Dual lesion spinal cord injury in a polytrauma patient: a case report

Spinal Cord Series and Cases, 2021 · DOI: https://doi.org/10.1038/s41394-021-00455-w · Published: September 19, 2021

Spinal Cord Injury Trauma Rehabilitation

Simple Explanation

Dual lesion SCI is when there are two separate areas of damage to the spinal cord, either at the same time or after the first injury. It's not very common, so we don't know much about how to treat it or what to expect. This report is about a 25-year-old woman who was shot and hurt her T5 vertebra, which caused spinal cord damage. Later, she had a stroke in her cervical spine because of swelling, which led to more problems. Dealing with patients who have dual lesion SCI is tricky when it comes to figuring out what's wrong and how to help them. This case shows some important things that doctors and therapists should keep in mind.

Study Duration

Not specified

Participants

25-year-old woman

Evidence Level

Level 4, Case Report

Key Findings

1
The patient initially presented with a T6 ASIA Impairment Scale (AIS) B paraplegia due to a gunshot wound to the T5 vertebra.
2
A subsequent cervical spinal stroke, resulting from cord edema, led to a C4 AIS A tetraplegia, indicating a second distinct spinal cord injury.
3
Frequent and thorough neurological examinations, specifically the ASIA examination, are crucial in acute TSCI patients to detect evolving injuries.

Research Summary

Dual lesion SCI is a rare condition involving two distinct regions of injury to the spinal cord, posing unique challenges in evaluation, management, and classification. This case report presents a patient with a gunshot wound to the thoracic spine who later developed a cervical spinal stroke, resulting in a dual lesion SCI. The case highlights the importance of repeated neurological examinations and a high index of suspicion for evolving injuries in polytrauma patients with TSCI to optimize functional outcomes through appropriate rehabilitation planning.

Practical Implications

Importance of Frequent Neurological Exams

Regular ASIA exams are crucial for identifying evolving SCI in acute trauma cases.

Maintain High Suspicion for Worsening Conditions

Clinicians should be vigilant for vascular insufficiency, infection, cord edema, and spinal instability in TSCI patients.

Individualized Rehabilitation Planning

Dual lesion SCI patients may require uniquely crafted rehabilitation plans, potentially involving outpatient or home rehabilitation before inpatient admission.

Study Limitations

1
Limited number of dual SCI cases reported in literature.
2
Lack of standardized classification for dual SCI.
3
Difficulty in accurately describing the patient's neurologic status with a single AIS designation.

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