Stroke evaluation in patients with high cervical spinal cord injuries

Case Diagnosis: Stroke evaluation

Case Description or Program Description: An 80-year-old male with a past medical history of spinal cord injury C2 ASIA A became unresponsive to voice and tactile stimuli during a routine dressing change. A code blue was activated, initial vitals were stable and blood glucose was 180. MICU then called a code stroke due to continued unresponsiveness. Due to the patient’s prior SCI a comprehensive NIHSS assessment was not able to be completed. The purpose of this case is to discuss the approach to stroke evaluation in patients with existing high cervical spinal cord injuries.

Setting: VA hospital

Assessment/Results: The patient did not exhibit response to noxious stimuli including pinching of his pinna and administration of normal saline into the auditory canal. A non-contrast CT head did not demonstrate evidence of acute intracranial abnormalities and a CTA head and neck demonstrated patent large vessels without evidence of obstruction or severe stenosis. The patient was noted to spontaneously regain consciousness 10 minutes after symptoms started.

Discussion (relevance): High cervical SCI can limit standard approaches to stroke evaluation and compensatory testing must be performed for thorough evaluation.

Conclusions: For this patient with a C2 ASIA A the standard NIHSS evaluation was not able to be appropriately completed and required additional testing to evaluate for CVA and lesion localization.