Spinal cord infarction due to a self-inflicted needle stick injury

Joseph, Gregory J.; Santosh, Celestine; Marimuthu, rasekaran; Fraser, Matthew; McLean, Andrew N.

doi:10.1038/sj.sc.3101619

Cited by 7 publications

(3 citation statements)

References 8 publications

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“…5–8 A self-inflicted needle-stick injury and spinal cord infarction has been described in a human being. 9 In the present case, we suspect that the needle entered the CNS through the atlanto-occipital junction. The caudodorsal to cranioventral linear hyperintense lesion in the muscles of the dorsal aspect of the neck and the direction towards the CMC supported this theory.…”

Section: Discussionmentioning

confidence: 62%

Intra-parenchymal brainstem haemorrhage secondary to iatrogenic needle injury after a parenteral injection in a cat

Brocal

Guevar

Stalin

et al. 2016

Journal of Feline Medicine and Surgery Open Reports

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Case summaryA 6-month-old female domestic shorthair cat was presented with acute onset non-ambulatory right hemiparesis and horizontal nystagmus following an injection attempt in the neck, during which the cat did not cooperate. Magnetic resonance imaging (MRI) revealed a well-defined intra-axial lesion on the right side of the myelencephalon. The lesion was T2-weighted hypointense and T1-weighted hypointense to isointense to grey matter, non-contrast enhancing, with perilesional oedema and signal void on T2*-weighted images. A linear hyperintense lesion in the muscles of the right dorsolateral aspect of the neck on short tau inversion recovery images was also observed. These MRI findings were consistent with iatrogenic brainstem haemorrhage and a muscle needle tract. The cat made a good recovery with just mild residual neurological deficits 6 weeks after the injury.Relevance and novel informationTo our knowledge, this is the first report of an iatrogenic brainstem needle injury in a cat and the first report of a central nervous system iatrogenic trauma after a parenteral injection. Care should be taken with neck parenteral injections, especially in the cranial cervical area.

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Section: Discussionmentioning

confidence: 62%

Intra-parenchymal brainstem haemorrhage secondary to iatrogenic needle injury after a parenteral injection in a cat

Brocal

Guevar

Stalin

et al. 2016

Journal of Feline Medicine and Surgery Open Reports

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“…22 In human patients, myelopathies secondary to various needleassociated injuries have been occasionally described, including intramedullary contrast injection, 23 CNS migration of a broken acupuncture needle 24 and spinal cord infarction following a self-inflicted needle-stick injury. 25 MRI features of needle-associated CNS injuries, without injection, have been previously described in four dogs and one cat, respectively. 3,5 MRI, performed between 8 h and 5 days after the incident, succeeded to demonstrate the needle trajectory either in the brainstem or in the paraspinal musculature in all cases.…”

Section: Discussionmentioning

confidence: 90%

Haematomyelia and myelomalacia following an inadvertent thoracic intraspinal injection in a cat

Dutil

Schweizer

Oevermann

et al. 2021

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 4-month-old cat was presented with acute paraplegia after the referring veterinarian performed a subcutaneous injection (cefovecin and dexamethasone) in the caudodorsal thoracic area, during which the cat suddenly became uncooperative. A complete neurological examination performed 1 day after the injection revealed paraplegia without deep pain perception and reduced segmental spinal reflexes in the pelvic limbs. Findings were consistent with either an L4–S3 myelopathy or a T3–L3 myelopathy with subsequent spinal shock. MRI showed swelling of the spinal cord from T1 to L1 with heterogeneous T2-weighted intramedullary hyperintensity and no contrast enhancement. A centrally located intraspinal signal void was visible in T2*-weighted images. These changes were compatible with a suspected traumatic intraspinal injection. Despite intensive supportive care over 4 days, neurological status did not improve and the cat was euthanased. Gross pathology findings revealed severe intramedullary haemorrhage and myelomalacia in the T10–L1 spinal cord segments. Histopathology of the spinal cord after haematoxylin and eosin staining revealed a severe intramedullary space-occupying haemorrhage with focal malacia. A trajectory-like, optically empty cavity containing some eosinophilic droplets at the edges was detected. Although no further evidence of trauma was noted in the surrounding structures, the spinal cord changes were compatible with a perforating trauma. Relevance and novel information To our knowledge, this is the first report of thoracic intraspinal injection causing myelomalacia defined by an ante-mortem MRI and confirmed post mortem by histopathology. The traumatic myelopathy appeared to be most compatible with an intraspinal injection causing vascular rupture.

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“…14) Rarer objects causing spinal injury include a pencil, a wood piece of a banister, a glass fragment, and an injection needle. 1,6,[12][13][14] Here we report a case of chopstick injury to the upper cervical spine.…”

Section: Introductionmentioning

confidence: 92%

Penetrating Injury of the Upper Cervical Spine by a Chopstick -Case Report-

Yamaguchi

Eguchi

Takeda

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 35-year-old man presented with penetrating spinal injury after attempting suicide by stabbing a wooden chopstick into his mouth. The object penetrated the pharynx, and the tip entered the spinal canal of the atlantoaxial vertebrae. Emergent surgery disclosed that the tip of the chopstick had penetrated between the dural sac and the vertebral artery. There was no dural tear or vertebral artery injury. The foreign body was removed successfully from the oral side. He recovered without neurological sequelae.

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Spinal cord infarction due to a self-inflicted needle stick injury

Cited by 7 publications

References 8 publications

Intra-parenchymal brainstem haemorrhage secondary to iatrogenic needle injury after a parenteral injection in a cat

Intra-parenchymal brainstem haemorrhage secondary to iatrogenic needle injury after a parenteral injection in a cat

Haematomyelia and myelomalacia following an inadvertent thoracic intraspinal injection in a cat

Penetrating Injury of the Upper Cervical Spine by a Chopstick -Case Report-

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