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Neurological Rehabilitation

Concomitant peripheral nerve injury and impact on ASIA impairment scale score

(Kiosk 3) Concomitant Peripheral Nerve Injury and Impact on ASIA Impairment Scale Score

Saturday, November 18, 2023
8:00 AM – 9:15 AM CT

    Primary Author(s)

  • Lydia G. Singerman, MD

    Resident
    Sidney Kimmel Medical College At Thomas Jefferson University/TJUH PM&R Program
    Phildelphia, Pennsylvania

    • Co-Author(s)

  • Lenny Rostomian, DO (he/him/his)

    Resident Physician
    Temple University Hospital Program
    Philadelphia, Pennsylvania

  • C.R. R. Sridhara, MD

    Director EDX Laboratory Moss Rehab
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Elkins Park, Pennsylvania

  • Esme Irvine, DO

    Resident physician
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Philadelphia, Pennsylvania

Case Diagnosis: Concomitant peripheral nerve injury and impact on ASIA impairment scale score

Case Description or Program Description: 21-year-old female who was an unrestrained passenger in a high-speed motor vehicle crash. She was ejected from the car causing multiple injuries including T3 spinous process displaced fracture (fusion/decompression between T1-T4), bilateral femur fractures (ORIF), left third metatarsal fracture, right occipital condyle fracture, multiple rib fractures and watershed infarcts with possible diffuse axonal injury. She was graded as a C8 AIS-C. If the lack of sensation at T1 dermatome is due to other causes would be graded as T4- AIS C.

Setting: Tertiary care electrodiagnostic laboratory

Assessment/Results: The electrodiagnostic findings revealed axon loss lesion of left median nerve distal to the innervation of the pronator teres with possibility of entrapment in the pronator muscle. There was 40% attenuation of left medial antebrachial cutaneous response compared to the right suggesting axon loss. These correlated with decreased sensation in the forearm and weakness of hand. Both the nerves are in the medial elbow region and likely area of the trauma.

Discussion (relevance): The revised ASIA grading system of 2019 for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) accounts for patients with concomitant musculoskeletal, neurological or other problems that impact on the ISNCSCI examination results. This case helps demonstrate the importance of these changes in multi-trauma patients. The use of electrodiagnostic evaluation helped to correctly classify ASIA grading that may impact rehab modalities, prognosis and care of patient.

Conclusions: ASIA grading is used for both prognostication and rehabilitation. Peripheral nerve injuries which are common in multi-trauma that can influence the ASIA exam are easily diagnosed with electrodiagnostic studies. It is important during examination of traumatic spinal cord injuries to be aware of concurrent injuries that can wrongly influence grading.