A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma

Toivo Hasheela; Aaron Musara

doi:doi:10.11648/j.ijn.20180202.11

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A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma

Toivo Hasheela, Aaron Musara

Published in International Journal of Neurosurgery (Volume 2, Issue 2)

Received: 8 August 2018 Accepted: 11 September 2018 Published: 17 October 2018

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Abstract

Spinal cord injury without radiographic abnormality (SCIWORA) is a well-documented finding in the paediatric population age groups, however in adults it is a rare occurrence. This case report gives an account of a case of an adult patient in whom a diagnosis of cervical SCIWORA was made and confirmed by MRI, following, seemingly, trivial trauma. A 46 year old man jumped from a small bridge, landed on his feet and fell backwards, immediately thereafter could no longer move or feel his trunk and limbs. Upon neurological assessment, he was found to have spastic quadriparesis, sensory level of C4, as well as bowel and bladder dysfunction. CT scan did not reveal any abnormalities; however MRI demonstrated spinal cord signal changes consistent with spinal cord contusion. Patient was managed conservatively in a rigid cervical collar, as well as per local protocols for the management of quadriplegia. He however eventually succumbed to respiratory failure compounded by aspiration pneumonia. Although SCIWORA is rare in the adult population groups, it does occur and can lead to significant morbidity and high mortality rates. Therefore adult patients presenting with neurologic deficits and normal static radiographs and CT scans, on a background of any degree of trauma, be it trivial, should not be brushed off lightly but rather investigated further with dynamic radiographs and MRI.

Published in	International Journal of Neurosurgery (Volume 2, Issue 2)
DOI	10.11648/j.ijn.20180202.11
Page(s)	23-26
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

SCIWORA, Contusion, MRI, CT Scan, Static/Dynamic Radiographs

References

[1]	Pang D, Wilberger JE. Spinal cord injuries without radiographic abnormalities in children. J Neurosurg. 1982; 57:144–29.
[2]	Como JJ, Samia H, Nemunaitis GA et al: The misapplication of the term spinal cord injury without radiographic abnormality (SCIWORA) in adults. J Trauma Acute Care Surg, 2012; 73: 1261–66.
[3]	Pang D, Pollack IF. Spinal cord injury without radiographic abnormality in children. The SCIWORA syndrome. J Trauma 1989; 29: 654–664.
[4]	Kasimatis GB, Panagiotopoulos E, Megas P et al: The adult spinal cord injury without radiographic abnormalities syndrome: magnetic resonance imaging and clinical findings in adults with spinal cord injuries having normal radiographs and computed tomography studies. J Trauma, 2008; 65 (1): 86–9.
[5]	Turgut M, Akpinar G, Akalan N et al. Spinal injuries in the pediatric age group: a review of 82 cases of spinal cord injury and vertebral column injuries. Eur Spine J 1996; 5:148–152.
[6]	Bondurant CP, Oró JJ. Spinal Cord Injury without Radiographic Abnormality and Chiari Malformation. J Neurosurg. 1993; 79:833–838.
[7]	Greenberg M. S., Handbook of Neurosurgery, 8th edition, New York: Thieme Medical Publishers, Inc. 2016; 999.
[8]	Yucesoy K, Yuksel KZ: SCIWORA in MRI era. Clin Neurol Neurosurg, 2008; 110: 429–33.
[9]	Shen H, Tang Y, Huang L et al: Applications of diffusion-weighted MRI in thoracic spinal cord injury without radiographic abnormality. Int Orthop, 2007; 31 (3): 375–83.
[10]	Ahmann PA, Smith SA, Schwartz JF et al. Spinal cord infarction due to minor trauma in children. Neurology1975; 25: 301–307.
[11]	Linssen WHJP, Praamstra P, Gabreels FJM et al. Vascular insufficiency of the cervical cord due to hyperextension of the spine. Pediatr Neurol 1990; 6: 123–125.
[12]	Madsen JR, Freiman T. Cervical Spinal Cord Injury in Children. Contemp Neurosurg. 1998; 20:1–5.

