April 2017

GSW to the neck

History 
••23yr male presents to ER s/p GSW to the neck
•Mandibular fracture, hyoid body injury
•No PMH
•No PSH
 
Examination
••BP 90/60 HR 65 RR 13 T 37
•Alert
•GCS 15
•C5 ASIA A
•Entry wound to posterior neck
•Exit wound left mandible
•Admission CT cervical spine obtained
•Flex/Ext films – gross instability (C5-6)
 
Further information
•Hospital Day #8
•Fevers and leukocytosis
•Neck CT – retropharyngeal abscess requiring neck exploration and esophageal repair.

•Hospital Day #15
•Unable to feel his arms
•MRI (w/ gado) obtained

 

Admission CT

Hospital Day 15

Questions

References:

•Dorflinger-Hejlek, E., et al., Diffusion-Weighted MR Imaging of Intramedullary Spinal Cord Abscess. Am J Neuroradiol, 2010. 31: p. 1651-1652.
•Kurita, N., et al., Intramedullary Spinal Cord Abscess Treated with Antibiotic Therapy. Neurol Med Chir, 2009. 49: p. 262-268.
•Sinha, P., et al., Intramedullary abscess of the upper cervical cord. Unusual presentation and dilemmas of management: Case report. Clinical Neurology and Neurosurgery, 2013. 115: 1845-1850.
•Do-Dai, D., et al., Magnetic Resonance Imaging of Intramedullary Spinal Cord Lesions: A Pictorial Review. Curr Probl Diagn Radiol, 2010.  Jul/Aug: p. 160-185.
•Nadkarni, T., et al., An intradural-extramedullary gas-forming spinal abscess in a patient with diabetes mellitus. Journal of Clinical Neuroscience, 2010. 17: 263-265.
•Mohindra, S., et al., Intramedullary abscess in association with tumor at the conus medullaris. J Neurosurg Spine, 2007. 6: 350-353.
•Wright, R. Lewis, Intramedullary Spinal Cord Abscess. Report of a case secondary to stab wound with good recovery after operation. J Neurosurg, 1965. 23: 208-210. 
•Dutton JEM, Alexander GI. Intramedullary spinal abscess. J Neurol Neurosurg Psychiat, 1954. 17: 303–317.
•HawrylukG., WhetstoneW., SaigalR., FergusonA., TalbottJ., BresnahanJ., DhallS., PanJ., BeattieM., and ManleyG. (2015). Mean arterial blood pressure correlates with neurological recovery after human spinal cord injury: analysis of high frequency physiologic data. J. Neurotrauma 32, 1958–1967  
  • Social Media:

Continue the discussion on LinkedIn with our members-only Case of the Month Discussion Group. Create a dialogue and see how your recommendations compare with your colleagues across the globe.