A patient with a C4 AIS B SCI is 6 weeks post-injury and shows new onset increased tone and spasticity below the lesion. This most likely indicates what?

A patient with a C4 AIS B SCI is 6 weeks post-injury and shows new onset increased tone and spasticity below the lesion. This most likely indicates what?

• A. The patient is developing a secondary spinal cord injury
• B. The patient's ASIA classification should be downgraded to AIS A
• C. The patient is experiencing autonomic dysreflexia
• D. Spinal shock is beginning to resolve

Answer: (D)

Spinal shock is a temporary loss of reflexes and flaccidity that follows a spinal cord injury. As this phase resolves, reflex circuits below the level of the injury begin to rebound, often presenting as increased tone and spasticity. At six weeks after a cervical AIS B injury, the appearance of new spasticity below the lesion is most consistent with the end of spinal shock and the start of the spasticity phase, reflecting recovery of reflex activity rather than new damage. It’s not autonomic dysreflexia, which would show sudden hypertension and autonomic symptoms in response to a stimulus. It’s not a secondary spinal cord injury, which would imply new loss of function. And while AIS status can change with recovery, the key point here is the emergence of spasticity signaling spinal shock resolution.

Spinal shock is a temporary loss of reflexes and flaccidity that follows a spinal cord injury. As this phase resolves, reflex circuits below the level of the injury begin to rebound, often presenting as increased tone and spasticity. At six weeks after a cervical AIS B injury, the appearance of new spasticity below the lesion is most consistent with the end of spinal shock and the start of the spasticity phase, reflecting recovery of reflex activity rather than new damage.

It’s not autonomic dysreflexia, which would show sudden hypertension and autonomic symptoms in response to a stimulus. It’s not a secondary spinal cord injury, which would imply new loss of function. And while AIS status can change with recovery, the key point here is the emergence of spasticity signaling spinal shock resolution.