Asmaa Saeed Alabdullah - Spinal cord injury (Saudi Arabia) Posted on August 3, 2012
Name: Asmaa Saeed Alabdullah 
Sex: Female
Country: Saudi Arabia
Age: 55
Diagnoses: 1.Spinal cord injury (SCI), post thoracic vertebra laminectomy 2. hypertension 3 levels (very high risk), 3. Anemia 4. Urinary tract infection
Admission Date: June 16, 2012
Days Admitted to Hospital: 29
Asmaa underwent a spinal epidural abscess operation 3 months ago. Soon after that, she developed paraplegia as well as difficulty urinating and a loss of sensation below the right T6 segment. The reflexes in both lower limbs were uncontrollable. Despite being given treatment and physical rehabilitation therapy for the lower limbs, Asmaa still was unable to do daily activities.
Admission PE:
Bp: 138/85mmHg; Hr: 61/min. Br: 18/min. Temperature: 36.2 degrees.
The skin and mucosa were normal, with no yellow stains or petechia. The thorax was symmetrical. Through auscultation, the respiratory sounds in both lungs were found to be clear with no signs of dry or moist rales. The heart sounds were strong and the cardiac rhythm was regular. There was no obvious murmur in the valves. The abdomen was smooth. The liver and spleen were not palpable under the ribs. There was a surgical scar on the throat and there was an operation scar in back too.
Nervous System Examination:
Asmaa Saeed Alabdullah was alert and she was in good spirits. The speech was clear and distinct. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and their diameter was 3.0mms. Both eyeballs could move freely and the pupils reacted normally to light stimulus. The forehead wrinkle pattern was symmetrical. The tongue was centered in the oral cavity and the teeth were shown without deflection. The neck had flexible movement. The muscle strength of the upper limbs was level 5-. There was no active movement in the lower limbs. There were muscle contractions when pain stimulation was applied. The muscle tone of both upper limbs was almost normal. The muscle tone of both lower limbs was slightly higher; this was combined with mild spasms. The tendon reflexes of both upper limbs were almost normal. The tendon reflexes of both lower limbs were not elicited. The abdominal reflexes were not elicited. The shallow sensation and deep sensation above the C7 and C8-T6 spinal cord segments were normal. The shallow sensation and deep sensation of the left C7 segment was decreased. The shallow sensation and deep sensation above the T5 segment was normal. There was hyperalgesia between the right T6 and T12 segments. The shallow sensation and deep sensation below the right T6 segment was decreased. The bilateral Hoffmann's sign and Rossolimo's sign was positive. Bilateral palm jaw reflex (-,-), sucking reflex was negative, bilateral Babinski's sign was positive. The meningeal irritation sign was negative. The patient was able to finish the finger-to-nose-test and rapid rotation test in a stable manner. She was unable to finish the heel-knee-shin test.
Treatment:
We initially gave Asmaa Saeed Alabdullah a complete examination and she was diagnosed with a spinal cord injury. Then we proceeded with the nerve nutrition, and improved the blood circulation in order to increase the blood supply to the damaged neurons. She also received treatment for the anemia and medication for the urinary tract infection. This was combined with daily physical rehabilitation training.
Post-treatment:
After treatment, the urinary tract infection had been healed. The anemia is almost corrected. The blood pressure is under control. The hyperalgesia in the right T6-T12 segments has been alleviated. The shallow sensation surface has been reduced to the T1 segment. The shallow sensation in both upper limbs and in the C7 segment is slightly better than before. The movement in both lower limbs has improved. When the knees are bent passively, the patient can maintain this position for a long time. There are muscle contractions in the thigh muscles and the muscle strength reached between level 1 and 2, the right thigh is more obvious. The tendon reflexes of both lower limbs are more sensitive than before. There is internal rotation when the right ankle is moved. The muscle strength of the small of the back has increased obviously. The patient can turn over and sit more easily.