Brown-Sequard syndrome associated with unusual spinal cord injury by a screwdriver stab wound.
BACKGROUND
Stab wounds resulting in spinal cord injuries are very rare. In direct central back stabbings, the layers of muscles and the spinal column tends to deflect blades, rarely causing injuries to the spinal cord. We report an unusual case of traumatic spinal cord injury by a screwdriver stab, presented as Brown-Séquard syndrome and discuss possible pitfalls on the surgical treatment.


METHODS
A 34 year-old man was brought to the emergency department after a group assault with a single screwdriver stab wound on the back. Neurological examination revealed an incomplete Brown-Sequard syndrome, with grade IV motor deficit on the left leg and contralateral hemihypoalgesia below T9 level. Radiological evaluation showed a retained 9 cm screwdriver that entered and trespassed the spinal canal at T6 level, reaching the posterior mediastinum with close relation to the thoracic aorta. Vascular injury could not be excluded. The joint decision between the neurosurgery and the vascular surgery teams was the surgical removal of the screwdriver under direct visualization. A left mini-thoracotomy was performed. Simultaneously, a careful dissection was done and screwdriver was firmly pulled back on the opposite path of entry under direct visualization of the aorta. The neurological deficit was maintained immediately after the surgical procedure. Follow-up visit after 1 year showed minor motor deficit and good healing.


CONCLUSIONS
It is important to consider all aspects of secondary injury on the surgical planning of penetrating spinal cord injury. The secondary injury can be minimized with multidisciplinary planning of the surgical procedure.
Department of Neurosurgery, University of São Paulo Nedical School Brazil.
André Luiz
AL
Beer-Furlan
Department of Neurosurgery, University of São Paulo Nedical School Brazil.
Wellingson Silva
WS
Paiva
Department of Neurosurgery, University of São Paulo Nedical School Brazil.
Wagner Malagó
WM
Tavares
Department of Neurosurgery, University of São Paulo Nedical School Brazil.
Almir Ferreira
AF
de Andrade
Department of Neurosurgery, University of São Paulo Nedical School Brazil.
Manoel Jacobsen
MJ
Teixeira
Brown-Sequard syndrome; Spinal cord injury; stab; wounds