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.
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Data availability
Data regarding this case report can be made available with maintaining patient’s privacy by requesting the corresponding author through provided e-mail.
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Acknowledgements
We thank to all faculty members and residents of Department of Physical Medicine and Rehabilitation, AIIMS, Patna for their support in care of the patient and data acquisition.
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AB identified the case and particular findings, conceptualized the manuscript, searched literature and wrote the manuscript; SKP reviewed the examination and investigations, determined management protocol and responsible for reviewing the manuscript; AKG helped in patient care, conceptualized the manuscript, helped in writing discussion and gave feedback for modifications of manuscript; JP examined the patient and acquired data and photographs; SG examined the patient and acquired data and helped in writing the manuscript.
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Biswas, A., Pandey, S.K., Gupta, A.K. et al. Very rare incidence of ascending paralysis in a patient of traumatic spinal cord injury: a case report. Spinal Cord Ser Cases 8, 69 (2022). https://doi.org/10.1038/s41394-022-00536-4
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DOI: https://doi.org/10.1038/s41394-022-00536-4
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