Delayed presentation of spinal cord injury without radiographic abnormality (SCIWORA): a case report.

Spinal Cord Injury without Radiographic Abnormality (SCIWORA) is an unprecedented event to occur in adults but may lead to serious complications including permanent neurological impairments and death. In this article, we report a case of a 60-year-old male presenting to the emergency for a head and neck trauma after a motorbike accident, who reported only a neck ache and a normal primary neurological exam. The evolution was marked by the occurrence of paraplegia with a diminished sphincter tone and hypoesthesia beneath the T12 dermatome level after six hours, confirmed by the Magnetic Resonance Imaging (MRI). He underwent a deferred laminectomy within 30 days after receiving methylprednisolone, with partial neurological improvement after two months. An early recognition of the diagnosis was challenge for the emergency physician, given the wide variability of clinical presentations. Magnetic resonance imaging (MRI) is a key examination to guide the diagnosis and the management of these patients.

Drug related adverse events due to cardiotropic agents : Epidemiology and prognosis in the emergency department.

INTRODUCTION: The severity of cardiotropic agents overuse is related to the risk of cardiac and hemodynamic life-threatening situations. Toxicity is attributed to their narrow therapeutic spectrum and pharmacodynamic properties. The clinical presentation, however, remains polymorphic and represents a challenge for the emergency physician to relate accountability to the exact agent. AIM: To evaluate epidemiological, clinical and prognostic profile of patients visiting emergency department in whom iatrogeny secondary to cardiotropic use was diagnosed. METHODS: This was a single-center prospective study over 12 months. We included successively all patients aged over 18 years in whom diagnosis of cardiotropic iatrogeny was made. Cardiotropic related drug-induced events were selected after collegial decision making processing. Prognosis was evaluated in terms of severity and mortality at day 30. Univariate analysis was conducted. P<0.05 was significant. RESULTS: We enrolled 51 patients. Median age was 72 years with IQR (25,75) of (62,78). Sex ratio was 0.64. Twenty cases of misuse were identified (39%) with 51% of cases being related to the physician. Accountability of the adverse drug event (ADE) was 51%. The ADE was considered severe in 45% of cases and the death rate on day 30 was 12%. Drug classes were dominated by beta-blockers in 20 patients (39%) and anti-arrhythmic agents (Amiodarone ®) in 18 patients (35%). Beta-blockers were significantly the most incriminated in the occurrence of severe ADE. A double iatrogeny was found in 13 patients (25%). Misuse and physician-related ADE were found to be predictive of the severity of ADE in univariate analysis with respectively: For misuse:(OR brut=22, CI95%=[5.2;93.5] ; p<0.001) and for related physician ADE (OR brut = 3,7 ; CI95%=[1.1;12] ; P= 0.015). Predictive factors of mortality at day 30 in the univariate analysis were: Past renal failure : OR brut 5,8; CI95%[1,3-26,5]; p=0,015 ; misuse with OR brut=16.7, 95% CI=[1.9-143.5], p=0.002 and severe ADE with OR brut=15, 95% CI=[1.75-129], p=0.032. CONCLUSION: This study showed that ADE related to Cardiotropic agents are frequent and remain a serious condition especially in elderly. Betablockers agents were the mostly incriminated therapeutic class in the severity of the clinical condition by its hemodynamic repercussions responsible of a high rate of hospitalizations and mortality. Misuse and physician-related ADE were found to be predictive of the severity. Whereas, occurrence of severe ADE, misuse and past renal failure were predictive of mortality. Moreover, in 51% patients, ADE was preventable and related to the prescription of physician showing the main role of the preventability and the role of the prescriber in the genesis of this severe condition.