Case report: "an unexpected origin of coma in a young adult"

Abstract

We report a peculiar case of acute non-traumatic coma due to neuromuscular hypoventilation syndrome caused by a non-traumatic spinal cord injury (NTSCI). A 21-year-old patient presented to the emergency room complaining of sudden onset weakness in his lower limbs and shortness of breath. While in the ER, he briefly became comatose and labs revealed an acute respiratory acidosis. Detailed neurologic examination ultimately revealed upper motor neuron signs and quadriplegia. He was ultimately diagnosed with a non-traumatic spinal cord injury, in particular, a cervical transverse myelitis which had caused acute diaphragmatic weakness. Although a very rare cause of coma, emergency medicine physicians need to be aware of transverse myelitis, a disorder that may result in rapidly progressive neurologic decline and is treated with immunomodulation.

Keywords: Carbon dioxide narcosis; Coma; Longitudinally extensive transverse myelitis; Non-traumatic quadriplegia.

Fig. 1

T2_tse sagittal images of the cervical spine showing major edema and minimal syrinx formation of the myelum extending all the way from C1 to C6

Fig. 2

Repeat MRI T2_tse sagittal images, 1 month after starting IVIG and corticosteroid therapy