The Queen's Quadraplegia

A 72-year-old former monarch with long-standing diabetes mellitus, hypertension, and atherosclerotic heart disease had the sudden onset of severe pain in her neck radiating into her shoulders and down her arms. Within minutes, her arms and legs became paralyzed, and her body felt numb from the neck down. (See Diagram)
 

On examination in the emergency room 1 hour later, she was awake, alert, and oriented with normal speech and mentation. Her cranial nerves were normal. There was flaccid, areflexic paralysis of all 4 limbs. No plantar reflexes could be elicited. She was unable to feel pin prick or distinguish between hot and cold stimuli over her trunk and limbs up to the clavicles anteriorly, and approximately up to the superior border of the trapezius muscles posteriorly. Although she could feel light touch in this area, the sensation was less intense than over her face and scalp. Position sense and vibration were normal, however.
 

Re-examination in the hospital 3 months later showed little recovery. The sensory examination was unchanged. The arms remained flaccid, areflexic, and paralyzed; and there were now fasciculations in all muscle groups from the shoulders to the hands. No fasciculations were present in the legs. The legs were still paralyzed, however, and they were now stiff; the knee and ankle jerks were exaggerated; and there were bilateral Babinski signs. She was incontinent of urine and feces.

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