Spinal cord injury without radiographic abnormality (SCIWORA) - Spinal injuries in the absence of identifiable bony or ligamentous injury on complete, technically adequate plain radiographs or computed tomography
- Typically located in the cervical region
- Most children with SCIWORA do have demonstrable injury of the spinal cord, spinal ligaments, or vertebral body end plate on magnetic resonance imaging (MRI)
- Suspect if history of blunt trauma with early (immediate) or transient symptoms of neurologic deficit or who have existing findings upon initial assessment
- Treatment and prognosis are based upon neurologic presentation and MRI findings
Testicular torsion - Tricksy
- May cause intermittent pain due to transient torsion
- Suspect in all patients with non-specific abdo pain
- c.f. Referred pain pathways
- Check testes!
- Check hernial orifices
#NOF - Classically shortened and externally rotated
- But ONLY if displaced - Most actually are not
Renal colic - Most effective analgesic is PR diclofenac
- Better even than morphine
Lhermitte's sign- Electrical sensation that runs down the back and into the limbs
- May be elicited by bending the head forward
- Suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla
- MS
- Transverse myelitis
- Behçet's disease
- Trauma
- Radiation myelopathy
- Vitamin B12 deficiency (subacute combined degeneration), incl. N2O abuse
- Compression of the spinal cord in the neck from any cause: cervical spondylosis, disc herniation, tumor, Arnold-Chiari malformation
Resuscitation guidelines
Notes - GCS must be 15 to clinically clear C-spine
- Neurological injury can => ischaemic ECG changes
- CN VI is the first to go with raised ICP
- WCC can rise in head trauma, MI
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