Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa, Japan.
Spinal Cord Ser Cases. 2021 May 13;7(1):37. doi: 10.1038/s41394-021-00402-9.
Spinal cord injury (SCI) is a major direct cause of accidental death. Cervical SCI can lead to death in a short time period by neurogenic shock. Prompt vasopressor administration is recommended for patients with SCI accompanied by hypotension (systolic blood pressure < 90 mmHg). We herein present the first fatal case of nonocclusive mesenteric ischemia (NOMI) secondary to cervical SCI in a patient who suddenly died 1 week after an accidental fall.
A 72-year-old man without medical history of cardiovascular disease suffered tetraplegia with a neurological level at C4 after a fall accident. He was fully conscious with stable respiratory ability, and the systolic blood pressure was maintained at >90 mmHg without vasopressor agents. High fever occurred 7 days after the accident and he died in the next morning. Autopsy revealed segmental intestinal necrosis from the ileum to the ascending colon, without mesenteric embolism, or severe arteriosclerosis.
This case implies that maintenance of >90-mmHg systolic blood pressure can insufficiently keep the blood flow to prevent NOMI, and the mean arterial blood pressure of >85 mmHg can be more plausible as suggested in the guideline. Monitoring the mean arterial blood pressure in acute SCI is useful not only for neurological recovery but also for the maintenance of vital intestinal perfusion.
脊髓损伤（SCI）是意外死亡的主要直接原因。颈 SCI 可因神经源性休克导致患者在短时间内死亡。对于伴有低血压（收缩压<90mmHg）的 SCI 患者，建议立即使用血管加压药。本文报告了首例颈 SCI 继发非闭塞性肠系膜缺血（NOMI）导致的致命病例，该患者在意外跌倒后 1 周突然死亡。
一名 72 岁男性，无心血管疾病病史，跌倒后发生四肢瘫痪，神经损伤平面为 C4。他意识完全清醒，呼吸能力稳定，收缩压维持在>90mmHg 以上，无需血管加压药。事故发生后 7 天出现高热，次日清晨死亡。尸检显示从回肠到升结肠的肠段坏死，无肠系膜栓塞或严重动脉硬化。
该病例提示，维持>90mmHg 的收缩压可能不足以保持血流以预防 NOMI，指南中建议将平均动脉血压>85mmHg 作为更合理的标准。在急性 SCI 中监测平均动脉血压不仅对神经恢复有用，对维持重要的肠道灌注也有用。
