Critical Care Medicine-Neurologic Disorders>>>>>Spinal Cord Injury
Question 2#

A 17-year-old football player presents to the ED with acute onset paraplegia after colliding head-on with another player during a training session. He is awake, alert, and oriented; has stable hemodynamics; and is in no respiratory distress with an oxygen saturation of 100% on room air. Neurological examination reveals lack of sensation below T8 and muscle weakness involving all flexors and extensors. CT scan and MRI examination of the spinal cord is negative for any acute pathology. Over the course of next few hours, his motor strength starts improving.

What would be the next course of treatment?

a. Steroids
b. EMG
c. Operative intervention
d. Close observation

Correct Answer is D

Comment:

Correct Answer: D

This patient has most likely suffered spinal cord concussion (SCC), which is a variant of mild SCI, clinically designated as transient paraplegia or neurapraxia, and characterized by variable degrees of sensory impairment and motor weakness that typically resolve within 24 to 72 hours without permanent deficits. Many patients show signs of recovery with the first few hours after injury and completely recover within 24 hours. Spinal cord injuries are classified as concussions if they met three criteria:

  1. Spinal trauma immediately preceded the onset of neurological deficits.
  2. Neurological deficits were consistent with spinal cord involvement at the level of injury.
  3. Complete neurological recovery occurred within 72 hours after injury.

SCC is predominantly a sport-related injury occurring in a wide variety of contact sports in adult and pediatric athletes including wrestling, hockey, gymnastics, and diving, but most commonly in American football. Because the injury is self-resolving, no further treatment is needed. There is, however, controversy over whether players who suffer SCC have a higher likelihood of sustaining SCI in future and whether they should be cleared for return-to-play.

References:

  1. Fischer I, Haas C, Raghupathi R, Jin Y. Spinal cord concussion: studying the potential risks of repetitive injury. Neural Regen Res. 2016;11(1):58- 60.
  2. Zwimpfer TJ, Bernstein M. Spinal cord concussion. J Neurosurg. 1990;72(6):894-900.