Subacute clinical onset of postraumatic myelopathy

Background. Subacute neurological deterioration unrelated to mechanical instability is a rare event. Cases report. The authors describe two patients with subacute neurological deterioration unrelated to mechanical instability, which occurred 24 hours after spinal cord injury. The phenomenon could not be prevented by steroid therapy carried out either before or after the onset of clinical signs. An early surgical decompressive procedure performed in one of the two patients, failed to reverse the clinical symptomatology. Findings. In the first case, temporal evolution of the neurological deterioration suggested a venous thrombosis with secondary congestive ischemia. whereas ischemia involving the anterior spinal artery seems to account for the deterioration observed in the second patient. Interpretation. Spinal cord haemodynamics plays the main role in mediating the onset of descending subacute posttraumatic myelopathy. The cure and the prevention of the secondary vascular injury still remains unknown.