• Aydın Aydoseli, Utku Özgen, Turgut Akgül, Elif Kocasoy Orhan, Ali Ekrem Adıyaman, Halil Can, and Cihat Karadağ.
• Department of Neurosurgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
• World Neurosurg. 2019 Apr 28.

BackgroundSubacute post-traumatic ascending myelopathy involves the rise in the high signal intensity on T2-weighted images four or more vertebral segments above the initial injured site and it usually occurs within the first few weeks after the injury. The pathophysiological mechanisms of traumatic spinal cord damage are not clearly understood, however there are some pathophysiological processes like arterial thrombosis, venous thrombosis, congestive ischemia, inflammatory or autoimmune reaction, and infection in the form of meningitis or myelitis that could lead to SPAM.Case DescriptionThe author present a case of T7 fracture due to left shoulder gunshot injury and ascending myelopathy up to C2 vertebra level, which occurred one week after the gunshot injury, without pre-traumatic cervical injury or syringomyelia. Although control MRI findings showed the second rise in the high signal intensity level of the spinal cord, T2-weighted signal intensity and cord edema was decreased and patient showed neurological improvement.ConclusionThis was the first case in the literature that showed rise two times in high signal intensity level in spinal cord due to gunshot injury. Inflammatory reactions and secondary injury processes might have led to neurological deterioration and ascending myelopathy in our case, therefore the patient may have showed neurological improvement after methylprednisolone therapy due to its anti-inflammatory and anti-edema effects. There is no clear evidence whether neurological improvement is associated with steroid therapy or it is because of the natural course of the SPAM.Copyright © 2019 Elsevier Inc. All rights reserved.

4 keywords...

hide…