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CURRENT ISSUEEUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063

 

Europa Medicophysica 1999 June;35(2):103-7

 CASE REPORT

Post-trau­matic ­cranio-cer­vical junc­tion epi­dural ­hematoma con­com­i­tant ­with pon­tom­e­dul­lary infarc­tion and tet­ra­plegia. Diag­nostic eval­u­a­tion and reha­bil­i­ta­tive treat­ment

Santilli V. 1, Insola A. 2, Finucci S. 3, Paris E. 1, Capici S. 1, Di Girolamo G. 3

1 Unità Spi­nale Uni­po­lare;
2 Neu­ro­fi­sio­logia, CTO - ­Roma;
3 ­Scuola di Spe­cia­liz­zaz­ione in Med­i­cina ­Fisica , e Ria­bil­i­taz­ione “Tor Vergata”, Roma

BACKGROUND: To ­report and dis­cuss a ­rare ­case of ­post-trau­matic, epi­dural ­hematoma ­located ven­trally at the cer­vi­com­e­dul­lary junc­tion ­with con­com­i­tant brain­stem infarc­tion. ­Post-trau­matic epi­dural he­matoma is usu­ally ­located dor­sally in the epi­dural ­space.
­METHODS: A 36-bed ­Spinal ­Unit ­within a stan­dard mul­ti­dis­ci­pli­nary struc­ture. ­Patient: a 65-­year-old ­woman ­with ­post-trau­matic ­spine ­injury.
­RESULTS: The ­main clin­ical ­finding in our ­patient was bilat­eral cor­ti­cos­pinal and cor­tic­o­bulbar ­tract involve­ment. The FIM ­score at admis­sion was 48 and 62 at dis­charge. MR ­showed the dis­place­ment and flat­tening of ­both the ­medulla oblon­gata and the ­most cra­nial por­tion of cer­vical ­cord due to the epi­dural he­matoma asso­ciated ­with an ­ischemic ­lesion of the pon­tom­e­dul­lary junc­tion. Cen­tral ­motor con­duc­tion ­studies ­revealed ­that the abnor­mality of the cen­tral ­motor path­ways was loc­al­ised at brain­stem ­level ­with ­normal con­duc­tion ­from the cer­vi­com­e­dul­lary junc­tion to the ­spinal ­cord.
CONCLUSIONS: ­This ­study ­reports the ­first ­case of ­spinal epi­dural hae­matoma ­located ven­trally in the cer­vical ­spine at the cer­vi­com­e­dul­lary junc­tion ­level and con­com­i­tant infarc­tion at pon­tom­e­dul­lary junc­tion fol­lowing a whip­lash ­injury. The neu­ro­phys­io­log­ical find­ings ­revealed paren­chymal ­damage at the ­level of the ­lower ­pons ­with no indi­ca­tions for sur­gical inter­ven­tion. ­Initiated in the inten­sive ­care ­unit, the man­age­ment ­strategy was con­ser­va­tive and ­involved ­both med­ical and reha­bil­i­ta­tive treat­ment. In our ­patient, ­motor and res­pir­a­tory func­tions ­were ­those ­most ­involved.

language: English


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