Approach to differentiating lesions (spinal cord) Quiz: Ace Your Exams

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A 37-year-old man presents to the emergency department following an altercation in which another individual stabbed the patient on the right side of the neck with a screwdriver. Witnesses report that the patient collapsed at the scene. There is no known medical history, and no medications are taken. Temperature is 37.0°C (98.6°F), pulse is 70/min, respirations are 12/min, and blood pressure is 110/68 mmHg. On examination, the patient is alert and appears appropriately anxious. The screwdriver is lodged in the right posterior neck. There is flaccid paralysis of the right arm and leg, along with impaired proprioception and vibration sense on the right. There are spontaneous movements of the left arm and leg. Which of the following additional examination findings confirms the suspected diagnosis?

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Loss of pain and temperature sensation in the left arm and leg

Dysarthria

Left hyperreflexia

Rightward tongue deviation

Right pupillary dilation