Neck injuries in young pediatric homicide victims

2009 ◽  
Vol 3 (3) ◽  
pp. 232-239 ◽  
Author(s):  
Laura K. Brennan ◽  
David Rubin ◽  
Cindy W. Christian ◽  
Ann-Christine Duhaime ◽  
Haresh G. Mirchandani ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Soft Tissue ◽  
Head Trauma ◽  
Cerebral Edema ◽  
Cervical Spinal Cord ◽  
Abusive Head Trauma ◽  
Cervical Cord ◽  
Neck Injuries ◽  
Cord Injury ◽  
Hypoxia Ischemia

Object In this study, the authors estimate the prevalence of injuries to the soft tissue of the neck, cervical vertebrae, and cervical spinal cord among victims of abusive head trauma to better understand these injuries and their relationship to other pathophysiological findings commonly found in children with fatal abusive head trauma. Methods The population included all homicide victims 2 years of age and younger from the city of Philadelphia, Pennyslvania, who underwent a comprehensive postmortem examination at the Office of the Medical Examiner between 1995 and 2003. A retrospective review of all available postmortem records was performed, and data regarding numerous pathological findings, as well as the patient's clinical history and demographic information, were abstracted. Data were described using means and standard deviations for continuous variables, and frequency and ranges for categorical variables. Chi-square analyses were used to test for the association of neck injuries with different types of brain injury. Results The sample included 52 children, 41 (79%) of whom died of abusive head trauma. Of these, 29 (71%) had primary cervical cord injuries: in 21 there were parenchymal injuries, in 24 meningeal hemorrhages, and in 16, nerve root avulsion/dorsal root ganglion hemorrhage were evident. Six children with abusive head trauma had no evidence of an impact to the head, and all 6 had primary cervical spinal cord injury (SCI). No child had a spinal fracture. Six of 29 children (21%) with primary cervical SCIs had soft-tissue (ligamentous or muscular) injuries to the neck, and 14 (48%) had brainstem injuries. There was a significant association of primary cervical SCI with cerebral edema (p = 0.036) but not with hypoxia-ischemia, infarction, or herniation. Conclusions Cervical SCI is a frequent but not universal finding in young children with fatal abusive head trauma. In the present study, parenchymal and/or root injury usually occurred without evidence of muscular or ligamentous damage, or of bone dislocation or fracture. Moreover, associated brainstem injuries were not always seen. Although there was a significant association of primary cervical cord injury with cerebral edema, there was no direct relationship to brainstem herniation, hypoxia-ischemia, or infarction. This suggests that cervical spinal trauma is only 1 factor in the pathogenesis of these lesions.

Soft-Tissue Damage and Segmental Instability in Adult Patients With Cervical Spinal Cord Injury Without Major Bone Injury

Spine ◽  
2012 ◽  
Vol 37 (25) ◽  
pp. E1560-E1566 ◽  
Author(s):  
Takeshi Maeda ◽  
Takayoshi Ueta ◽  
Eiji Mori ◽  
Itaru Yugue ◽  
Osamu Kawano ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Soft Tissue ◽  
Tissue Damage ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Adult Patients ◽  
Segmental Instability ◽  
Bone Injury ◽  
Cord Injury

scholarly journals Transcutaneous spinal cord stimulation of the cervical cord modulates lumbar networks

2020 ◽  
Vol 123 (1) ◽  
pp. 158-166 ◽  
Author(s):  
Trevor S. Barss ◽  
Behdad Parhizi ◽  
Vivian K. Mushahwar
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
H Reflex ◽  
Cervical Cord ◽  
Arm Cycling ◽  
Cord Injury ◽  
Walking Capacity ◽  
Transcutaneous Spinal Cord Stimulation ◽  
Lumbar Cord

