19 Nov - Syncope with funky neurological symptoms on recovery

Today's case was a previously healthy 71 y/o male who sustained a witnessed syncopal attach where he fell and hit is face on the ground.  He rapidly regained consciousness, but when he awakened he could not use his hands or feet and had bilateral upper and lower extremity numbness.  Distal muscle weakness was more prononced than proximal muscle weakness.  On arrival to the hospital he was bradycardic with normal blood pressure and denied light headedness.  ECG revealed sinus bradycardia, rate ~48 with an LBBB.  Due to his neurologic signs and symptoms MRI of the cervical spine was performed which revealed cord contusion with siginificant canal stenosis and osteophytes.

Spinal cord contusions are typically seen in contact sports injuries and motor vehicle crashes.  Such an injury from a low velocity fall is unusual.  An ovid search turned up no articles reporting this occurence. 

Steroid treatment is controversial but may be effective if started within a few hours of injury.  This article reviewed current recommendations - SPINE Volume 28, Number 9, pp 941–947 and is available on Ovid full text.

As far as the bradycardia goes - he is felt to need permanent pacemaker - the AHA and ACC recently revised guidelines for permanent caridiac pacing and antiarrhythmia devices and it would be useful to be familiar with these gudelines (especially class I indications) for board purposes.