostic testing for accurate diagnosis. Functional gains made during inpatient rehabilitation, including ambulation with an AFO and improved strength and sensation, highlight the power of multidisciplinary care.
Conclusions:
Accurate diagnosis of this clinical presentation required careful correlation of clinical exam, imaging, and electrodiagnostics, as SCI can mask peripheral nerve lesions.
