Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report

Abstract

IntroductionDelayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet.Case presentationWe report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region.ConclusionsThis case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.

Infarction of the cervical spinal cord in a 20-year-old healthy man resulting in complete quadriplegia

“…The only other cases of delayed onset paralysis after trauma found were those in whom symptoms developed a maximum of 24 h after the initial injury 5. The absence of pain or the evolution of neurological symptoms in the 8 months between injury and onset of paralysis suggests that the posterior spinal arteries or a transverse infarction of the spinal cord was unlikely.…”

Delayed Post-Traumatic Spinal Cord Infarction with Quadriplegia: A Case Report

“…Traumatic spinal cord infarction is a rare condition that encompasses various types of vertebral artery injuries, including occlusion, dissection, intimal tears, stenosis, and pseudo-aneurysm formation [1][2][3][4]. Delayed post-traumatic spinal cord infarction is a devastating complication that has been reported in children and adults after injuries without vertebral bone fractures [5][6][7]. Spinal cord ischemia has been reported to occur after aortic surgery, profound arterial hypotension, and intense exercise [2,4,8], but traumatic spinal cord injuries after vehicle accidents have not been reported.…”

Perfusion assessment in rat spinal cord tissue using photoplethysmography and laser Doppler flux measurements

“…Secondary injury resulting from disruption of the blood supply, either by laceration, occlusion, or other deformation of blood vessels, can lead to prolonged ischemia, 10,11 even after very mild trauma. 12 The tissue of the spinal cord, like all central nervous system tissue, is extremely sensitive to hypoxia or anoxia resulting from hypoperfusion, and irreversible ischemic injury can result within a very short time. 13 Quantification of ischemia resulting from SCI is traditionally performed by postmortem examination of the distribution and extent of cell death in histological specimens.…”