Missed injuries of the spinal cord.

Ashworth, MT; Arthur, Mary E.; Pye, Geoff; Loehry, C A

doi:10.1136/bmj.284.6325.1334-b

Cited by 2 publications

(2 citation statements)

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“…With some radiological abnormalities, it is easy for us to make a diagnosis of SCI because the sensitivity of CT for detecting bone injuries is very high and CT is available in almost all modern facilities. Several authors have already reported hypothermia patients with SCI . In this modern era, SCI in severe hypothermic patients would only be difficult to diagnose if there was no evidence of radiological abnormality.…”

Section: Discussionmentioning

confidence: 99%

Severe hypothermia secondary to spinal cord injury without radiographic abnormality

Kanezaki

Ishii

Miyazaki

et al. 2014

Acute Medicine & Surgery

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Case: A 64-year-old female was found lying by a river. She was unconscious and her lower body was under water. The patient was transported to the emergency room of our hospital. On arrival, her rectal temperature was 24.6°C. We immediately started rewarming and artificial respiration. Five days after admission, rewarming was completed and she became conscious and could communicate. Initially, she had been injured and examination showed paraplegia. Magnetic resonance imaging of her cervical spine showed no findings indicating bony or ligament injury, but there was a T2 high intensity area at C5/6 and C6/7 levels. The patient was diagnosed with spinal cord injury without radiological abnormality.Outcome: At 5 months post-injury, the patient was able to walk without crutches. Conclusion: Spinal cord injury might be missed if there are no radiographic abnormalities. Spinal cord injury without radiological abnormality should be considered as a differential diagnosis of accidental hypothermia.

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Section: Discussionmentioning

confidence: 99%

Severe hypothermia secondary to spinal cord injury without radiographic abnormality

Kanezaki

Ishii

Miyazaki

et al. 2014

Acute Medicine & Surgery

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“…Injuries in the central nervous system, such as intracerebral bleeding and subdural hematoma, as well as chronic illnesses like Parkinson's disease, Alzheimer's disease or neoplasms can indirectly lead to impaired temperature regulation (Fox et al 1970, Chang andGill 1981). With spinal cord injuries, the afferent and efferent autonomic nerve fibers involved in thermo-sensing and thermoregulatory effector activities can be interrupted, leading to both increased heat loss and impaired heat generation (Pledger 1963;Ashworth et al 1982;Menard and Hahn 1991). Peripheral neuropathies, such as that caused by diabetes mellitus, can impair temperature regulation capacity; high plasma osmolality related to poorly regulated diabetes mellitus, as well as hypoglycemia or ketoacidosis all have a negative effect on the thermoregulatory activity of the hypothalamus.…”

Section: Predisposing Factorsmentioning

confidence: 99%

Accidental hypothermia and local cold injury: physiological and epidemiological studies on risk

Brändström

2013

Acta Anaesthesiol Scand

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PhD dissertation abstractBackground and objective: The objectives were to first determine incidence and contributing factors to cold-related injuries in Northern Sweden, both of those that led to hospitalisation and those that led to fatality. A further aim was to assess post-cooling hand-rewarming responses and the effects of training in a cold environment, both on fingertip rewarming and on function of the autonomic nervous system, to evaluate if there was adaptation related to prolonged occupational cold exposure. Methods: In a retrospective analysis, cases of accidental coldrelated injury with hospital admission in Northern Sweden in 2000-2007 were analysed. Cases of fatal hypothermia in the same region in 1992-2008 were analysed. A cohort of volunteers was studied before and after many months of occupational cold exposure. Subject hand-rewarming response was measured after a cold hand immersion provocation, and was categorised as slow, moderate, or normal in rewarming speed. This cold provocation and rewarming assessment was performed before and after their winter training. Heart rate variability (HRV) was analysed from the same cold provocation/recovery sequences. Results: For the 379 cases of hospitalisation for cold-related injury, annual incidences for hypothermia, frostbite, and drowning were 3.4/100,000, 1.5/100,000, and 1.0/100,000 inhabitants, respectively. Male gender was more frequent for all categories. Annual frequencies for hypothermia hospitalisations increased during the study period. Hypothermia degree and distribution of cases were 20% mild (between 32°C and 35°C), 40% moderate (31.9-28°C), and 24% severe (< 28°C), while 12% had temperatures over 35.0°C. The 207 cases of fatal hypothermia showed an annual incidence of 1.35 per 100,000 inhabitants: 72% in rural areas, 93% outdoors, and 40% found within 100 m of a building. Paradoxical undressing was documented in 30%. Ethanol was detected in femoral vein blood in 43%. Contributing comorbidity was common, including heart disease, previous stroke, dementia, psychiatric disease, alcoholism, and recent trauma. Post-training, baseline fingertip temperatures, and cold recovery

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Missed injuries of the spinal cord.

Cited by 2 publications

References 0 publications

Severe hypothermia secondary to spinal cord injury without radiographic abnormality

Severe hypothermia secondary to spinal cord injury without radiographic abnormality

Accidental hypothermia and local cold injury: physiological and epidemiological studies on risk

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