[A case of quadriplegia with respiratory paralysis surviving as a candidate for rehabilitation].
A case of a 20-year-old woman who survived respiratory quadriplegic state and then became to be a candidate for rehabilitation is reported. The patient was injured in an automobile accident and immediately developed cardiopulmonary arrest, quadriplegia and maximum mydriasis bilaterally. She was transferred to our hospital six minutes after the accident. Immediate and appropriate resuscitation could bring restoration of only cardiac contractions without spontaneous breathing and minimal movement of extremities. Skull and cervical spine x-rays showed anterior atlanto-axial dislocation with a fracture of dens in addition to a linear skull fracture in the right temporoparietal region. Traction by Glisson's method was applied initially three and a half hours after the accident under controlled ventilation with a respirator. Five days after the onset, her consciousness became clear and she displayed an onionskin pattern of anesthesia with sensory preservation around her mouth and nose. Subsequently quadriplegia gradually improved from the lower extremities to the upper, however the proximal muscles of the upper extremities remained to be involved for a long period of time. The authors speculated that such a peculiar pattern of paralysis was due to the injury of the rostral part of the pyramidal decussation and to the acute central cord injury at the C2 level of the spinal cord. Halo-vest immobilization technique was applied and active postural drainage was done as the treatment of the respiratory quadriplegia. She could wean off the respirator four months after the onset and became independent in her active daily living six months after the accident.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D005260:Female; D006801:Humans; D011782:Quadriplegia / Q000150:complications / Q000534:rehabilitation* / Q000628:therapy; D012133:Respiratory Paralysis / Q000209:etiology* / Q000628:therapy