Long-Term Survival Following Complete Medulla/Cervical Spinal Cord Transection
Article Outline
A 20-year-old white man, without significant medical history, lost control of his motor bike while traveling at high speed. At the scene, the patient was unconscious and had a Glasgow Coma Scale score of 3. A witness at the scene provided immediate and successful resuscitation before the patient’s transport to the emergency department.
Diagnosis
Complete medulla/cervical spinal cord transection
A magnetic resonance image (Figure) revealed a complete medulla/cervical spinal cord transection with atlanto-occipital dislocation. The patient underwent occipitocervical stabilization. The patient had an Injury Severity Score of 75, which by definition is inconsistent with survival. Now, 2 years after the injury, the patient is still alive but is fully dependent on continuous life support and care. This case illustrates the possibility of long-term survival after complete medulla/cervical spinal cord transection if immediate and successful resuscitation is provided at the scene.
Figure.
Mid-sagittal T2-weighted magnetic resonance image of the cervical spine. Used with permission of Oliver P. Gautschi, MD, Department of Orthopaedic and Trauma Surgery, Royal Perth Hospital, Perth Western Australia, Australia.
For the diagnosis and teaching points, see page 545.
PII: S0196-0644(06)02073-7
doi:10.1016/j.annemergmed.2006.08.013
© 2007 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
