title: [Tetraplegia in the course of coma from drug intoxication].
abstract: It is reported a case of quadriplegia occurring in a 67-year-old women after she commits suicide with flunitrazepam. The patient stayed during around twenty hours unconscious, in the sitting position, with an extreme flexion of the neck on the left side. After injection of flumazenil the patient's consciousness was restored. Nevertheless a complete sensitive and motor deficit at the C4 and C5 level was then observed. Several diagnosis such as peripheral neuropathy, infectious disease, or arterial occlusion were eliminated and we finally postulated that the regulation of the spinal blood flow had likely been disturbed by the prolonged flexion of the neck, the hypotension and the putative respiratory depression. The fact that the patient suffered from cervicarthrosis would have already impaired the spinal blood flow regulation and consequently had probably damaged the spinal cord. No clinical improvement of the quadriplegia was noticed and the patient died in the intensive care unit thirteen days after admission. Such an exceptional complication after a toxic coma remind us the necessity to avoid long lasting vicious position of the cervical spine in anaesthesia and emergency practice.
authors.affiliation: Département d'anesthésie-réanimation, CHU Jean Verdier, 93143 Bondy, France.
authors.forename: F
authors.initials: F
authors.lastname: Morazin
authors.forename: R
authors.initials: R
authors.lastname: Gauzit
authors.forename: S
authors.initials: S
authors.lastname: Pham-Tourreau
authors.forename: A
authors.initials: A
authors.lastname: Teboul
authors.forename: J L
authors.initials: JL
authors.lastname: Pourriat
mesh_terms: D000368:Aged; D014151:Anti-Anxiety Agents / Q000506:poisoning*; D000931:Antidotes / Q000627:therapeutic use; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use; D005445:Flunitrazepam / Q000506:poisoning*; D006801:Humans; D008279:Magnetic Resonance Imaging; D011782:Quadriplegia / Q000139:chemically induced* / Q000473:pathology; D012039:Regional Blood Flow / Q000502:physiology; D013116:Spinal Cord / Q000098:blood supply; D013405:Suicide
chemical_list: D014151:Anti-Anxiety Agents; D000931:Antidotes; D005442:Flumazenil; D005445:Flunitrazepam