Article


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


Viktor Bartanusz1 1 *, Mateo Ziu1 , Leisha E Wood2 and Jean-Louis Caron1 * Corresponding author: Viktor Bartanusz bartanusz@uthscsa.edu


Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA


2Travis County Medical Examiner’s Office, 1213 Sabine Street, Austin, TX, 78701, USA


Journal of Medical Case Reports 2012, 6:314 doi:10.1186/1752-1947-6-314 © 2012 Bartanusz et al.; licensee BioMed Central Ltd.


Abstract


Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovas- cular 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 presentation We 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.


Conclusions


This 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 impor- tance, even in patients with minimal post-traumatic symptoms.


Keywords Spinal cord blood supply; Ischemia; Minor head trauma


Introduction The regulation of spinal cord blood flow (SCBF) in normal and pathological conditions is still largely unknown. Numerous experimental stud- ies address the question of blood circulation in the injured spinal cord1


, but clinical cases of doc-


umented dysfunction of spinal cord circulation are of paramount importance for further under- standing of this enigmatic phenomenon. Delayed post-traumatic spinal cord infarction is a devastating complication described in chil- dren after injuries without vertebral fracture2 even after intensive physical exercise3


or . In adults,


spinal cord ischemia has been reported to occur after aortic surgery, scoliosis correction, and pro- found arterial hypotension4-6


, but delayed spinal 26 | SpinalSurgeryNews | Autumn 2012


cord infarction after minor head trauma has not been described yet. We report the case of a patient who was hospitalised for observation after sustaining a minor head trauma. Except for a few subjec- tive symptoms in the upper and lower extrem- ities, the results of a neurological exam were unremarkable. Twelve hours after admission, our patient developed a fatal infarction of the cervical and upper thoracic spinal cord. The goal of this case report is to point out the fra- gility of blood supply to the upper thoracic and cervical spinal cord in adults with chronic spinal canal stenosis, in which minimal hemo- dynamic perturbation may have catastrophic consequences.


Case presentation A 45-year-old Hispanic man was transported to our hospital after a blow with a dragline weight provoked head flexion. On presentation, he com- plained of lower-extremity numbness and pain in his back and around his abdomen. An examination revealed no point tenderness to palpation on his cervical, thoracic, or lumbar spine. The strength in the upper and lower extremities was preserved except for bilateral finger flexion weakness (mo- tor grade 3). Hyporeflexia was noticed throughout. His rectal tone was normal. Hyperesthesia in a patchy distribution throughout his upper and low- er extremities and patchy pinprick hypoesthesia in the lower extremities were observed. Propriocep- tion was reduced only in his left toe.


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