Inpatient Multidisciplinary Rehabilitation in Adult Spinal Cord Injury Without Neuroimaging Abnormality (SCIWNA): A Case Report.

Spinal cord injury without radiographic abnormality is a condition primarily observed in the pediatric population. However, its occurrence in adults remains underreported. This case report aims to describe a rare instance of adult spinal cord injury without neuroimaging abnormality (SCIWNA) following a road accident in a 52-year-old woman, emphasizing the clinical nuances and management challenges associated with this condition. The patient presented with tetraplegia (American Spinal Injury Association Impairment Scale D) with a neurological injury level at C4, exhibiting subtle improvements during inpatient care. Comprehensive examinations revealed conflicting clinical and imaging findings, leading to the diagnosis of SCIWNA. A tailored rehabilitation program involving a multidisciplinary team resulted in notable improvements in neuromotor function, gait, and activities of daily living. The mechanisms behind SCIWNA in adults remain debated, possibly involving pre-existing spinal pathologies exacerbated by trauma. Neurological deficits can range from minor sensory issues to severe tetraplegia with unpredictable times of onset. Diagnostic challenges persist due to normal imaging results despite clinical symptoms. Treatment guidelines lack consensus, encompassing conservative approaches, steroid administration, and surgical interventions in select cases. This rare case of SCIWNA underscores the diagnostic complexity when clinical spinal cord injury contrasts with normal neuroimaging. This report highlights the significance of clinical assessment and the evolving landscape in diagnosing SCIWNA in adults. In addition, the absence of a standardized management protocol emphasizes the need for individualized strategies tailored to patient-specific needs, warranting further research and consensus-building among healthcare professionals.

Spinal cord infarction in children: Can gymnastics be a cause?

INTRODUCTION: Spinal cord infarction (SCI) in children is rare and difficult to diagnose. Fibrocartilaginous embolism (FCE) is probably the underlying cause for some unexplained cases of spinal cord infarcts. Abrupt back pain followed by a progressive syndrome of myelopathy appears to be the typical presentation, with a close temporal relationship between the onset of symptoms and preceding minor trauma. Supportive care and rehabilitation are essential in the treatment of children with SCI. CASE REPORT: A previously healthy 12-year-old girl who practiced acrobatic gymnastics was admitted to a rehabilitation centre 14 days after being diagnosed with an acute anterior SCI with no identified cause. Sensory modality of pin prick and light touch were impaired, with the former more significantly affected. She was not able to run and had difficulty on monopodal standing and performing motor sequencing. Additionally, she mentioned ineffective cough along with flatus incontinence and normal bladder function. After a 4-week multidisciplinary rehabilitation program her neurologic deficits improved. DISCUSSION: Given the patient's age and clinical presentation, a literature review led to the consideration of FCE as the most likely definitive diagnosis. It should be recognized as a cause of SCI especially in those involved in sport activities, even if previous trauma is denied.

Hand function and adaptive equipment use in patients with rheumatoid arthritis.

OBJECTIVES: Evaluation and characterization of hand function in patients with rheumatoid (RA) arthritis and, secondarily, identification of the use of adaptive equipments. MATERIAL AND METHODS: Firstly, a written informed consent was obtained and then an anonymous questionnaire was filled by RA outpatients after observation at the rheumatology consultation with no other musculoskeletal or neuromuscular disorders that would determine major functional impairment of hand function. Sociodemographic and clinical variables were collected and the Cochin Hand Functional Scale (CHFS) was applied. Classical deformities of hand and/or wrist were observed and recorded by the attending physician. RESULTS: A total of 79 patients were enrolled. In the overall sample, most patients were female A sample of 79 patients, mostly female (69.60%), with a mean age of 59.72 ± 11.77 years and with a mean diagnosis duration of 11.72 ± 8.29 years. The majority (73.40%) had at least one hand or wrist deformity, the most frequent being atrophy of the interosseous muscles followed by ulnar deviation of the metacarpophalangeal joints and piano key deformity of the wrist. The mean CHFS score was 17.94 ± 18.26 points with a minimum and maximum value recorded of 0 and 80 points, respectively. The presence of hand deformities, Health Assessment Questionnaire score (HAQ), hand pain and diagnosis duration were correlated with the CHFS score. Six patients had assistive devices and only in one case it was used to overcome hand's functional impairment. CONCLUSIONS: Most patients presented at least one classic RA deformity after a mean diagnosis duration of approximately 12 years and under pharmacological treatment. Despite this, most patients scored significantly below CHFS maximum score, but only 18 reported no difficulty in any of the tasks mentioned in the scale. The fact that only a minority of these patients had assistive devices should alerts us to the need for a more thorough functional assessment and identification of needs among RA patients.