Spinal Trauma is Never without Sin: A Tetraplegia Patient Presented Without any Symptoms

Abstract

Spinal cord injuries are amongst the most dangerous injuries, leading to high mortality and morbidity. Injured patients are occasionally faced with life-threatening complications and quality-of-life changing neurological deficits. Thoracic and cervical spinal segments are the most effected sites of injury and a wide range of complications including paraplegia, respiratory and cardiovascular compromise secondary to autonomic dysfunction or tetraplegia may ensue. We aim to draw attention to the progressive nature of the neurological deficits in a patient admitted asymptomatically. Also, we would like to discuss the importance of swift diagnosis and management in such patients. In asymptomatic patients in whom no fractures are diagnosed with CT scans, a neurological examination should be repeated several times to exclude any neurological injuries that were missed. MRI should be ordered in an emergency setting even though it is not frequently used as a diagnostic modality. This should be done especially in patients without any fractures on CT but with neurological signs.

Keywords: MRI myelography; Motor vehicle accident; spinal injury; spinal radiology; tetraplegia.

Figure 1

(a) Acute infarction in the left parietal-tempero-occipital region in diffusion magnetic resonance imaging. (b) Its ADC diffusion magnetic resonance imaging.

Figure 2

Central protrusions of the intervertebral discs at the C2-C7 level exerting pressure on the spinal cord and narrowing the spinal canal in the anterior-posterior diameter. (a) Lysthesis at C2 and C3 on the cervical magnetic resonance imaging, intensity changes due to flexion-distraction type opened and closed fracture of the C3 and a teardrop fracture, (b) CT images of the same levels. (c) Compression fractures of the vertebral corpus of T3 and T11, and possible degenerative changes on T1, T2 and T5 on MRI, (d) CT image of the same level.