Man with trauma after a fall
Journal
Journal of the American College of Emergency Physicians open
Journal Volume
1
Journal Issue
3
Date Issued
2020-06
Author(s)
Abstract
A 53-year-old man was sent to our emergency department because of a drunken and unintentional high fall from the fifth floor to the canopy on the second floor, ∼15 meters high. At triage, he exhibited clear consciousness, and physical examination revealed thoracic deformity, absent anal tone, and a 0 score of muscle power of bilateral lower extremities. Neurologic examination also disclosed absence of knee and ankle jerk reflexes, sensory loss below T10 level, and urinary incontinence. The scout view (Figure 1) and emergency CT scan (Figure 2) both showed abnormal penile erection. The patient's CT scan revealed fracture-dislocation at T11 level with complete spinal cord transection (Figure 3) along with rib fractures, pneumothorax, and lung contusion. There were no injuries to the brain, abdominal organs, or extremities. The cause of spinal cord injury-related priapism is thought to be because of increased parasympathetic input following blockage of sympathetic pathway.1 The sympathetic outflow originates from approximately T2 and innervates penis and clitoris from the lowest levels of the spinal cord, the conus, which could explain why lesion at any level in the spinal cord from the brainstem to the conus may induce priapism.2 Priapism in spinal cord injury usually occurs shortly after trauma and may resolve spontaneously from a few hours to up to 30 hours after the event. It appears to be invariably associated with complete spinal cord transection and may indicate poor prognosis. However, the proportion of male patients with priapism after suffering acute complete spinal cord transection is unclear because of few reported cases in literature. Under the impression of T11 traumatic spondyloptosis, our patient underwent transpedicular screw fixation and posterolateral fusion by artificial bone grafts. However, he remained hemiparaplegic even after the surgery and rehabilitation. The authors declare no conflict of interest. Yes.
Type
journal article