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APA Style

Toivo Hasheela, Aaron Musara. (2018). A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma. International Journal of Neurosurgery, 2(2), 23-26. https://doi.org/10.11648/j.ijn.20180202.11

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ACS Style

Toivo Hasheela; Aaron Musara. A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma. Int. J. Neurosurg. 2018, 2(2), 23-26. doi: 10.11648/j.ijn.20180202.11

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AMA Style

Toivo Hasheela, Aaron Musara. A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma. Int J Neurosurg. 2018;2(2):23-26. doi: 10.11648/j.ijn.20180202.11

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@article{10.11648/j.ijn.20180202.11,
  author = {Toivo Hasheela and Aaron Musara},
  title = {A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma},
  journal = {International Journal of Neurosurgery},
  volume = {2},
  number = {2},
  pages = {23-26},
  doi = {10.11648/j.ijn.20180202.11},
  url = {https://doi.org/10.11648/j.ijn.20180202.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20180202.11},
  abstract = {Spinal cord injury without radiographic abnormality (SCIWORA) is a well-documented finding in the paediatric population age groups, however in adults it is a rare occurrence. This case report gives an account of a case of an adult patient in whom a diagnosis of cervical SCIWORA was made and confirmed by MRI, following, seemingly, trivial trauma. A 46 year old man jumped from a small bridge, landed on his feet and fell backwards, immediately thereafter could no longer move or feel his trunk and limbs. Upon neurological assessment, he was found to have spastic quadriparesis, sensory level of C4, as well as bowel and bladder dysfunction. CT scan did not reveal any abnormalities; however MRI demonstrated spinal cord signal changes consistent with spinal cord contusion. Patient was managed conservatively in a rigid cervical collar, as well as per local protocols for the management of quadriplegia. He however eventually succumbed to respiratory failure compounded by aspiration pneumonia. Although SCIWORA is rare in the adult population groups, it does occur and can lead to significant morbidity and high mortality rates. Therefore adult patients presenting with neurologic deficits and normal static radiographs and CT scans, on a background of any degree of trauma, be it trivial, should not be brushed off lightly but rather investigated further with dynamic radiographs and MRI.},
 year = {2018}
}

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TY  - JOUR
T1  - A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma
AU  - Toivo Hasheela
AU  - Aaron Musara
Y1  - 2018/10/17
PY  - 2018
N1  - https://doi.org/10.11648/j.ijn.20180202.11
DO  - 10.11648/j.ijn.20180202.11
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
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EP  - 26
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20180202.11
AB  - Spinal cord injury without radiographic abnormality (SCIWORA) is a well-documented finding in the paediatric population age groups, however in adults it is a rare occurrence. This case report gives an account of a case of an adult patient in whom a diagnosis of cervical SCIWORA was made and confirmed by MRI, following, seemingly, trivial trauma. A 46 year old man jumped from a small bridge, landed on his feet and fell backwards, immediately thereafter could no longer move or feel his trunk and limbs. Upon neurological assessment, he was found to have spastic quadriparesis, sensory level of C4, as well as bowel and bladder dysfunction. CT scan did not reveal any abnormalities; however MRI demonstrated spinal cord signal changes consistent with spinal cord contusion. Patient was managed conservatively in a rigid cervical collar, as well as per local protocols for the management of quadriplegia. He however eventually succumbed to respiratory failure compounded by aspiration pneumonia. Although SCIWORA is rare in the adult population groups, it does occur and can lead to significant morbidity and high mortality rates. Therefore adult patients presenting with neurologic deficits and normal static radiographs and CT scans, on a background of any degree of trauma, be it trivial, should not be brushed off lightly but rather investigated further with dynamic radiographs and MRI.
VL  - 2
IS  - 2
ER  -

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Author Information

Toivo Hasheela

Neurosurgery Unit, Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
Aaron Musara

