Hemiplegia Cruciata caused by a Stab Wound of the Spinal Cord

Abstract

A 56-year-old female sustained a neck laceration by a piece of glass, which broke when she fell backward. She immediately became quadriplegic and was transported to a local hospital, then deteriorated and was referred to the authors' hospital. Neurological examination revealed quadriplegia that was particularly pronounced in the right arm and left leg. Pain sensation was decreased in the right upper and lower extremities below the C3 level. Cervical spine films showed glass fragments in the gap between the occipital bone and the C1 arch. Computed tomography dramatically demonstrated glass fragments that had become fixed in the spinal cord at the spinomedullary transition. A suboccipital craniectomy and C1 laminectomy allowed visualization of the dural laceration. Opening of the dura exposed a glass fragment penetrating the upper cervical spine just caudal to the left tonsil. It was successfully removed with a hemostat clamp. Postoperatively, the patient was soon able to walk without assistance. To the authors' knowledge, upper cervical spinal cord injury caused by glass has previously been reported only twice, although broken glass is a common cause of wounds. Also, this patient exhibited signs of "hemiplegia cruciata," which is thought to be due to damage to the pyramidal decussation.