Introduction: Traumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability. Most of them occur due to motor vehicle injuries and falls from a height. Since these are high-velocity injuries, thoracolumbar fractures are commonly associated with other injuries like rib fractures, pneumo-hemothorax, and rarely great vessel injuries, hemopericardium and diaphragmatic rupture. Materials and Methods: In this article - having the patient and the THEBA Bioethics Committee approval (no. 3159/30.01.2020) – it is presented the case of a 26-year-old patient who suffered a polytrauma due to defenestration from the 10th floor - about 30 m high -resulted in thoraco-lumbar SCI associated with other severe injuries, hospitalized in Neuromuscular Clinical Division by transfer from the Neurosurgery Clinic of our hospital, for neuromotor recovery, presenting a L1 AIS/ Frankel C quadriplegia and neurogenic bladder. During the hospitalization, the patient presented psychomotor agitation, food and medication rejection, which is why repeated psychiatric evaluations were requested and performed. Following the recovery program, the patient's evolution was favorable: recovered the weight deficit, improved the motor control and sensitivity, the urethral indwelling catheter was suppressed and the intermittent catheterization program was started with later regaining of the micturition control. The patient was assessed functionally using the following scales: AIS/Frankel, modified Ashworth, Functional Independence Assessment (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL/IADL). Results:The patient benefited from a complex program of neuromuscular rehabilitation, with a favorable evolution, with the increasing scores from the evaluated scales and, thus, with a final performance of walking with support on short distances, as well as a sphincter reeducation with the neurogenic bladder remission. Conclusions: Associating interdisciplinary approach with a customized rehabilitation program in a patient with an onset of psychotic disorder, polytraumatized by defenestration from the 10th floor, with thoraco-lumbar SCI and other severe injuries led to neuromotor and psychiatric improvements, and sphincter function reeducation with an important improvement in patient's quality of life. Keywords: neuromuscular rehabilitation, traumatic spinal cord injury, psychiatric disorder, polytrauma,

IntroductionThe impact of accidents is important both for younger and older people. We live in a multisensory environment and the interaction between our genes and the environment shapes our brains. Cortical blindness as a result of head trauma (to the brain's occipital cortex) is a rare phenomenon and can be a total or partial loss of vision in a normal-appearing eye. How patients will adjust to the loss of vision and its consequences might be a challenge let along if they have mobility imparement (tetraplegia) as well. Adaptation and reintegration of patients into society after motor recovery in the context of visual sensory deficit. TBI survivors themselves and their families are likely more interested in quality-of-life outcomes, such as reintegration into the community, successful return to work or school, and functional capacity in everyday life. Cognitive and behavioural changes, difficulties maintaining personal relationships and coping with school and work are reported by survivors as more disabling than any residual physical deficits. As with all rehabilitation, the goal is to help the person achieve the maximum degree of return to their previous level of functioning. Case presentationHaving the patient and TEHBA Bioethics Committee aproval, we will present the evolution of a case with postraumatic spastic tetraplegia post severe traumatic brain injury, blindness post traumatic bilateral occipital lesions and psycho-cognitive syndrome. Clinical and paraclinical aspects will be discussed (patient history and clinical examination, results of imaging and laboratory tests, the neuromioartrokinetic exam, specific rating scales, both medical and kinetotherapeutic treatments).We will address the case in terms of particularities and treatment approach (neurorehabilation of a motor deficit in the context of a major sensory deficiency) and evolution during hospitalization. ConclusionsTrauma has been known to result in cortical blindness but the exact pathophysiology remains unknown and remains a matter of continued debate. Cortical blindness may occur after trauma, however, most cases regardless of etiology, are reversible and have no long term sequelae. While TBI can cause long-term physical disability, it is the complex neurobehavioural sequelae that produce the greatest disruption to quality of life. As with all rehabilitation, the goal is to help the person achieve the maximum degree of return to their previous level of functioning. In the setting of polytrauma, a careful ophthalmologic and neurologic examination of the trauma patient, together with a high index of suspicion, is necessary for the diagnosis of this condition. Heightened awareness of the causes should be followed with appropriate imaging and management.

Spinal cord injuries and strokes are frequent causes of motor deficit in patients of all ages, with complex family and social consequences (through sensitivity and movement disorders). On the other hand, toxic-nutritional abuses (especially ethanolic) cause morpho-physiological changes throughout the body, with frequent consecutive neuro-psychic manifestations, followed by (potentially) various traumatic injuries. Therefore, the biological and scientific clinical follow-up of traumatized vertebro-medullary patients is of particular importance. With the approval of the Bioethics Commission of the Bagdasar Arseni Emergency Clinical Hospital (TEHBA) Bucharest (number 9181 dated April 11, 2018), we will present the special case of a patient admitted to the Neuromuscular Recovery Clinic of THEBA for incomplete tetraplegia motor deficit AIS/Frankel D, with neurologic level C6 after a vertebral-medullary trauma (produced in conditions of ethanol abuse) and with parieto-occipital ischemic vascular accident produced simultaneously. The peculiarities of this case are the possible (but less common) immediate consequences of vertebralmedullary traumas: paravertebral nervous ganglion lesions; arterial (carotid / vertebral) dissections, which can cause ischemic lesions, all requiring appropriate clinical and therapeutic management. Spinal cord injuries can be favored by toxic-nutritional abuse and may have immediate, late, and permanent morpho-physiological consequences. However, sometimes the clinical evolution and prognosis are surprisingly positive.