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Wed Jan 16 13:12:46 GMT 2008

Ah!  I KNEW somebody would find a trauma teaching point in all this...

Very important insight, Dr. Coats.  Thanks.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Coats Tim -
Professor of Emergency Medicine
Sent: Wednesday, January 16, 2008 3:12 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: a likely occurence?

Children with medical problems affecting limbs often give a history of
trauma - because children are falling around every day so there is
almost always an episode of minor trauma shortly before the symptoms
started.

A classic example is of septic arthritis of hip presenting with a
history of trauma. The sequence of events is: 1) Child complains of a
painful knee - due to the hip infection. 2) Parent asks 'Have you bumped
it?'. 3) Child says they fell over playing football. 4) Doctor is told
'My child fell over playing football and his knee hurts'. 5) Doctor
assumes that this is an injury takes an Xray of the knee and misses the
diagnosis.

My guess is that the history of a fall in the case that you present is
completely un-connected with the symptoms.

Tim. Coats.
Professor of Emergency Medicine.
Leicester, UK

-----Original Message-----
From: Mike Smertka [mailto:medic0947969 at yahoo.com] 
Sent: 16 January 2008 01:36
To: Trauma &amp, Critical Care mailing list
Subject: RE: a likely occurence?

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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a likely occurence?