An adult patient fell from 10 feet high onto concrete and landed on his back. He is awake and alert but complains of loss of sensation and paralysis in his legs. You should suspect

• A. Spinal injury
• B. Brain injury
• C. Pulmonary embolism
• D. Cardiac contusion

Answer: (A)

When a person has a high‑energy fall, lands on the back, and then develops loss of sensation and paralysis in the legs, the most likely issue is injury to the spinal cord. The spinal cord carries the signals between the brain and the body, so damage to it from a vertebral fracture or dislocation can cause numbness, weakness, or paralysis below the level of injury while the patient remains alert. This pattern is much more consistent with a spinal injury than with a brain injury, which would typically alter mental status or produce different neurological signs, or with a pulmonary embolism or cardiac contusion, which present with chest-related symptoms rather than focal leg paralysis.