Ulus Travma Acil Cerrahi Derg. 2021; 27(6): 702-705 | DOI: 10.14744/tjtes.2020.12686

Spinal cord contusion and paraplegia resulting from indirect gunshot injury

Chen-Wei Wu¹, Chien-Chin Hsu², Kuo-tai Chen^3
1Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
²Department of Emergency, Chi-Mei Medical Center, Tainan-Taiwan
³Department of Biotechnology, Southern Tainan University of Technology, Tainan-Taiwan

Emergency physicians may overlook spinal cord injury in patients when the direct impact of a gunshot on the spine is lacking. A 30-year-old man who was shot on his right chest wall was brought to the emergency department. He arrived in a state of shock and underwent emergent thoracotomy for massive hemothorax. After surgery, he was found to be paraplegic. Magnetic resonance imaging of the spine showed T4 spinal cord contusion. The penetrating bullet dissipates energy to the surrounding tissue and contuses the spinal cord. Another assumption of the spinal cord injury is the impairment of blood supply to the cord. No effective treatment exists for gunshot-related indirect injury to the spinal cord. These reported cases reminded emergency physicians that after stabilization of the patient with a gunshot wound, a complete neurologic examination should be performed to discover occult spinal cord injury.

Keywords: Gunshot, indirect injury; paraplegia; spinal cord injury.

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Dolaylý ateþli silah yaralanmasýna baðlý omurilik kontüzyonu ve parapleji

Chen-Wei Wu¹, Chien-Chin Hsu², Kuo-tai Chen^3
1Taipei Týp Üniversitesi Týp Fakültesi, Acil Týp Bölümü, Taipei-Tayvan
²Chi-Mei Týp Merkezi, Acil Durum Bölümü, Tainan-Tayvan
³Güney Tainan Teknoloji Üniversitesi, Biyoteknoloji Bölümü, Tainan-Tayvan

Acil hekimleri, ateþli silahýn omurgaya doðrudan etkisi olmadýðý durumlarda hastalarda omurilik yaralanmasýný gözden kaçýrabilirler. Sað göðüs duvarýndan vurulmuþ 30 yaþýndaki erkek hasta acil servise getirildi. Þok durumunda gelen hastaya masif hemotoraks nedeniyle acil torakotomi yapýldý. Ameliyattan sonra hastanýn paraplejik olduðu tespit edildi. Spinal manyetik rezonans görüntülemede T4 seviyesinde kontüzyon görüldü. Delici merminin enerjisi çevre dokulara yayýlýr ve omurilikte kontüzyona neden olur. Omurilik yaralanmasýna dair bir baþka varsayým, spinal korda olan kan akýþýnýn bozulmasýdýr. Ateþli silahla iliþkili dolaylý omurilik yaralanmasý için etkili bir tedavi mevcut deðildir. Bildirilen bu olgular, acil hekimlerine ateþli silah yarasý olan hastanýn stabilizasyonundan sonra, gizli omurilik yaralanmasýný saptamak için tam bir nörolojik muayene yapýlmasý gerektiðini hatýrlatmaktadýr.

Anahtar Kelimeler: Ateþli silah, dolaylý yaralanma; omurilik yaralanmasý; parapleji.

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