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Spinal Cord Infarction 64yr Old Male: Prognosis??

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  • Spinal Cord Infarction 64yr Old Male: Prognosis??

    I’m so glad that I found this forum! This is my first post, and I’m sure to be asking many questions as the weeks and months pass! My dad is a special education teacher, and was in the process of moving from Chicago to Phoenix to teach in a new school. My parents were moving into a dream home, and were very much looking forward to starting a new life in the desert! Most importantly, they were looking forward to never having to scrape ice off their car windows! My dad went to Phoenix a few weeks early, while my mom wrapped things up at her job, and took care of packing up the house. I was so happy for them, but couldn't help but sense that things were going too good to be true. I was right.

    Here’s where it goes bad. My father walked into an ER in Phoenix about 3 weeks ago with severe pain and numbness in his hand. The doctors discovered an obstructed right subclavical artery. Interventional radiology was used to attempt to open up the artery, without much success. He wound up having his arm amputated just below the elbow. He was sedated and intubated in the ICU for 10 days. At some point during this time, the doctors said that he suffered a “neurological event.” Because of the stents used to open his arteries, the doctors were not able to perform an MRI (must wait 8 weeks!) and render a definitive diagnosis of what happened. Numerous CT scans reveled nothing.

    When my dad woke up 10 days later, we discovered that he had no motor function or feeling in his lower extremities or hand. After about 2 days, he started to develop some feeling, but no motor function. After about 5 days, he has recovered feeling in most of his legs and torso. He still has no real motor function in his legs, but is able to move his thumb. It also appears that he can sometimes keep his knees to his chest, and press his knees against the PT’s hands.

    He was admitted to Barrow for inpatient rehab on Monday this week, and we’re hoping that he will be on the road to some recovery. Fortunately his spirits are good, and he ready to face the enormous challenge ahead!

    So, while I wait for the MRI and results, I was wondering if anyone has had experience w/ a SCI resulting from a spinal cord infarction? Is it more likely that an infarction would cause an incomplete vs. complete injury? How likely will it be that he will be able to return to teaching?? I know that he loves the special ed kids, and will need that to motivate his recovery.

    Thanks for taking the time to read this! Looking forward to all of your experience and expertise!
    Last edited by JTK; 09-22-2010, 11:33 PM.

  • #2
    JTK, I don't have any knowledge about the situation you and your father are facing, but I am glad that you found CareCure because there is so much combined wisdom here. Barrow is supposed to be one of the best places in the world for neurological treatment and rehab, and I wish you and your dad every good thing.
    MS with cervical and thoracic cord lesions


    • #3
      Me, maybe. I had a cervical laminectomy and when I woke up in the recovery room, everything worked. I remember scratching my head and found scabs from the pins they used during the surgery.

      The next few days are hazy as I was in major pain. At some point, one or two days later, I woke up and discovered that my hands and arms didn't work. They tested everything with pins and they found that only my arms and hands were affected. An MRI revealed a severely swollen spinal cord.

      The surgeon said that I had suffered a spinal cord stroke or infarction. Two other doctors felt my spinal cord had swollen when it was released from the compression it had been in for two years.

      I never lost sensation, walking, or control of bladder/bowels. My hands slowly came back. Some of my arm movement came back, but not the biceps or deltoids at all. I have a central cord injury at C-5 that is incomplete.

      It is too early to predict your dad's eventual recovery, but his recovery so far sounds promising.


      • #4
        Yes, unfortunately SCI due to infarct is fairly common. Has he had any improvement at all yet? It is fairly commjonm for those injuries to be incomplete, and for there to be some degree of return for a year or more. No way to tell how much. Glad he is in rehab.

        Any chance your dad is a military veteran and therefore eligible for VA SCI rehab? He will get more that way than with any private insurance.

        He certainly should be able to return to teaching. He should establish a case with the state Dept. of Voc Rehab ASAP with the help of his rehab case manager, and start talking to the school about any accommodations he may need. I have many clients with much worse SCI who teach full time in elementary, seconday and college level education.

