Presentation of Traumatic Paralysis?

[AnthonyM83]

How many have encountered paralysis in the field? What kind of MOI's were they from? Was it immediately obvious? Was there any question about where they were in too much pain/anxiety/cold to follow commands or whether they actually couldn't move extremities? What kinds of injuries did the patient have? How did they present?

Just trying to draw on others' experiences, so if I come upon the situation I have something to reference/cross-check it, some context and index of suspicion.

[canadian_ghost]

I had one patient that was kicked in her head during a soccer tournament. On arrival patient could not move fingers. After some time in the hospital the paralysis did go away. I think it was spinal shock. Um yes it was immediately obvious because she was telling us she couldn't feel them. When we asked her to move them she said she was but nothing was going on. Fair amount of pain in the head and she was fairly anxious.

There was no visible injuries except for the lump on her head.

x-rays showed nothing wrong with the neck so I suspect it to be spinal shock? Am I wrong, was it something else?

[firedoc5]

Some may have paralysis come and go, especially if the receiving hosp. is somewhat far away. Repeat assessment and document any change one way or the other frequently.

[Dustdevil]

There was no visible injuries except for the lump on her head.

x-rays showed nothing wrong with the neck so I suspect it to be spinal shock? Am I wrong, was it something else?

No, you got it. Happens a lot in football, it seems, even at the high school level. I've also encountered it two or three times in MVA victims. It's damn scary when you find that rare patient with a motor-sensory deficit. You suddenly get very, very conscious of your handling of the patient.

In my experience, it is almost always immediately obvious on scene. Seems like about half the time, they lose consciousness from the incident (concussion), and then awake unable to move their legs. Last one I had was a 30ish female in a rollover MVA. There really wasn't that much damage, but she was unrestrained and presented conscious and alert, laying on the ceiling of the upside down sedan. There were no obvious injuries, but she had no sensation or motor abilities in her legs. She was hypertensive (which surprises a lot of people because of the "shock" name), but surprisingly calm. I saw her a week later at the store, walking around as if nothing had ever happened.

[p3medic]

Motorcycle accidents and shootings have produced the most cord injuries that I have seen, all with deficits at presentation.

[ohemt648]

My experience was similar to that of Dustdevils. 40 something male unrestrained in rollover. Bystander stated he was unconscious for about 4-5 mins prior to my arrival. Presented to me alert to person but not events. Vehicle was on its top with minimal damage, pt on ceiling face down, one leg wrapped around steering column other leg on top of dash. Only visible injuries were minors lacs. to head and left forearm. Pt stated he could not feel his legs and he was unable to identify my touch anywhere on his lower extremities. After extrication priapism was also noted.

After following up the next day we were told he had "damage" to L-4 L-5.

Hope that helps,

648

[Dustdevil]

The interesting thing is, most actual spinal fractures I have seen did not have paralysis.

And most paralysis I have seen did not have a spinal fracture.

[zzyzx]

About 9 months ago we had this teenager who knocked down a tree and two lightposts at 4 in the morning. The damage to his truck was huge, and he was lucky to have not been killed outright. We were first on, and he was slightly confused (4/6/4) but following commands. His only complaint was that he was having trouble breathing. He was anxious and moving around quite a bit (moving his arms and upper body), and we told him to relax.

During the extrication, another medic happened to notice that he had a major deformity to his spine. When we got him out, we told him to wiggle his toes but he could not.

He was only 19 but will be paralyzed for the rest of his life. No other injuries. I was suprised that he never once complained about not being able to move his legs.