Lesión medular por violencia de género / Spinal cord injury due to gender violence

Objetivo. Analizar las características fundamentales de la lesión medular en una serie de mujeres de edad superior a 18 años en situación de violencia de género. Material y métodos. Período de estudio: 1992-2004. Variables: edad, nivel de lesión, clasificación ASIA, mecanismo lesional, nacionalidad, nivel cultural y aspectos legales. Resultados. Número de mujeres totales: 689 y 7 lo fueron como consecuencia de violencia de género. Edad media: 32 años (rango: 23-40). Nivel lesional: cervical (4), dorsal (2), lumbar (1). Clasificación ASIA: completa (6), incompleta (1). Causas: agresión por arma blanca (3), precipitación (3), accidente de tráfico intencionado por parte del agresor (1). Dos mujeres estaban embarazadas en el momento de la agresión. Nacionalidad: española (3) y extranjera (4). Pico de incidencia máximo (año 2002) con 4 casos. En todos los casos el nivel cultural era bajo. Se apreciaba gran reticencia para reconocer el problema de violencia de género como causa de la agresión. Conclusiones. La incidencia de la agresión en el contexto de violencia género como causa de la lesión medular en nuestra población femenina adulta fue del 1 %. Esta causa se reconoce de forma más explícita, y por lo tanto con mayor frecuencia, en los años recientes. Consideramos que nuestra serie muestra indicios de que es probable que un porcentaje (de cuantía desconocida) de situaciones como caídas casuales o precipitaciones, puedan en realidad traducir un trasfondo de violencia de género. Creemos que el abordaje de estos casos implica a un equipo multidisciplinar, ya que en su génesis intervienen factores socioculturales y psicológicos

Objective. The authors review the main clinical and social features of a series of women aged above 18 years who suffered spinal cord injury in setting of gender violence. Material and methods. Study period: 1992-2004. Variables: age, lesion level, ASIA classification, injury mechanism, sociocultural level, legal aspects. Results. The total number of women admitted to our hospital was 689, 7 of whom had been injured as a result of domestic violence. Mean age: 32 years (range: 23-40). Level of spinal cord injury: cervical (4), dorsal (2), lumbar (1). ASIA classification: complete (6), incomplete (1). The direct causes were: aggression by knife (3), precipitation (3), and provoked car accident (1). Two women were pregnant at the time of the aggression. Nationality: Spanish (3), foreigner (4). Maximum peak incidence was in 2002 (4 cases). In all cases the social level was low. It was observed that all women, in spite of evidence, did not initially admit a problem of domestic violence by a partner as the real cause of their lesion. Conclusions. The incidence of gender violence as a cause of spinal cord injury in our female population was 1 %. It seems that this cause is recognized more frequently in recent years. It is probable that an undetermined number of accidental falls or precipitations may actually be generated in a background of gender violence. We think that a multidisciplinary approach is warranted as social and psychological factors play an important role in these patients

[Clinical characteristics of spinal cord injury caused by infection]. / Características clínicas de la lesión medular de causa infecciosa.

INTRODUCTION: Infections account for 3% of all non-traumatic spinal cord injuries. The demographic distribution and clinical course are still not fully understood in these patients. AIMS: The aim of this study was to determine the clinical-epidemiological characteristics and clinical course in patients with infectious spinal cord injury referred to our centre. PATIENTS AND METHODS: A retrospective study (over the period 1997-2003) was carried out. Variables examined included age, sex, type of injury, aetiology, causing agent, ASIA classification on admission and discharge. RESULTS: N = 27 (8% of the total number of non-traumatic spinal cord injuries). Mean age: 37.3 years (range: 14-75). Higher prevalence was found between the ages of 20 and 39 years (48.1%) and in males (70.4%). A prevalence of dorsal injuries (59.3%) was also observed. On hospital admission most of the injuries were incomplete (70.4%) and this figure increased to 77.8% on discharge. Spondylodiscitis was the most frequent cause (51.9%) and Staphylococcus aureus was found to be the most common microbiological causing agent. The greatest prevalence of complete injuries was observed in cases of dorsal injuries (43.75%). All cases of tuberculosis were situated in the dorsal region (p < 0.05). CONCLUSIONS: In our care centre, non-traumatic spinal cord injuries of an infectious origin seem to be most often caused by spondylodiscitis due to S. aureus, with a higher incidence in the dorsal region. They predominantly affect males in their thirties and forties, and usually give rise to incomplete injuries.