It has been established that coordinated arm and leg (A&L) cycling facilitates corticospinal drive and modulation of cervico-lumbar connectivity and ultimately improves overground walking in people with incomplete spinal cord injury or stroke. This study examined the effect of noninvasive transcutaneous spinal cord stimulation (tSCS) on the modulation of cervico-lumbar connectivity. Thirteen neurologically intact adults participated in the study. The excitability of the Hoffmann (H) reflex elicited in the soleus muscle was examined under multiple conditions involving either the arms held in a static position or rhythmic arm cycling while tSCS was applied to either the cervical or lumbar cord. As expected, soleus H-reflex amplitude was significantly suppressed by 19.2% during arm cycling (without tSCS) relative to arms static (without tSCS). Interestingly, tSCS of the cervical cord with arms static significantly suppressed the soleus H-reflex (−22.9%), whereas tSCS over the lumbar cord did not suppress the soleus H-reflex (−3.8%). The combination of arm cycling with cervical or lumbar tSCS did not yield additional suppression of the soleus H-reflex beyond that obtained with arm cycling alone or cervical tSCS alone. The results demonstrate that activation of the cervical spinal cord through both rhythmic arm cycling and tonic tSCS significantly modulates the activity of lumbar networks. This highlights the potential for engaging cervical spinal cord networks through tSCS during rehabilitation interventions to enhance cervico-lumbar connectivity. This connectivity is influential in facilitating improvements in walking function after neurological impairment. NEW & NOTEWORTHY This is the first study to investigate the modulatory effects of transcutaneous spinal cord stimulation (tSCS) on cervico-lumbar connectivity. We report that both rhythmic activation of the cervical spinal cord through arm cycling and tonic activation of the cervical cord through tSCS significantly modulate the activity of lumbar networks. This suggests that engaging cervical spinal cord networks through tSCS during locomotor retraining interventions may not only enhance cervico-lumbar connectivity but also further improve walking capacity.

Intubation Biomechanics: Clinical Implications of Computational Modeling of Intervertebral Motion and Spinal Cord Strain during Tracheal Intubation in an Intact Cervical Spine

2021 ◽  
Author(s):  
Benjamin C. Gadomski ◽  
Bradley J. Hindman ◽  
Mitchell I. Page ◽  
Franklin Dexter ◽  
Christian M. Puttlitz
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Tracheal Intubation ◽  
Cervical Spinal Cord ◽  
Maximum Force ◽  
Cervical Cord ◽  
Injury Threshold ◽  
Force Magnitude ◽  
Cord Injury ◽  
Cervical Motion

Background In a closed claims study, most patients experiencing cervical spinal cord injury had stable cervical spines. This raises two questions. First, in the presence of an intact (stable) cervical spine, are there tracheal intubation conditions in which cervical intervertebral motions exceed physiologically normal maximum values? Second, with an intact spine, are there tracheal intubation conditions in which potentially injurious cervical cord strains can occur? Methods This study utilized a computational model of the cervical spine and cord to predict intervertebral motions (rotation, translation) and cord strains (stretch, compression). Routine (Macintosh) intubation force conditions were defined by a specific application location (mid-C3 vertebral body), magnitude (48.8 N), and direction (70 degrees). A total of 48 intubation conditions were modeled: all combinations of 4 force locations (cephalad and caudad of routine), 4 magnitudes (50 to 200% of routine), and 3 directions (50, 70, and 90 degrees). Modeled maximum intervertebral motions were compared to motions reported in previous clinical studies of the range of voluntary cervical motion. Modeled peak cord strains were compared to potential strain injury thresholds. Results Modeled maximum intervertebral motions occurred with maximum force magnitude (97.6 N) and did not differ from physiologically normal maximum motion values. Peak tensile cord strains (stretch) did not exceed the potential injury threshold (0.14) in any of the 48 force conditions. Peak compressive strains exceeded the potential injury threshold (–0.20) in 3 of 48 conditions, all with maximum force magnitude applied in a nonroutine location. Conclusions With an intact cervical spine, even with application of twice the routine value of force magnitude, intervertebral motions during intubation did not exceed physiologically normal maximum values. However, under nonroutine high-force conditions, compressive strains exceeded potentially injurious values. In patients whose cords have less than normal tolerance to acute strain, compressive strains occurring with routine intubation forces may reach potentially injurious values. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Buspirone Dose-Response on Facilitating Forelimb Functional Recovery in Cervical Spinal Cord Injured Rats

