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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
Official Journal of the , , , ,
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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
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.