Características clínicas de la lesión medular de causa infecciosa / Clinical characteristics of spinal cord injury caused by infection

Introducción. La etiología infecciosa representa el 3% de la lesión medular no traumática. La distribución demográfica y evolución clínica no son completamente conocidas en estos pacientes. Objetivos. Conocer las características clinicoepidemiológicas y la evolución en pacientes con lesión medular infecciosa remitidos a nuestro centro. Pacientes y métodos. Estudio retrospectivo (período 1997-2003). Variables: edad, sexo, tipo de lesión, etiología, agente causal, clasificación ASIA al ingreso y al alta. Resultados. N = 27 (8% del total de lesiones medulares no traumáticas). Edad media: 37,3 años (rango: 14-75). Mayor prevalencia en edades comprendidas entre 20 y 39 años (48,1%) y en varones (70,4%). Se observa una mayor prevalencia de lesiones dorsales (59,3%). Al ingreso la mayoría de lesiones fueron incompletas (70,4%), y aumentaron hasta un 77,8% al alta. La espondilodiscitis fue la causa más frecuente (51,9%), y el Staphylococcus aureus, el agente microbiológico etiológico más frecuente. La mayor prevalencia de lesiones completas se observa en lesiones dorsales (43,75%). El 100% de los casos de tuberculosis asentaron en la región dorsal (p < 0,05). Conclusiones. En nuestro centro, la lesión medular de causa no traumática de etiología infecciosa parece estar producida en mayor frecuencia por espondilodiscitis por S. aureus, con una mayor incidencia en la región dorsal. Afecta predominantemente a varones en la tercera y cuarta décadas de la vida y suele producir lesiones incompletas (AU)

Introduction. Infections account for 3% of all non-traumatic spinal cord injuries. The demographic distribution and clinical course are still not fully understood in these patients. Aims. The aim of this study was to determine the clinicalepidemiological characteristics and clinical course in patients with infectious spinal cord injury referred to our centre. Patients and methods. A retrospective study (over the period 1997-2003) was carried out. Variables examined included age, sex, type of injury, aetiology, causing agent, ASIA classification on admission and discharge. Results. N = 27 (8% of the total number of nontraumatic spinal cord injuries). Mean age: 37.3 years (range: 14-75). Higher prevalence was found between the ages of 20 and 39 years (48.1%) and in males (70.4%). A prevalence of dorsal injuries (59.3%) was also observed. On hospital admission most of the injuries were incomplete (70.4%) and this figure increased to 77.8% on discharge. Spondylodiscitis was the most frequent cause (51.9%) and Staphylococcus aureus was found to be the most common microbiological causing agent. The greatest prevalence of complete injuries was observed in cases of dorsal injuries (43.75%). All cases of tuberculosis were situated in the dorsal region (p < 0.05). Conclusions. In our care centre, non-traumatic spinal cord injuries of an infectious origin seem to be most often caused by spondylodiscitis due to S. aureus, with a higher incidence in the dorsal region. They predominantly affect males in their thirties and forties, and usually give rise to incomplete injuries (AU)

[Cardiovascular changes in cervical spinal cord lesions]. / Alteraciones cardiovasculares en los lesionados medulares cervicales.

A study is performed on the alterations in blood pressure and heart rate in 36 patients with cervical spinal cord lesions with as evolution of at least 5 years. We have found fluctuations in blood pressure and heart rate when passing from lying to standing position, before urinating and from one day to another. The incidence of autonomic dysreflexia crisis is observed in 178 patients suffering cervical spinal cord lesions of the Hospital Nacional de Parapléjicos, Toledo. This is a scarcely known entity by physicians in general and the patient's life very often depends on its diagnosis and correct treatment.