Traumatic lumbar hematomyelia causing spinal shock: A case report

Abstrak

Inggris

Background: Spinal cord hemorrhage or hematomyelia can arise from trauma or non-trauma causes, adverse effect of anticoagulation therapy and ruptured vascular malformation. Bleeding in epidural space is common and complications such as acute spinal cord syndrome can arise due to the compression and destruction of the spinal cord. Symptoms of hematomyelia might be varied depending on location of the lesion, often accompanied with acute radicular pain. In this case study, we reported a case of spinal shock after traumatic lumbar hematomyelia. Case: A 13-year-old girl presented to Dr. Moewardi General Hospital with inferior paraparesis, bladder and bowel incontinence, a day after falling on her gluteus. Physical examination revealed reduced motoric and sensory function below 12th thoracal dermatome, with no patellar and reduced Achilles reflexes. Conventional X-ray was unremarkable and further investigation with MRI showed a hematoma on thoracal 10 to 12 vertebrae. Motor and sensory functions were improved after 12 days administration of corticosteroids and further improvement was seen almost immediately after decompression surgery. Objective: To describe a case of spinal shock caused by traumatic lumbar hematomyelia Method: This is a case report study describing spinal shock which improved after administration of corticosteroid and decompression surgery. Conclusion: Spinal shock could be caused by traumatic lumbar hematomyelia, which is characterized by loss of motor, sensory, and bladder function, and decompression surgery improved the prognosis.

Bahasa Indonesia

Latar belakang: Perdarahan medulla spinalis atau hematomyelia dapat timbul akibat trauma maupun non trauma, efek samping terapi antikoagulasi, dan ruptur dari malformasi vaskular. Pendarahan di ruang epidural sering terjadi dan komplikasi seperti sindrom medulla spinalis akut dapat meningkat karena kompresi dan destruksi medulla spinalis. Gejala hematomyelia mungkin bervariasi tergantung pada lokasi lesi, seringkali disertai dengan nyeri radikuler akut. Dalam studi kasus ini, kami melaporkan kasus syok spinal setelah hematomyelia akibat trauma lumbal. Kasus: Seorang anak perempuan berusia 13 tahun datang ke RSUD Dr. Moewardi dengan paraparesis inferior, inkontinensia urin dan alvi, sehari setelah jatuh terduduk. Pemeriksaan fisik menunjukkan penurunan fungsi motorik dan sensorik di bawah dermatom toraks ke-12, tanpa refleks patela dan penurunan refleks Achilles. Foto X-ray konvensional dalam batas normal dan penyelidikan lebih lanjut dengan MRI menunjukkan hematoma pada vertebra toraks 10 sampai 12. Fungsi motorik dan sensorik membaik setelah pemberian kortikosteroid dan operasi dekompresi. Simpulan: Syok spinal dapat disebabkan oleh hematomyelia lumbal traumatis, yang ditandai dengan hilangnya fungsi motorik, sensorik, dan kandung kemih, dan operasi dekompresi dapat meningkatkan prognosis.

Kata kunci

• traumatic hematomyelia
• spinal shock
• case report