Dose-Response ◽  
2021 ◽  
Vol 19 (1) ◽  
pp. 155932582199813
Author(s):  
Rakib Uddin Ahmed ◽  
V. Reggie Edgerton ◽  
Shuai Li ◽  
Yong-Ping Zheng ◽  
Monzurul Alam
Keyword(s):  
Spinal Cord ◽  
Grip Strength ◽  
Dose Response ◽  
Cervical Spinal Cord ◽  
Dose Dependence ◽  
Dorsal Column ◽  
Cervical Cord ◽  
Sprague Dawley ◽  
Post Injury ◽  
Cord Injury

Buspirone, widely used as a neuropsychiatric drug, has also shown potentials for motor function recovery of injured spinal cord. However, the optimum dosages of such treatment remain unclear. In this study, we investigated the dose-response of Buspirone treatment on reaching and grasping function in cervical cord injured rats. Seventeen adult Sprague-Dawley rats were trained to reach and grasp sugar pellets before a C4 bilateral dorsal column crush injury. After 1 week post-injury, the rats were divided into 3 groups to receive 1 of 3 different dosages of Buspirone (i.p., 1 dose/day: 1.5, n = 5; 2.5, n = 6 and 3.5 mg/kg b.w., n = 6). Forelimb reaching and grip strength test were recorded once per week, within 1 hour of Buspirone administration for 11 weeks post-injury. Different dose groups began to exhibit differences in reaching scores from 4 weeks post-injury. From 4-11 weeks post-injury, the reaching scores were highest in the lowest-dose group rats compared to the other 2 dose groups rats. Average grip strength was also found higher in the lowest-dose rats. Our results demonstrate a significant dose-dependence of Buspirone on the recovery of forelimb motor functions after cervical cord injury with the best performance occurring at the lowest dose tested.

Value of gas myelography in early management of acute cervical spinal cord injuries

1975 ◽  
Vol 42 (3) ◽  
pp. 330-337 ◽  
Author(s):  
Alain B. Rossier ◽  
Jean Berney ◽  
Arthur E. Rosenbaum ◽  
Jurg Hachen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Spinal Cord ◽  
Cord Compression ◽  
Cervical Cord ◽  
Valuable Contribution ◽  
Early Management ◽  
Specific Patient ◽  
Content Type ◽  
Cord Injury

✓ Gas myelography was carried out in 22 patients with acute cervical spinal cord injuries in whom oily contrast media seemed contraindicated. The authors believe this technique makes a valuable contribution to the basic decision regarding the surgical versus medical treatment of a specific patient with a cervical cord injury. They emphasize the importance of visualizing cord compression due to disc herniation in these cases and conclude that gases are the optimal contrast agents for visualization of the entire circumference of the spinal cord.

scholarly journals Integrative treatment of paralytic small intestine following acute cervical cord injury: A case report

2020 ◽  
Vol 11 ◽  
pp. 80
Author(s):  
Yoshitaka Hirano ◽  
Hideya Isai ◽  
Akinori Onuki ◽  
Kazuo Watanabe
Keyword(s):  
Spinal Cord ◽  
Small Intestine ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Posterior Longitudinal Ligament ◽  
Neurological Status ◽  
Sensory Loss ◽  
Cervical Cord ◽  
Cord Injury ◽  
Cervical Cord Injury

Background: A patient developed paralysis of the small intestine following an acute traumatic hyperextension cervical spinal cord injury attributed to the ossification of the posterior longitudinal ligament (OPLL) C3–C6. The persistent ileus finally resolved utilizing Kampo medications (traditional Chinese therapy) consisting of both bukuryoin (TJ-69) and hangekobokuto (TJ-16). Case Description: A 63-year-old male became acutely quadriplegic secondary to a hyperextension injury incurred during a fall. Radiographic studies confirmed mixed OPLL extending from C3–C6 resulting in marked cord compression, there was a clear spinal cord contusion. His neurological status using the American Spinal Injury Association (ASIA) Scale was Grade “A;” there were was complete motor and sensory loss below the C5 level. After a C3–C6 expansive laminoplasty, the ASIA scale improved to Grade B. However, he then developed a persistent small intestine ileus resulting in marked abdominal distention. When conventional therapies failed to resolve the problem, Kampo medicines, consisting of both bukuryoin (TJ-69) and hangekobokuto (TJ-16), were administered. The ileus improved within 2 days and fully resolved within the 1st postoperative week. Conclusion: The utilization of Kampo medications, consisting of both bukuryoin (TJ-69) and hangekobokuto (TJ-16), or the combined bukuryoingohangekobokuto (TJ-116) effectively resolved a postoperative paralytic small bowel ileus following a cervical laminoplasty performed in a quadriplegic patient. Keywords: Acute cervical cord injury, Cervical ossification of the posterior longitudinal ligamentOPLL, Complication management, Integrative medicine, Paralytic small intestine

