Nontraumatic ischemic spinal cord injury following vigorous exercise: a case report

Abstract

Background: Spinal cord injuries (SCI), although rare in children, lead to significant morbidity and mortality.

Case presentation: This report describes the case of a 15-year-old male adolescent who developed SCI due to paradoxical embolism of a deep vein thrombus following strenuous exercise. He presented with bilateral upper limb weakness that progressed to severe tetraparesia, sensory deficits, and autonomic instability. Imaging revealed medullary ischemia with hypoperfusion of the anterior spinal artery. A family history of thromboembolism and obesity were noted as risk factors in the patient; however, thrombophilia screening was negative. Optimized fluid therapy was initiated for the medullary shock associated with dexamethasone and enoxaparin. As neurological recovery was incomplete, the patient was enrolled in an intensive rehabilitation program.

Conclusion: To the best of our knowledge, this is the first reported case of medullary ischemia due to a paradoxical embolism of a deep vein thrombus through a patent foramen ovale in an adolescent. This case highlights the need for a multidisciplinary approach to optimize long-term outcomes after medullary ischemia.

Keywords

Adolescent / Medullary shock / Spinal cord ischemia / Thromboembolism

Conflict of interest

The authors declare no conflict of interest.

Author contributions

Sousa A and Branco J participated in conception and design, provision of study materials and patients, data collection and assembly. All authors contributed to data analysis and interpretation, manuscript writing, and final approval of the manuscript.

Funding

None.

Ethical approval of studies and informed consent

All procedures performed in this study were in accordance with the Helsinki Declaration (as revised in 2013) and with the ethical standards of the institutional research committee, and the study is exempt from ethical approval. Written informed consent was obtained from the patient for the publication of this case report.

Acknowledgements

None.

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