Neurosurgery Unit, Department of Surgery, University of Zimbabwe, Harare, Zimbabwe

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APA Style

Toivo Hasheela, Aaron Musara. (2018). A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma. International Journal of Neurosurgery, 2(2), 23-26. https://doi.org/10.11648/j.ijn.20180202.11

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ACS Style

Toivo Hasheela; Aaron Musara. A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma. Int. J. Neurosurg. 2018, 2(2), 23-26. doi: 10.11648/j.ijn.20180202.11

Copy | Download

AMA Style

Toivo Hasheela, Aaron Musara. A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma. Int J Neurosurg. 2018;2(2):23-26. doi: 10.11648/j.ijn.20180202.11

Copy | Download

@article{10.11648/j.ijn.20180202.11,
  author = {Toivo Hasheela and Aaron Musara},
  title = {A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma},
  journal = {International Journal of Neurosurgery},
  volume = {2},
  number = {2},
  pages = {23-26},
  doi = {10.11648/j.ijn.20180202.11},
  url = {https://doi.org/10.11648/j.ijn.20180202.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20180202.11},
  abstract = {Spinal cord injury without radiographic abnormality (SCIWORA) is a well-documented finding in the paediatric population age groups, however in adults it is a rare occurrence. This case report gives an account of a case of an adult patient in whom a diagnosis of cervical SCIWORA was made and confirmed by MRI, following, seemingly, trivial trauma. A 46 year old man jumped from a small bridge, landed on his feet and fell backwards, immediately thereafter could no longer move or feel his trunk and limbs. Upon neurological assessment, he was found to have spastic quadriparesis, sensory level of C4, as well as bowel and bladder dysfunction. CT scan did not reveal any abnormalities; however MRI demonstrated spinal cord signal changes consistent with spinal cord contusion. Patient was managed conservatively in a rigid cervical collar, as well as per local protocols for the management of quadriplegia. He however eventually succumbed to respiratory failure compounded by aspiration pneumonia. Although SCIWORA is rare in the adult population groups, it does occur and can lead to significant morbidity and high mortality rates. Therefore adult patients presenting with neurologic deficits and normal static radiographs and CT scans, on a background of any degree of trauma, be it trivial, should not be brushed off lightly but rather investigated further with dynamic radiographs and MRI.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - A Case of Classical ‘SCIWORA’ in an Adult Following Trivial Trauma
AU  - Toivo Hasheela
AU  - Aaron Musara
Y1  - 2018/10/17
PY  - 2018
N1  - https://doi.org/10.11648/j.ijn.20180202.11
DO  - 10.11648/j.ijn.20180202.11
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 23
EP  - 26
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20180202.11
AB  - Spinal cord injury without radiographic abnormality (SCIWORA) is a well-documented finding in the paediatric population age groups, however in adults it is a rare occurrence. This case report gives an account of a case of an adult patient in whom a diagnosis of cervical SCIWORA was made and confirmed by MRI, following, seemingly, trivial trauma. A 46 year old man jumped from a small bridge, landed on his feet and fell backwards, immediately thereafter could no longer move or feel his trunk and limbs. Upon neurological assessment, he was found to have spastic quadriparesis, sensory level of C4, as well as bowel and bladder dysfunction. CT scan did not reveal any abnormalities; however MRI demonstrated spinal cord signal changes consistent with spinal cord contusion. Patient was managed conservatively in a rigid cervical collar, as well as per local protocols for the management of quadriplegia. He however eventually succumbed to respiratory failure compounded by aspiration pneumonia. Although SCIWORA is rare in the adult population groups, it does occur and can lead to significant morbidity and high mortality rates. Therefore adult patients presenting with neurologic deficits and normal static radiographs and CT scans, on a background of any degree of trauma, be it trivial, should not be brushed off lightly but rather investigated further with dynamic radiographs and MRI.
VL  - 2
IS  - 2
ER  -

Copy | Download