Signs of spinal cord transsection

1. Big picture

Spinal cord transsection means a complete transverse lesion of the spinal cord. Clinically, the examiner wants you to recognize a spinal cord level: below a certain segment there is bilateral motor, sensory, and autonomic failure.

The key exam idea is:

Complete spinal cord lesion = bilateral paralysis + bilateral sensory loss below a level + bladder/bowel/sexual dysfunction.

In the acute phase it may look like a peripheral lesion because of spinal shock: flaccidity, hypotonia, and absent reflexes. Later it becomes a typical upper motor neuron lesion below the level: spasticity, hyperreflexia, clonus, and Babinski sign.