Bell’s Cruciate paralysis in a patient victim of a gunshot wound in the cervical region

Abstract

Bell’s cruciate paralysis is characterized by paralysis of the upper limbs associated with little or no deficit in lower limbs. Its diagnosis is often overlooked, given that its symptoms similarities to that occasioned by the centromedullary syndrome, whose incidence is considerably higher. The present case report describes the case of a 16-year-old male patient victim of a gunshot wound in the anterior cervical region that developed Bell’s cruciate paralysis. The Magnetic Resonance Imaging (MRI) of the cervical spine showed medullary signal change in the cervicomedullary junction, with anteromedial location. A somatotopy of the corticospinal tract was suggested by Bell (1970) at cervicomedullary transition, with the anatomical hypothesis that fibers responsible for the movement of the upper limbs would cross higher and more superficially that the fibers of the lower limbs. This case combines the MRI assessment with the clinical outcome and corroborates with the Bell’s anatomical theory.