A 56-year-old woman is brought to the emergency department due to several days of progressive dyspnea, productive cough, and fever. Today, her son found her very short of breath and obtunded. The patient has a history of hypertension, type 2 diabetes mellitus, and long-standing rheumatoid arthritis. Examination reveals bilateral pneumonia and severe respiratory distress. The patient is lethargic without focal neurologic deficits. Urgent endotracheal intubation is performed for mechanical ventilation, and the patient is started on broad-spectrum antibiotics. Repeat examination 2 hours later shows that she has developed areflexic, flaccid paralysis of all extremities. Which of the following is the most likely cause of the neurologic deficits in this patient?

Question

A 56-year-old woman is brought to the emergency department due to several days of progressive dyspnea, productive cough, and fever.  Today, her son found her very short of breath and obtunded.  The patient has a history of hypertension, type 2 diabetes mellitus, and long-standing rheumatoid arthritis.  Examination reveals bilateral pneumonia and severe respiratory distress.  The patient is lethargic without focal neurologic deficits.  Urgent endotracheal intubation is performed for mechanical ventilation, and the patient is started on broad-spectrum antibiotics.  Repeat examination 2 hours later shows that she has developed areflexic, flaccid paralysis of all extremities.  Which of the following is the most likely cause of the neurologic deficits in this patient?

Quizplus · Accepted Answer

Eductional Objective: Long-standing rheumatoid arthritis can affect the cervical spine, causing vertebral malalignment (subluxation) that can affect the atlantoaxial joint.  Extension of the neck during endotracheal intubation can worsen the subluxation, leading to acute compression of the spinal cord and/or vertebral arteries.

A 56-Year-Old Woman Is Brought to the Emergency Department Due