SCIWORA (Spinal Cord Injury Without Abnormalities) Syndrome. Case report

Abstract

Introduction: SCIWORA syndrome (Spinal Cord Injury Without Abnormalities) is a myelopathy that manifests after rachimedullary traumas, without showing bone damage, spinal instability or any other type of evident affectation in conventional radiological images such as plain radiography and computed tomography. This syndrome is more prevalent in the pediatric population, however, cases have been described in adulthood, with a significant impact on quality of life. Clinically it is characterized by neurological deficits such as transient paresthesia, numbness or paralysis, associated with spinal cord involvement, demonstrable only with magnetic resonance imaging. Materials and methodology: We present the case of a 65-year-old male patient who suffered a fall from his own height, resulting in flaccid paraplegia and loss of sensibility in
lower limbs. With suspicion of SCIWORA syndrome, as there were no findings in the tomographic study; with subsequent determination of spinal cord changes in magnetic resonance imaging of the dorsal and lumbar spine. A review of the literature was carried out to contextualize the case and to understand SCIWORA syndrome in depth. Results: The patient presented flaccid paraplegia in lower limbs, urinary and fecal incontinence, following a fall from his own height with impact on the dorsal lumbar region. The clinical diagnosis was based on the loss of sensibility and complete mobility observed in the neurological examination. In the complementary studies performed, the tomographic images did not show structural lesions, but the MRI showed findings compatible with osteodegenerative changes related to osteoarthritis, in STIR sequence (with fat suppression), hyperintensity within the spinal cord from T9 to L1, without enhancement with contrast
medium, suggesting contusion. The patient was classified with a diagnosis of SCIWORA Syndrome, clinical management based on corticosteroids as anti-inflammatory and physical therapy, which led to a significant improvement in mobility and sensitivity of the patient. Conclusions: SCIWORA syndrome is a relevant diagnosis in patients with spinal cord trauma and neurological symptoms. Early recognition and appropriate treatment are crucial for long-term prognosis, in favor of maintaining the best possible quality of life. Although it is considered a diagnosis of exclusion in low and high energy trauma, its possible long term complications underline the importance of an optimal management from its recognition.