Brown-Sequard Syndrome after an Accidental Stab Injury of Cervical Spine: A Case Report

Stabbing injury of the spinal cord: A case report and systematic literature review

BACKGROUND

Spinal cord injury caused by stab wounds (SCISW) represents one of the rarest causes of traumatic spinal cord injury. Because of their rarity, management of such cases may be challenging due to the lack of specific guidelines.

METHODS

The systematic review was performed on 30th June 2024 according to the PRISMA 2020 guidelines. A literature search was conducted across four databases: PubMed, Scopus, Web of Science, and The Polish Medical Bibliography. Additionally, a unique case was presented as an illustrative clinical presentation.

RESULTS

A total of 89 eligible articles, including 78 case reports (89 patients) and 11 case series (882 patients), were found. The current report describes a case of a 41-year-old man with one neck stab wound and a stab wound of the chest. Clinical examination demonstrated complete paraplegia and a lack of sensation below the level of T1. Magnetic resonance imaging (MRI) showed a complete transection of the spinal cord at the T1-T2 level. Due to the lack of foreign bodies at the injury site, the patient was managed conservatively.

CONCLUSION

Direct stabbing injuries rarely lead to complete transection of the spinal cord as in our case. Computed tomography (CT) scans or plain radiographs are necessary to exclude retained foreign bodies. MRI as a further imaging tool can confirm the SCI and may be useful as a predictor of outcomes. Regarding optimal management, conservative treatment should be preferred over surgical intervention in the absence of a foreign body at the injury site.

Brown-Séquard Syndrome Following a Thoracic Spine Stab Wound: A Case Report

Nonmissile penetrating spine injury represents a small percentage of spinal cord injuries (SCIs), estimated at 0.8% in Western countries. This paper presents a detailed case report of a 28-year-old man with a history of substance use who suffered multiple injuries following a violent incident. The patient was found with a knife embedded in his thoracic spine, prompting immediate medical intervention. Computed tomography and postoperative magnetic resonance imaging revealed the extent of spinal cord and anatomical involvement. A thorough physical medicine and rehabilitation evaluation was conducted post-surgery, leading to a diagnosis of Brown-Séquard syndrome with associated sensorimotor deficits. This paper highlights the challenges posed by penetrating SCIs while reviewing the literature.

Microsurgical repair of severed thoracic spinal cord and clinical outcome: technical case report

Background

This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome. Surgical technique and post-operative management is discussed.

Case presentation

A 34-year-old fit and well healthy man was admitted with a history of stab injury to the thoracic spine at thoracic T2/3 level with ASIA impairment score (AIS) score D with an incomplete spinal cord affecting his left lower limb with complete paralysis and right lower limb paresis with impaired sensation below T6 level to L5. Neuroimaging confirmed a penetrating knife injury traversing the T2/3 level causing hemi-section of the spinal cord confirmed intraoperatively. He underwent an urgent exploratory surgery of his spine and a T2/3 laminectomy was performed to aid removal of the knife. The dura was noted to be contused and severed spinal cord was noted to be severed with associated cord oedema. A microsurgical repair of the severed cord was performed with duroplasty followed by intense neuro-rehabilitation. On a 3 month follow up his AIS score is E with lower limb power is 5/5 bilaterally and he is able to mobilise independently up to 8–10 steps without any supportive aid and with crutches he is independently functional and mobile.

Conclusion

This is the first documented case of microsurgical repair of severed thoracic spinal cord secondary to traumatic knife injury. In the management of such scenario, apart from the removal of foreign body, repair of the cord with duroplasty should be carefully considered. The role of spinal neuroplasticity in healing following timely repair of the spinal cord along with intense rehabilitation remains the key. This had resulted in a good clinical and functional outcome with in a 18-month follow up.

Immunization with neural-derived peptides increases neurogenesis in rats with chronic spinal cord injury

Aims

Immunization with neural‐derived peptides (INDP) has demonstrated to be a promising therapy to achieve a regenerative effect in the chronic phase of the spinal cord injury (SCI). Nevertheless, INDP‐induced neurogenic effects in the chronic stage of SCI have not been explored.

