In a patient trapped under a tractor who becomes unconscious, what is the most likely cause for the lack of movement in lower extremities?

In the scenario of a patient trapped under a tractor who then becomes unconscious, the most likely cause for the lack of movement in the lower extremities is bilateral compartment syndrome. This condition occurs when there is a marked increase in pressure within the fascial compartments of the limbs, typically due to trauma or prolonged compression, like being trapped under a heavy object.

Compartment syndrome leads to reduced blood flow to the muscles and nerves, causing ischemia. As pressure builds, it may also lead to muscle necrosis and nerve damage, which can result in profound weakness or paralysis in the affected limbs. The fact that the patient is unconscious further supports the likelihood of severe and immediate compromise to blood flow and tissue perfusion, which is consistent with bilateral compartment syndrome.

While suggestions of other potential injuries like an epidural hematoma, central cord syndrome, or intracerebral hemorrhage might explain some neurological deficits, they do not directly account for the acute presentation of bilateral lower extremity incoordination or paralysis specifically associated with the significant external pressure. The clinical context strongly aligns with bilateral compartment syndrome, given the mechanism of injury and the acute collapse of neurological function.