        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


        • #5
          JTK, What an awful set of circumstances just when things were going so well.
          Please keep us posted.


          • #6
            Thank you all for the replies! My dad finished his 3rd day of rehab and seems to be adjusting well to the new routine. It's been a while since he's exercised this much!

            He is starting to have very slight movement in his middle and index fingers. Still no movement in the legs and feet. He has a lot of feeling in his abs and legs, and definitely feels the movement during his PT.


            • #7
              UPDATE: My dad was able to move his fingers today! He started to have some movement in his thumb last week, but today he was able to move his fingers apart and slightly grasp my moms hand. An emg is scheduled for today, which will be the first since he arrived at Barrow, and we're hoping that the MRI will hapen next week. Once that happens, hopefully the PT will move to his legs!


              • #8
                Such encouraging news! I'm very pleased for you and your dad. Thank you for this update, and do continue to keep us posted.
                MS with cervical and thoracic cord lesions


                • #9
                  UPDATE: I'm still trying to interpret and digest the results from a recent EMG test, but the doctors think the paralysis may be due to nerve damage from a critical illness, as opposed to a cord injury. The tests indicated brisk reflexes, but slow response times. My understanding is that any response, even if slow, indicates it's not a cord injury. Fortunately the MRI is finally being scheduled, which will hopefully provide a definitive diagnosis. If the injury is limited to the nerves, how would that change the recovery outlook?

                  Also, the hospital gave us a heads up that insurance company is starting to question the treatments. Apparently they feel that, in light of the amputation and paralysis, it makes more sense to stop rehab and move my dad into a nursing home! Is this to be expected?


                  • #10
                    The insurance company is not so much interested in your dad's health and well-being as in their bottom line. It will likely be a continuing hassle with them. You may need to push on the hospital staff a little to get them to, in turn, push back on the insurance company.

                    Also - call the insurers, and ask them to assign a case manager to your dad's case. The case manager's job will to follow and understand in detail what's going on with our dad. With that greater understanding, it's much more likely that the proper care will be authorized. Lacking a case manager, things happen strictly by the book, or, worse, by multiple persons' interpretation of the book, with a different person handling each claim. Once you have a case manager (who in my experience has always been a knowledgeable nurse), you can call that person directly to discuss potential claims, for example, for durable medical equipment (DME).

                    The changes he's experiencing are IMHO a good sign, but there's no way to predict with any certainty what will happen in the long term. My wife's injury was probably due to an infarct during spinal surgery (she also was 64 at the time). Over about 5 years, she has regained a lot of feeling below the injury (T5), but no control. My understanding is that that's not unusual.

                    Best wishes to your dad
                    - Richard


                    • #11
                      Richard is right. The insurance company's only interest is to save money, not your dad's best interest. You need to talk to your dad's case manager and get them to push back on this. He needs acute rehab precisely because of his additional disabilities; they should not preclude him getting the therapy he needs in that setting if there is still a realistic goal of getting him home again. A nursing home will not provide him with the care or therapy he needs.

                      You did not say whether or not he is a military veteran. If so, I would work at getting him moved to a VA SCI Center if possible. That would require a cord, not peripheral nerve injury.

                      A EMG can only determine the degree of peripheral nerve damage, not cord damage which can still exist. It is very rare for peripheral nerve damage to show up is usually a more insideous and slow onset (except for acute problems such as Guillan-Barre Syndrome). An SSEP can determine if there is cord damage, although not the full extent.

                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


                      • #12
                        Thanks again for the replies! Sci-Nurse- My dad is not a vet. Fortunately, his employer called the insurance company and told them to basically back off! We're so fortunate to be receiving this kind of support from his employer!

                        An MRI was finally performed. Preliminary results indicated a herniated disk in the neck. The doctors have not said anything about an infarction. Could it be possible that the paralysis is a result of a herniated disc?? If so, would fixing the disc result in recovery? They are going to move my dad to the ICU as a precaution.