Methods and Results

In this study, we analyzed the effect of INDP on both motor and sensitive function recovery; afterward, we assessed neurogenesis and determined the production of cytokines (IL‐4, IL‐10, and TNF alpha) and neurotrophic factors (BDNF and GAP‐43). During the chronic stage of SCI, rats subjected to INDP showed a significant increase in both motor and sensitive recovery when compared to the control group. Moreover, we found a significant increase in neurogenesis, mainly at the central canal and at both the dorsal and ventral horns of INDP‐treated animals. Finally, INDP induced significant production of antiinflammatory and regeneration‐associated proteins in the chronic stages of SCI.

Conclusions

These findings suggest that INDP has a neurogenic effect that could improve motor and sensitive recovery in the chronic stage of SCI. Moreover, our results also envision the use of INDP as a possible therapeutic strategy for other trauma‐related disorders like traumatic brain injury.

Pneumorrhachis and hyponatremia after a neck hack-A case report

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A rare case of pneumorrhachis after a cervical penetrating injury.

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Presentation of metabolic, cardiopulmonary derangements and other biochemical sequela of penetrating cervical injury.

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The importance of multidisciplinary team effort for the management of penetrating cervical injury.

Introduction

Penetrating cervical spinal cord injury (SCI) is a rare clinical entity that requires a multitude of health care specialists for proper management. The unpredictable nature of penetrating SCI and complex systemic sequela contribute to the high mortality rates of penetrating SCI.

Presentation of case

An 18-year-old-male patient was admitted to the emergency department with tetraparesis following a penetrating injury to the neck. Radiological examination revealed fractures of C4 and C5 spinous processes and extensive intradural pneumorrhachis. The patient was managed operatively with laminectomy, vertebral augmentation, and duroplasty. An acute decreased level of consciousness was observed four days after the operation. Laboratory investigation revealed critically low plasma sodium level. The patient remained decerebrated despite electrolyte correction and pronounced brain dead on the seventh postoperative day.

Discussion

Metabolic derangements and pulmonary physiologic changes following trauma are lethal complications. Hyponatremic encephalopathy and disrupted pulmonary function caused by high cervical compression by the extensive pneumorrhachis contributes to the morality in this case report.

Conclusion

This case report presents a rare clinical entity along with its’ complications. Prompt clinical stabilization, strict biochemical monitoring, and multidisciplinary care from health care specialists are mandatory for SCI patients.

Imaging findings of penetrating spinal cord injuries secondary to stab wounds on magnetic resonance imaging in a tertiary trauma unit, South Africa

BACKGROUND

In South Africa, the leading cause of spinal cord injuries is motor vehicle accidents, followed by violence-related injuries, including gunshot injuries and stab wounds. Controversy regarding management persists. Magnetic resonance imaging (MRI) is the gold standard to rule out surgical causes of neurological deficit.

OBJECTIVES

To determine the spectrum of imaging findings in penetrating spinal cord injuries, specifically related to stab wounds, in a Tertiary Academic Hospital in the Free State province and whether these imaging findings influenced immediate surgical decision-making and outcomes of patients.

METHOD

Consecutive sampling was used to retrospectively select patients who presented with spinal penetrating injuries secondary to stab wounds during the period 01 August 2013-30 September 2016 and received MRI investigation. Fifty-six patients were included. Magnetic resonance imaging investigations were reviewed by the authors, with documentation of MRI findings, relevant patient demographics and clinical information into Excel spread sheets. Statistical analysis was performed by the Biostatistics Department of the University of the Free State.

RESULTS

The most common MRI finding was a high signal intensity wound tract (96.6%), followed by cord signal changes (91.1%) and cord oedema (82.1%). Thirty-nine extra-axial collections were diagnosed in 30 penetrating injuries, of which only one had spinal compressive effects. Four patients (7.1%) demonstrated pseudo-meningoceles. None of the included patients had an indication for emergency spinal surgery on review of imaging.

CONCLUSION

Magnetic resonance imaging findings did not alter the surgical course of action in our study patients. Despite this, MRI is a valuable modality in evaluation of penetrating spinal cord injuries in the post-traumatic phase (<24 h) for the presence of pseudo-meningoceles that pose an infection and delayed complication risk.