Images in Intensive Medicine
SCIWORA, an injury to know and diagnose
SCIWORA, una lesión a conocer y a perseguir
R. Viejo Moreno
, C. Benito Puncel, Z. Eguileor Marín
Corresponding author
Servicio de Medicina Intensiva, Hospital Universitario de Guadalajara, Guadalajara, Spain
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B) Corte axial a nivel de C1 con estenosis de canal medular en TC en 2018 de 6<span class="elsevierStyleHsp" style=""></span>mm (asterisco gris). C) Corte sagital en TC en la que se objetiva estenosis de canal en unión craneocervical ya conocida sin lesión aparente de partes blandas (flecha gris sin relleno). D) Resonancia magnética en secuencia T1: estenosis raquídea con engrosamiento dural difuso y alteración de la señal en región inferior de bulbo, así como intramedular cervical compatible con mielopatía traumática (flecha gris con relleno).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Viejo Moreno, C. Benito Puncel, Z. Eguileor Marín" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Viejo Moreno" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Benito Puncel" ] 2 => array:2 [ "nombre" => "Z." 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Rodriguez-Ruiz, A. López-Lago, M. Álvarez Barredo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Rodriguez-Ruiz" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "López-Lago" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Álvarez Barredo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301146?idApp=WMIE" "url" => "/21735727/0000004300000006/v1_201907250825/S2173572719301146/v1_201907250825/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Intensive Medicine</span>" "titulo" => "SCIWORA, an injury to know and diagnose" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "392" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Viejo Moreno, C. Benito Puncel, Z. Eguileor Marín" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Viejo Moreno" "email" => array:1 [ 0 => "rviejo@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Benito Puncel" ] 2 => array:2 [ "nombre" => "Z." "apellidos" => "Eguileor Marín" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Guadalajara, Guadalajara, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "SCIWORA, una lesión a conocer y a perseguir" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 1000 "Tamanyo" => 134262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography scan in 2008: axial acquisition at C1–C2 level showing spinal cord canal stenosis (6<span class="elsevierStyleHsp" style=""></span>mm) (grey asterisk). (B) Computed tomography scan in 2018: axial acquisition at C1 level showing spinal cord canal stenosis (6<span class="elsevierStyleHsp" style=""></span>mm) (grey asterisk). (C) Computed tomography scan: sagittal acquisition showing the already known canal stenosis at the craniocervical junction, with no apparent soft tissue lesions (vacant grey arrow). (D) Magnetic resonance imaging: T1-weighted acquisition showing canal stenosis with diffuse dural thickening and signal alteration in lower bulbar zone, together with cervical intramedullary image consistent with traumatic myelopathy (solid grey arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old woman. <span class="elsevierStyleItalic">History:</span> perinatal anoxic encephalopathy; atloaxoid subluxation with critical canal stenosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) – neurosurgery being discarded in 2008 due to surgical risk. Seizure episode with head injury (head in cervical hyperflexion). The patient was assisted by out-hospital emergency care (112), initially in asystolia. Resuscitation was started, with recovery of pulse after lung isolation. In hospital: blood pressure 80/50<span class="elsevierStyleHsp" style=""></span>mmHg, heart rate 45<span class="elsevierStyleHsp" style=""></span>bpm, SatO<span class="elsevierStyleInf">2</span> 100% and temperature 33<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span>. The full body CT scan revealed no acute lesions and confirmed the already known atloaxoid subluxation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and C). In the Intensive Care Unit: tetraplegia, areflexia, anal sphincter atonia and absence of respiratory effort in pressure support ventilation. The MRI scan revealed lesions consistent with acute cervical myelopathy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). With a diagnosis of spinal cord injury without radiographic abnormality (SCIWORA), under noradrenaline perfusion and the administration of dexamethasone, the patient failed to recovery respiratory activity.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Viejo Moreno R, Benito Puncel C, Eguileor Marín Z. Sciwora, una lesión a conocer y a perseguir. Med Intensiva. 2019;43:392.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 1000 "Tamanyo" => 134262 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography scan in 2008: axial acquisition at C1–C2 level showing spinal cord canal stenosis (6<span class="elsevierStyleHsp" style=""></span>mm) (grey asterisk). (B) Computed tomography scan in 2018: axial acquisition at C1 level showing spinal cord canal stenosis (6<span class="elsevierStyleHsp" style=""></span>mm) (grey asterisk). (C) Computed tomography scan: sagittal acquisition showing the already known canal stenosis at the craniocervical junction, with no apparent soft tissue lesions (vacant grey arrow). (D) Magnetic resonance imaging: T1-weighted acquisition showing canal stenosis with diffuse dural thickening and signal alteration in lower bulbar zone, together with cervical intramedullary image consistent with traumatic myelopathy (solid grey arrow).</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000006/v1_201907250825/S2173572719300980/v1_201907250825/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000006/v1_201907250825/S2173572719300980/v1_201907250825/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300980?idApp=WMIE" ]
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