What question did this study set out to answer?

To highlight the challenges and implications of diagnosing spinal cord injury without radiographic evidence in ICU patients.

June 9, 2026Cureus0 citationsOpen Access

Cervical Spinal Cord Injury Without Radiographic Evidence of Trauma (SCIWORET) in an Adult: A Rare Diagnosis in the Intensive Care Unit

JVJoana Vaz NCNuno CatorzeTenaris (United States)JNJ. NunesUniversidade Presbiteriana Mackenzie

Key Points

To highlight the challenges and implications of diagnosing spinal cord injury without radiographic evidence in ICU patients.
Case report of a 67-year-old man with cardiac arrest and spastic tetraparesis in the ICU.
Utilized CT and MRI imaging to assess spinal condition and injury.
Emphasized early MRI use for diagnosis and intervention.
CT scan showed no acute trauma, but MRI revealed hyperintense T2-signal indicating spinal cord infarction.
Achieved near-total functional recovery after intensive rehabilitation post-diagnosis.
Demonstrated importance of recognizing 'neurological mismatch' in post-arrest patients.

Abstract

Spinal cord injury without evidence of trauma (SCIWORET) is an uncommon clinical entity in adults, typically associated with pre-existing degenerative spinal conditions, as well as vascular susceptibility. Its diagnosis in the intensive care unit (ICU) is challenging due to the confounding effects of sedation and post-arrest encephalopathy. A 67-year-old man suffered a cardiac arrest triggered by severe hyponatremia (Na+ 115 mmol/L ) during colonoscopy preparation. After resuscitation, he exhibited spastic tetraparesis. While CT was negative for acute trauma, MRI revealed a hyperintense T2-signal from the bulbomedullary junction to C3, with a characteristic "H-sign" in the anterior horns, confirming spinal cord infarction or transverse myelitis of undetermined etiology, favoring the diagnosis of SCIWORET. Following intensive rehabilitation, the patient achieved near-total functional recovery. SCIWORET should be suspected in post-arrest patients with "neurological mismatch." Early MRI is essential to differentiate focal spinal ischemia from global hypoxic brain injury, facilitating early multidisciplinary rehabilitation.

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