Stingray spear injury to the pediatric spinal cord: case report and review of the literature
- PDF / 493,410 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 87 Downloads / 160 Views
CASE REPORT
Stingray spear injury to the pediatric spinal cord: case report and review of the literature A. Caceres 1
&
N. A. Schlobin 2,3 & S. Lam 2,3 & J. Zamora 1 & J. L. Segura 1
Received: 13 March 2020 / Accepted: 16 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Stingray injuries are rare, mostly causing injuries to the lower extremities but occasionally fatal if there is direct puncture of the thorax, abdomen, or neck. Direct combined stingray injury to the central nervous system has not been reported in the literature. Herein we present the case of a 12-year-old boy who, while wading at the seashore of the Costa Rica’s Pacific Ocean, sustained a combined oblique penetrating injury to the C6 vertebra caused by a Stingray. He initially presented to the hospital with a complete asymmetric right C6/left T1 ASIA A examination, priapism, and loss of anal sphincter tone. Imaging revealed fracture of the posterior elements of C6 with an oblique trajectory into the left radicular foramen. T2W images did not reveal anatomical section but rather edema and minor bleeding in the epidural space. The patient underwent medical management and serial imaging. During the next 3 months, there was recovery of sensation on the right hemi body, bilateral paresthesias and asymmetric progressive improvement in strength on both legs. Acute care management and midterm term follow up are provided, along with a review of the literature for salient management considerations when evaluating and treating combined penetrating and envenomation injuries caused by stingrays. To our knowledge, this is the first report of such injury to the spine. Keywords Stingray . Spear injury . Pediatric . Child . Spinal cord . Case report
Introduction About 150 ray species exist worldwide, mostly living in shallow waters along the coasts of tropical or subtropical areas [1]. Stingrays are the most common group of fish involved in venomous injury to humans. However, stingray injuries to humans are rare, with ranging from around 750 to 2000 in the USA and thousands in tropical regions, mostly in coastal and island communities [2, 3]. The indigenous stingrays found in the Central American shorelines are composed of the Dasyatis longa (75.7%), Aetobatus narinari (12.6%), and Rhinoptera steindachneri
* A. Caceres [email protected] 1
Servicio de Neurocirugía, Hospital Nacional de Niños, “Dr. Carlos Sáenz Herrera”, San José, Costa Rica
2
Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
3
Division of Pediatric Neurosurgery, Lurie Children’s Hospital, Chicago, IL, USA
(5.4%) species [4]. While the former is attributed to most of the sting accidents with envenomation, Aetobatus narinari is related to trauma given its massive size and the latter is considered harmless [3–7]. Most stingray injuries occur to the lower extremity in waders or the arm in fishermen [8–13]. However, they are occasionally fatal, such as in direct puncture occurs to the thorax causing immediate
Data Loading...
