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Wed Jan 16 03:00:14 GMT 2008

Is there any possibility that this was one of those freak occurrences 
where there is a haematogenous transfer of an underlying infection 
(whether viral or bacterial) to newly damaged tissue with concurrent 
trauma? I have heard of this with osteomyelitis but have never heard of 
this with nerve tissue. However it may explain why there was sensory and 
motor loss which resolved once the inflammatory process decreased.
Just a thought
Chris

Mike Smertka wrote:
> No i didn't call the discovery channel, I was just trying to make sense out of my little part while filling out discharge papers with what little info I was given. I couldn't remember the name guillian barre :( so thanks for reminding me.
>    
>   Thanks all
>    
>   Mike
>
> "Moore, Rick" <Rick.Moore at TriadHospitals.com> wrote:
>   Yes both would likely shed protein into the CSF. Transverse Myelitis
> fits due to the pain, but normally does not completely resolve. Guillian
> Barre normally doesn't cause pain or numbness but will completely
> resolve. Sounds like a good episode of Medical Incredible or Medical
> Detectives.
> Rick 
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
> Sent: Tuesday, January 15, 2008 2:25 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: a likely occurence?
>
> Well, we agree on the "doubt trauma" part. I think any other guesses
> would be conditional or atypical, hence my decision to take a stab at it
> myself. 
>
> Still, I would imagine that GBS -- or any flavor of myelitis -- would
> have probably shed protein into the CSF. Wouldn't it?
>
> Pret
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Moore, Rick
> Sent: Tuesday, January 15, 2008 2:01 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: a likely occurence?
>
>
> I discussed this with one of our ED physicians and his response is
> "Transverse Myelitis vs. Guillian Barre, doubt trauma".
> Rick Moore, RN
> College Station(Tx)Medical Center 
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
> Sent: Tuesday, January 15, 2008 11:49 AM
> To: Trauma & Critical Care mailing list
> Subject: RE: a likely occurence?
>
> Disclaimer: Pret Bjorn is a nurse. And bolder than he is bright.
>
> Were all of her shots up to date?
>
> This is a soft mechanism and an odd story for trauma. I'd think central
> cord is a reach, especially if nothing lights up on her MRI.
>
> The medical differential (inasmuch as I pretend to understand it) isn't
> much more helpful. Gets into stuff like Guillian-Barre and polio -- and
> there again, this story is wanting for a good fit. 
>
> Might have to settle for a good outcome in the absence of good answers.
> Have you called the Discovery Channel?
>
> Pret Bjorn
> Bangor, ME USA
>
>
>
>
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Mike Smertka
> Sent: Tuesday, January 15, 2008 12:26 PM
> To: Trauma &, Critical Care mailing list
> Subject: a likely occurence?
>
>
>
> Hey everyone, 
>
> Today I was fortunate enough to be presented with a clinical issue
> rather than an academic one. But I have not seen anything like it before
> so I figure I would put it up for discussion. (before anyone asks, yes,
> I have heard of central cord syndrome, and I realize this sounds similar
> at a different location, that is why I am asking) 
>
> 11 y/o female, pushed down at school, fell on full backpack. (weight
> unknown, estimate ~10 lbs) but was also ill at the time with flu like
> symptoms. 
>
> Over a course of 7 days (at home and school), developed pain in lower
> legs, which advanced into lower sacral area, followed by complete loss
> of motor/sensation in lower extremities. was taken to an outlying
> facilty by parents. after failed attempts at LP was given antibiotics,
> antivirals, and transferred to facility here. (regional childrens
> center) after 2 days the LP was finally done and nothing abnormal was
> found. MRI showed soft tissue swelling, in the lumbar/sacral region. (I
> have no way to digitally scan the film or I would put it here) after
> another 11 days in hospital, function and sensory returned to lower
> extremities. Patient was discharged and complained of fatigue and muscle
> weakness but didn't want to stay any longer. Left hospital under her own
> power. (with parents of course) 
>
> But my question is such:
>
> It sounds to me like this patient had some imparement because of soft
> tissue swelling pressing on the nervous or venous tissues. I was told
> the greatest fear was a viral infection that would recur and usually
> leaves permanant damage each time it does. (based on the flu-like
> symptoms and absence of brusing.) 
>
> Ultimately neither was ruled in or out. has anyone seen either of
> these possibilities before? If so, how common is it? Is your first
> thought trauma or medical? Obviously there is the possibility of both,
> but having never seen it take 2 days to get an LP, I am of the mind it
> was most likely trauma related. here long hospital stays are not
> uncommon, but to see a patient walk out with only symptoms of fatigue,
> and localized weakness, seems very remarkable if it were a virus that
> causes permanant damage. The patient was referred to physical therapy,
> but it is doubtful she will go because of financial constraints and will
> probably be returning to her family physician for follow up. (a
> considerable distance away)
>
> Would appreciate your thoughts on the matter. 
>
> Mike
>
>
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-- 

Chris Wilson

Lecturer in Nursing

Flinders University

82013354

0414253393

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