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

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: English

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


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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.

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