Late onset posttraumatic vascular myelopathy without spinal chord injury – a case report

Author(s): Maria Erika Hevia Vaca, Michael Frink, Maximilian Schulze, Steffen Ruchholtz, Martin Bäumlein

Background: Yet, we couldn´t find any reported case of a trauma patient, that describes a late onset complete paraplegia of the lower limbs caused by spinal chord ischaemia without a spinal (chord) injury. Leading causes are dissections of the aorta and their reconstructions.

Case presentation: Here, we present a case of a 43 year old male patient with traumatic dissection of the external iliac artery and demolition of the iliac vein on the left side . Moreover, he was in hypovolemic shock. Injuries of the spine or the spinal chord were not apparent. He was able to move both legs on demand. After performance of damage control surgery at the day of the accident, the patient presented a complete sensoric and motoric deficit 7 days after surgery, the MRI showed a vascular myelopathy.

Conclusion: The myelopathy could be caused by impaired arterial perfusion due to hypovolaemia and disrupted arterial flow on the Adamkiewicz artery. A venious congestion as well as fibrocartilary embolisation are causes that also need to be dicussed.