ABSTRACT
Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.
ABSTRACT
Background and aims: Person-in-a-barrel syndrome (PIBS) is clinically characterized by brachial diparesis, with preserved cranial and crural muscle strength. It is a rare neurological syndrome most commonly caused by bilateral and symmetric injury of the motor neurons that control the upper limb movements, including bilateral injury to the brain hemispheres, brainstem, cervical spinal cord, brachial plexus, or peripheral nerves. Methods: N/A Results: A 70-year-old male patient with a history of hypertension, dyslipidaemia and hyperuricemia was admitted with an acute and rapidly progressive (10 days of evolution) bilateral upper limb weakness. The patient denied respiratory or gastrointestinal symptoms, fever or recent cervical trauma/pain. Two weeks earlier he was given the first dose of the Pfizer-BioNTech™ vaccine for COVID- 19. The neurological examination revealed severe brachial diparesis and generalized hyporeflexia. Ancillary testing revealed positive serum anti-GM1 and GD1b antibodies. The PCR for SARS-CoV-2 was negative (with positive serum T-Spike antibodies). CSF analysis and Brain/Spinal MRI were normal. The electromyography and nerve conduction studies disclosed diffuse motor conduction blocks in the upper extremities, ultimately fulfilling criteria for Acute Motor Axonal Neuropathy (AMAN) with reversible conduction failure. Intravenous human immunoglobulin (0.4g/kg/day, 5 days) and rehabilitation were started, with subsequent motor improvement. Conclusion: To our knowledge this is the first case of AMAN presenting as PIBS. We intend to highlight that AMAN should be added to the list of causes of this syndrome. The role of the COVID-19 vaccine in this case remains uncertain, and it is not possible, at this moment, to infer causality.