title: Spinal cord injury in a 14-year-old male secondary to cervical hyperflexion with exercise.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To present an interesting case of a 14-year-old male with acute paresis of upper extremities and progressive difficulty with lower extremities. The patient is a competitive wrestler and was performing his daily abdominal workout 'sit-ups' with hands interlocked behind his head. During the end and immediately following his abdominal workout, he felt progressive weakness in his upper extremities. He was rushed to the hospital within an hour and seen in the emergency room and admitted to the neurology service for a presumed thromboembolic event.
  
  
  METHODS
  New York, USA.
  
  
  RESULTS
  The patient was negative for any hematologic disease or coagulopathy. Magnetic resonance imaging was negative for any mass effect on the spinal cord and neurological examination revealed bilateral upper extremity paraparesis 3/5 and lower extremity spasticity and propioceptive dysfunction. The patient was treated with corticosteroids and rigid collar, follow-up examination at 3 months revealed resolution of symptoms.
  
  
  CONCLUSIONS
  The pathophysiology of central cord syndrome is thought to be primarily secondary to a hyperextension injury, which causes buckling of the ligamentum flavum and increasing spinal cord diameter which leads to cord compression. This syndrome is more commonly seen in the spondylotic elderly. This case involves a teenager with normal canal diameter; however, combining aggressive exercise with extreme cervical hyperflexion, one can plausibly account for an acute ischemic event or repetitive microinjury to the spinal cord.
authors.affiliation: North Texas Neurosurgical Associates and Denton Regional Medical Center, Denton, TX 75093, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Dickerman
authors.forename: M A
authors.initials: MA
authors.lastname: Mittler
authors.forename: C
authors.initials: C
authors.lastname: Warshaw
authors.forename: J A
authors.initials: JA
authors.lastname: Epstein
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications*; D002574:Cervical Vertebrae / Q000473:pathology; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013119:Spinal Cord Injuries / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods