1211 - Acute Traumatic Spinal Cord Injury with Horner’s Syndrome: A Case Report

Case Diagnosis: Traumatic incomplete tetraplegia

Case Description: A 22-year-old male sustained a left neck gunshot wound, resulting in left C7-T1 fractures. He underwent C5-T3 laminectomy and was admitted to inpatient rehabilitation for C5 AIS-D acute traumatic tetraplegia. On admission, he reported left upper extremity weakness, paresthesias, and spasms. Physical examination showed left-sided flaccid tone in the finger flexors and abductors, along with ipsilateral ptosis, miosis, and anhidrosis, consistent with superimposed C8-T1 radiculopathy and Horner’s syndrome.

His pain and spasticity improved with baclofen. He demonstrated an increase in strength and function with a slower rate of recovery of the left C8-T1 innervated muscles of the hand.

Discussions: Traumatic injury to C7-T1 can damage both first-order sympathetic neurons (originating in the hypothalamus and terminating at the C8-T2 level) and second-order pre-ganglionic neurons (exiting at T1 and ascending to the superior cervical ganglion). Lesions here can result in Horner’s syndrome and may occur with flaccid weakness at associated myotomes. In addition to performing an ISNCSCI examination to classify the level of spinal cord injury (SCI), a comprehensive neurological examination of cranial nerves, tone, and reflexes is crucial for diagnosing concomitant neurological injuries post-spinal trauma. Additional diagnostics, such as MRI plexus or EMG, can be considered to help characterize the primary injury and prognosticate nerve recovery.

In patients with complex neurologic injuries, including myelopathy, radiculopathy, and Horner’s, a combination of treatment approaches should be used, including medical management and therapeutic interventions. Physical and occupational therapy can be safely conducted in patients with Horner’s syndrome.

Conclusions: Horner’s syndrome can occur in traumatic SCIs when there is concomitant C8/T1 nerve root injury. Clinicians should recognize this complication in patients with low cervical or high thoracic SCI to ensure comprehensive management and optimal rehabilitation outcomes.