title: Unusual foreign body causing quadriparesis: case report.
abstract: OBJECTIVE
  An unusual foreign body traversing the spinal canal at the foramen magnum level is described. Interesting radiological findings and a review of nonmissile penetrating injuries are presented. This case demonstrates the importance of a thorough physical examination and the use of neurodiagnostic imaging in an inebriated, uncooperative patient with neurological dysfunction.
  
  
  METHODS
  The patient presented with quadriparesis confounded by cocaine intoxication. A physical examination revealed only a small punctate lesion in the posterior occipital region.
  
  
  METHODS
  After detection of the foreign body, the patient underwent immediate surgical exploration and removal of the object. The dura was repaired primarily, and the patient was maintained on intravenous antibiotics for 7 days.
  
  
  CONCLUSIONS
  With physical therapy, the patient was walking with assistance at 2 weeks postsurgery. Upper extremity strength, especially intrinsic hand movement, was most severely affected. At 10 months' follow-up, the patient's only deficits were mild intrinsic hand weakness and incoordination with fine finger movements. Immediate surgical exploration is indicated for patients with retained fragments and progressive neurological dysfunction.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Tomaras
authors.forename: R W
authors.initials: RW
authors.lastname: Grundmeyer
authors.forename: T S
authors.initials: TS
authors.lastname: Chow
authors.forename: T W
authors.initials: TW
authors.lastname: Trask
mesh_terms: D000328:Adult; D005260:Female; D005547:Foreign Bodies / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005898:Glass; D006801:Humans; D008279:Magnetic Resonance Imaging; D009460:Neurologic Examination; D009809:Odontoid Process / Q000293:injuries / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D011782:Quadriplegia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013124:Spinal Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000150:complications* / Q000175:diagnosis / Q000601:surgery