Delayed presentation of spinal cord injury without radiographic abnormality (SCIWORA): a case report

Spinal Cord Injury without Radiographic Abnormality (SCIWORA) is an unprecedented event to occur in adults but may lead to serious complications including permanent neurological impairments and death. In this article, we report a case of a 60-year-old male presenting to the emergency for a head and neck trauma after a motorbike accident, who reported only a neck ache and a normal primary neurological exam. The evolution was marked by the occurrence of paraplegia with a diminished sphincter tone and hypoesthesia beneath the T12 dermatome level after six hours, confirmed by the Magnetic Resonance Imaging (MRI). He underwent a deferred laminectomy within 30 days after receiving methylprednisolone, with partial neurological improvement after two months. An early recognition of the diagnosis was challenge for the emergency physician, given the wide variability of clinical presentations. Magnetic resonance imaging (MRI) is a key examination to guide the diagnosis and the management of these patients.