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Thread: Spinal Intra-Dural Hematoma T2

  1. #1

    Spinal Intra-Dural Hematoma T2

    Hi There,

    3 weeks ago my sister suffered a sudden onset of chest pains. The doctor initially thought of it as heart attack and thought nothinig about the leg numbness. However, 4 hours later, they realized it was spinal cord related and operated on her 8 hours after onset of symptoms.

    Blood clot was found and decompression was done at T2-T4. Doctors couldn't find the cause and has ruled out AVM after CT scans.

    She is paraplegic from T2.

    About a week after surgery, she was able to move her right toe and have some sensation on her left leg. She thinks she can control some bowel movements although accidents still happen. She feels she has a full bladder but unable to pass them by herself.

    Two weeks after surgery she is in rehabilitation. And yesterday, with much effort, she succeeded to raise her right leg briefly. She can also move her right toes and left ankle now.

    Based on the above, can anyone tell me what we can expect in terms of recovery level? I do understand that the prognosis depends on the sensory and motor movements after surgery, and if they are incomplete or complete. Before surgery the doctor classifies her as ASIA A, but i'm not sure if the signs so far move her into B? I do understand that each injury is different, but I do hope for some success stories where we may relate to.

    Thank you all.

  2. #2
    The fact that she is getting early and continuing return is an excellent sign that some return will continue for some time...at least 2 years, but how much she get back it is impossible to predict at this time. It is common that primarily vascular injuries of the cord have more potential for return than more common traumatic injuries.

    I hope she is at an excellent SCI specialty rehabilitation center, and that she has good insurance that will allow her to not only have sufficient inpatient rehab time, but a comprehensive and ongoing outpatient therapy program that will allow her to maximize any return that she gets. Can you share where she is now?

    Does she have any anal sensation? This would probably move her into the B category, and if she is getting motor return below her level as well then she may actually be a C.

    Can you get her on our forums here?

    (KLD)

  3. #3
    Thank you very much for your prompt reply.

    We are from SIngapore and yes, the rehabilitation center she is at is supposed to be specialised in SCI. She has just started and learning more practical things like learning to get up, shift and eventually learn transfers.

    Are there other therapy she should be undergoing to try and maximize the return on areas below her injury given that she has shown some early return? We are doing calf and hamstring stretching for her every 2 hourly.

    I will ask her if she has anal sensation, i do know she seems to think she can pass bowels voluntarily. But as I mentioned, there had been still accidents, meaning she doesn't know she had passed.

    Thankfully we do have insurance that should take care of this rehabilitation.

  4. #4
    Hi, I confirmed that she has anal sensation...

  5. #5
    No, right now there is nothing we can do to increase the rate of return, including doing all that stretching (let her rest between therapy sessions!!). Stretching twice daily should be completely sufficient to maintain ROM, and stretching alone does not increase strength.

    Electrical stimulation may help to strengthen muscles that are starting to come back to get them strong enough to start doing resistance type exercises (weights and pulleys). Talk to her physiatrist and PT about this.

    Ask her physician to repeat her ASIA exam. Sounds like she is at least a B.

    (KLD)

  6. #6
    Thanks KLD.

    Will ask her PT about Electrical Stimulation. Is this FES that I've read in some places?

  7. #7
    FES is similar, but not the same thing. FES stands for Functional Electrical Stimulation, so is technically the use of electrical muscle stimulation for functional activities (such as riding a stationary bike, walking, ADLs, etc.). A simplier machine can be used for direct stimulation of muscles to exercise them and build strength. Most therapists should already have access to this type of electrical stimulation among their bag of tricks called "modalities".

    (KLD)

  8. #8

    Electrical Stimulation

    Hi KLD,

    We asked the therapist and they started her on a first session of stimulation. SHe managed to move her left leg too voluntarily as a result, although it is still grade 1 i think.

    Also, the doctor has graded her ASIA C now.

    Her therapists has been pretty encouraging and we are quite happy with them.

    Thanks for your advice, if something else comes to mind, please let us know. THanks.

    Edw

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