A 19-year-old woman was admitted to the emergency department following a high-speed car crash. She did not have her seat belt fastened and was found 40 m from the vehicle. On admission, the Glasgow Coma Score was 15 points. She was conscious and oriented in space and time, but lower limb paraplegia and right arm paralysis were present. Her pupils were miotic and reactive. Tendon reflexes in the lower limbs were absent, but no asymmetry in the legs or spine deviation were apparent in the initial exploration. She was hemodynamically stable and had no dyspnea. Thoracic and abdominal exploration showed no abnormal findings or signs.
Cranial computed tomography (CT) showed a parietotemporal fracture, a small epidural hematoma, and multiple contusions. Thoracic CT showed multiple rib fractures, bilateral pulmonary contusions, and bilateral anterior pneumothorax. Abdominal CT revealed fracture of the first lumbar vertebral transverse process, fracture of the third lumbar vertebral spinous process, and fracture of the second lumbar vertebral body with complete dislocation at the L1-L2 level. The patient was transferred to a tertiary hospital for neurosurgery evaluation and treatment. At present, she continues to have paraplegia, but her arm paralysis has improved considerably.
© 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.