Very rare incidence of ascending paralysis in a patient of traumatic spinal cord injury: a case report.

ABSTRACT:

Introduction

After spinal cord injury, further neurological deterioration up to one to two neurological levels is not uncommon. Late neurological deterioration can occur after two months, mainly due to the syrinx formation. In a rare case like in sub-acute post-traumatic ascending myelopathy, the neurological level may ascend more than four levels from the initial level of injury and it usually starts within a few weeks after injury.

Case presentation

Our case was diagnosed as a case of traumatic spinal cord injury having a lower thoracic neurological level of injury initially, which rapidly progressed over a few weeks into a higher thoracic neurological level. He was operated with pedicle screw fixation of the spine before admission to rehabilitation unit. He was having progressive ascending neurological deterioration, starting a few days after surgery, which was evident by the progression of neurological level by more than four segments clinically. Cerebrospinal fluid(CSF) study showed no significant abnormality. Magnetic resonance imaging (MRI) study showed involvement of the spinal cord at the upper thoracic region. Patient was monitored to note any further worsening. Rehabilitation and supportive measures were provided according to standard protocol.

Discussion

Very few cases of ascending paralysis of more than four levels have been reported globally. It results in increased morbidity and mortality in spinal cord injury patients. In our case few possible reasons are ruled out but the actual underlying reason was not clear. Various hypotheses have been proposed as the cause in previous published literatures. Management is mostly supportive.

SUBMITTER: Biswas A 

PROVIDER: S-EPMC9325770 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature