The Trait That Caused Quadriplegia: Rare Case of Sickle Cell Trait and Anterior Spinal Cord Infarction

No author information is available for this submission.

23 views
0 downloads

Video

Presentation

The authors are in the process of completing this submission.

Please try again later.

Abstract

Authors: Matthias Linke DO1, Aaron Bolds MD1, Miquel Escalon MD, MPH1, 1Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai

Background: Is Sickle Cell Trait (SCT) benign? There is a debate in Neurology whether sickle cell trait is a risk factor in early stroke; with increased sickling rates with dehydration, oxygen reduction, and exercise leading to strokes.1,2 The detrimental effects of sickle cell trait has also caused the sudden deaths of some young athletes 2,3. We report only the second case of a spinal cord infarction of an individual with SCT in order to bring more attention to this disease.

Methods: The medical record was reviewed from a 21 year old male with SCT who developed an anterior spinal cord infarction for risk factors to determine the cause for the infarction.

Results: The patient developed a severe unrelenting headache at 6 am on June 2016. The patient was found down by his mother at 9 am with acute tetraplegia. The patient underwent neurological evaluation including MRI and MAR. Imaging was consistent with an anterior spinal artery stroke affecting the anteromedial medulla and cervical spine. Hypercoagulable work-up was negative. The patient required mechanical ventilation with placement of tracheostomy and percutaneous enteral feeding tube. The patient stabilized medically but did not regain any motor function of his upper or lower extremities. He was weaned off the ventilator at a subacute facility. The patient is being followed in a SCI clinic with examination showing intact touch Light touch only and position sense, but paralyzed muscles in both upper and lower extremities. Family and social history incluseds a father who has sickle cell trait and the mother who does not. The patient was living with his parents until the time of his stroke and has been in a Skilled/Subacute Care facility since his infraction. Imaging studies showed a T2 Sagital MRI 2 days after onset of symptoms demonstrating T2 changes in the medulla and cervical spinal cord. T2 Sagital Axial MRI showing anterior spinal cord T2 changes

Conclusion: Sickle cell trait causes variable sickling with abnormal shaped hemoglobin S causing impaired blood flow.4,5 In our patient impaired blood flow affected the anterior portion of the spinal cord, which is supplied by the anterior spinal artery. Clinically the patient presents with an Anterior Spinal Syndrome spinal cord injury secondary to infarction of his anterior spinal cord resulting from hypercoagulable state due to Sickle Cell Trait. Sickle Cell Trait is a risk factor for infarctions, including of the spine, and should be considered during work up and treatment of persons that suffer a spinal cord infarct

References:

  1. Hyacinth HI, Carty CL, Seals SR, et al. Association of Sickle Cell Trait With Ischemic Stroke Among African Americans: A Meta-analysis. JAMA Neurol. 2018;75(7):802. doi:10.1001/jamaneurol.2018.0571
  2. Mitchell BL. Sickle Cell Trait and Sudden Death. Sports Med - Open. 2018;4(1):19. doi:10.1186/s40798-018-0131-6
  3. Crowder MD, Cools KS, Kucera KL, et al. Sudden death in high school athletes: a case series examining the influences of sickle cell trait. Pediatrics. 2018;142(1 MeetingAbstract):414-414. doi:10.1542/peds.142.1_MeetingAbstract.414
  4. Westerman MP, Green D, Gilman‐Sachs A, et al. Coagulation changes in individuals with sickle cell trait. American Journal of Hematology. 2002;69(2):89-94. doi:10.1002/ajh.10021
  5. Ali JM, Besser M, Goddard M, et al. Catastrophic sickling crisis in patient undergoing cardiac transplantation with sickle cell trait. American Journal of Transplantation. 2019;19(8):2378-2382. doi:10.1111/ajt.15379

Discussion

Ask a Question

Get involved to find out more about this Presentation.

All Comments

Create an Account or Log In to participate in the discussion

Loading discussions

Keywords

spinal cord injury

sickle cell trait

anterior spinal cord infarct

tetraplegia

airway management

anatomy

anemia

anemia, hemolytic

anemia, hemolytic, congenital

anemia, sickle cell

bacterial infections and mycoses

blood

blood flow

bone and bones

brain diseases

cardiovascular diseases

causality

cells

central nervous system

central nervous system diseases

cerebrovascular disorders

cervical spine

congenital, hereditary, and neonatal diseases and abnormalities

death

dehydration

disease

electromagnetic phenomena

electromagnetic radiation

environment and public health

epidemiologic factors

epidemiologic methods

genetic diseases, inborn

headache

health care evaluation mechanisms

health care quality, access, and evaluation

health occupations

hematologic diseases

hemic and lymphatic diseases

hemoglobinopathies

history

imaging

infarction

infection

investigative techniques

ischemia

light

magnetic phenomena

male

medicine

meninges

metabolic diseases

musculoskeletal system

necrosis

nervous system

nervous system diseases

neurologic manifestations

neurology

nutrition

nutritional and metabolic diseases

optical phenomena

order

ostomy

otorhinolaryngologic surgical procedures

oxygen

pain

pathologic processes

pathological conditions, signs and symptoms

pediatrics

performance

physical phenomena

pia mater

probability

public health

quality of health care

radiation

radiation, nonionizing

risk

risk factors

seals

secondary

signs and symptoms

skeleton

spinal cord

spine

sports

statistics as topic

stroke

surgical procedures, operative

syndrome

therapeutics

thoracic surgical procedures

tracheostomy

transplantation

vascular diseases

ventilation

water-electrolyte imbalance