scholarly journals Mechanism of Restoration of Forelimb Motor Function after Cervical Spinal Cord Hemisection in Rats: Electrophysiological Verification

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Takumi Takeuchi ◽  
Masahito Takahashi ◽  
Kazuhiko Satomi ◽  
Hideaki Ohne ◽  
Atsushi Hasegawa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Electrical Activity ◽  
Motor Function ◽  
Cervical Spinal Cord ◽  
Cervical Cord ◽  
Adult Rats ◽  
Corticospinal Tracts ◽  
Compound Muscle Action Potentials ◽  
Cord Injury ◽  
Recovery Of Motor Function

The objective of this study was to electrophysiologically assess the corticospinal tracts of adult rats and the recovery of motor function of their forelimbs after cervical cord hemisection. Of 39 adult rats used, compound muscle action potentials (CMAPs) of the forelimbs of 15 rats were evaluated, before they received left C5 segmental hemisection of the spinal cord, by stimulating the pyramid of the medulla oblongata on one side using an exciting microelectrode. All 15 rats exhibited contralateral electrical activity, but their CMAPs disappeared after hemisection. The remaining 24 rats received hemisection first, and CMAPs of 12 rats were assessed over time to study their recovery time. All of them exhibited electrical activity of the forelimbs in 4 weeks after surgery. The remaining 12 rats received additional right C2 segmental hemisection, and variation of CMAPs between before and after surgery was examined. The right side of the 12 rats that received the additional hemisection exhibited no electrical activity in response to the stimulation of the pyramids on both sides. These results suggest that changes in path between the resected and healthy sides, activation of the ventral corticospinal tracts, and propriospinal neurons were involved in the recovery of motor function after cervical cord injury.

scholarly journals Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

2021 ◽  
Author(s):  
Michela Colombari ◽  
Claire Troakes ◽  
Stefania Turrina ◽  
Franco Tagliaro ◽  
Domenico De Leo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Head Trauma ◽  
English Language ◽  
Abusive Head Trauma ◽  
Forensic Assessment ◽  
Blood Collection ◽  
Fundamental Interest ◽  
Cord Injury ◽  
Cord Blood Collection ◽  
Cervical Level

AbstractAbusive head trauma (AHT) in children is notoriously one of the most challenging diagnoses for the forensic pathologist. The pathological “triad”, a combination of intracranial subdural haematoma, cerebral oedema with hypoxic-ischaemic changes and retinal haemorrhages, is frequently argued to be insufficient to support a corroborated verdict of abuse. Data from all available English-language scientific literature involving radiological and neuropathological spinal cord examination is reviewed here in order to assess the contribution of spinal cord changes in differentiating abusive from accidental head trauma. In agreement with the statistically proven association between spinal subdural haemorrhage (SDH) and abuse (Choudhary et al. in Radiology 262:216–223, 2012), spinal blood collection proved to be the most indicative finding related to abusive aetiology. The incidence of spinal blood collection is as much as 44–48% when all the spinal cord levels are analysed as opposed to just 0–18% when the assessment is performed at cervical level only, in agreement with the evidence of the most frequent spinal SDH location at thoracolumbar rather than cervical level. In this review, the source of spinal cord blood collection and how the age of the child relates to the position of spinal cord lesions is also discussed. We concluded that the ante mortem MRI examination and post mortem examination of whole-length spinal cord is of fundamental interest for the assessment of abuse in the forensic setting.

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