title: Delayed diagnosis of an unsuspected pelvic fracture in a patient with tetraplegia.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  In patients with a complete spinal cord injury (SCI) above T6 level, autonomic dysreflexia (AD) can be the only alerting sign of complications below the level of injury. A case report is presented of a patient with tetraplegia who progressively developed an AD syndrome after falling from a wheelchair. Initially, he was treated for symptomatic urinary tract infection and only later an unstable pelvic fracture was detected.
  
  
  RESULTS
  A patient with chronic tetraplegia fell from his wheelchair while intoxicated. After the fall, he showed no signs of injury. Two days later, AD symptoms appeared while lying on his side or sitting. He presented to his community-based physician and received antibiotics for concomitant urinary tract infection. Because of persisting complaints, the patient was referred to the Spinal Cord Unit. Once the history of falling from the wheelchair was made known, symptoms of AD were suggestive of an internal injury. Radiography showed pelvic fracture and conservative treatment was administered. The fractures healed in 3 months, the therapeutic bed rest regimen was relaxed without trigerring AD symptoms.
  
  
  CONCLUSIONS
  AD symptoms can suggest complications below the SCI level. Awareness and recognition of these symptoms are of utmost importance. However, etiology may be misleading. The role of a community-based general physician is to recognize the right moment when the need of a specialized assessment in a Spinal Cord Unit arises. In addition, patients should also be well informed about the most common possible complications from specialized SCI centers.
authors.forename: Jiri
authors.initials: J
authors.lastname: Kriz
authors.forename: Ross
authors.initials: R
authors.lastname: Andel
authors.forename: Renata
authors.initials: R
authors.lastname: Hakova
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D011782:Quadriplegia / Q000150:complications* / Q000175:diagnosis; D011859:Radiography; D015898:Tomography Scanners, X-Ray Computed
keywords: Autonomic dysreflexia; Osteporosis; Patients with tetraplegia; Pelvic fracture; Spinal cord injury