Cervical Spinal Cord Injury Without Radiographic Evidence of Trauma (SCIWORET) in an Adult: A Rare Diagnosis in the Intensive Care Unit.

Authors

Joana Vaz, Nuno Catorze, Jorge Nunes, José Ramalho, Marta Sousa

Published in

Cureus. Volume 18. Issue 6. Pages e110400. Epub Jun 07, 2026.

Abstract

Spinal cord injury without evidence of trauma (SCIWORET) is an uncommon clinical entity in adults, typically associated with pre-existing degenerative spinal conditions, as well as vascular susceptibility. Its diagnosis in the intensive care unit (ICU) is challenging due to the confounding effects of sedation and post-arrest encephalopathy. A 67-year-old man suffered a cardiac arrest triggered by severe hyponatremia (Na+ 115 mmol/L ) during colonoscopy preparation. After resuscitation, he exhibited spastic tetraparesis. While CT was negative for acute trauma, MRI revealed a hyperintense T2-signal from the bulbomedullary junction to C3, with a characteristic "H-sign" in the anterior horns, confirming spinal cord infarction or transverse myelitis of undetermined etiology, favoring the diagnosis of SCIWORET. Following intensive rehabilitation, the patient achieved near-total functional recovery. SCIWORET should be suspected in post-arrest patients with "neurological mismatch." Early MRI is essential to differentiate focal spinal ischemia from global hypoxic brain injury, facilitating early multidisciplinary rehabilitation.

PMID:
42416942
Bibliographic data and abstract were imported from PubMed on 08 Jul 2026.

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