Neurology and Skiing

We’re mostly talking about orthopedic, spinal cord and head injuries.

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Spinal Cord Injuries:

The incidence of spinal cord injury (SCI) is around 1 per 100,000 visits (mostly thoracolumbar spine), usually caused  caused by a simple fall, followed by hitting a tree.

The incidence of SCI for snow boarders is higher, around 4 per 100,000 visits (mostly cervical), and usually caused by a backward fall during a jump (>75%) or other tick.

Most SCIs in skiers and snow boarders occur in 15-25 years olds.

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Head trauma:

The incidence of head trauma is 3.8 per 100,000 ski visits, usually from direct collision with trees.  The incidence of head trauma is higher for snow boarding, around 6.5 per 100,000 visits, more often caused by falling backwards.  Most head traumas result in concussions, but 14% are severe head trauma, and 4% are fatal.

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Others

I came across this case report of another unusual neurologic skiing complication: 
A 45-year old woman first developed distorted vision in the left eye, like looking through a kaleidoscope while skiing.  Soon afterwards, her right leg started jerking, causing her to fall. 
It turned out that she had sustained a left carotid artery dissection causing high grade stenosis during skiing.
There are a few other reports of cervical artery dissection from skiing.

Intrathecal baclofen for spasticity in non-ambulatory patients

We have already made several posts about intrathecal baclofen for reducing spasticity and improving function in ambulatory patients:

However, intrathecal baclofen can also be used in patients with spasticity who are non-ambulatory or bedbound:

Normalizing muscle tone may not improve function, but it alleviates pain, allows for better positioning and hygiene, and improves quality of life.

Click here to find out more about our spasticity center.

2012-13 Neurology Student Research Presented at Drexel University College of Medicine

Monmouth neurology students presenting their posters during medical student research day at Drexel University College of Medicine in Philadelphia on March 20, 2013:

1: Addressing blood glucose control in diabetic peripheral neuropathy:  A missed opportunity for neurologists?

Darsi Pitchon and Seun Ku Kim

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Key points:

Most neurology visits for diabetic neuropathy did not include counseling about blood glucose levels, unless they were with a neuromuscular fellowship trained sub specialist.   Because neuropathy can be the presenting and/or predominant problem in diabetes, some of these patients may be primarily followed by their neurologist, so this is a missed treatment opportunity.

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2.  Acute myelopathy with normal CSF and imaging:

Denis Chang

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Key Points:

Spinal cord infarction from fibrocartilaginous embolism can present with acute quadriparesis in young patients with normal CSF and MRI scans.  If this diagnosis is suspected, a follow-up MRI 2-3 days can be quite helpful.  This is not an inflammatory process, and will not improve with steroids or other immunosupressive medications, which can hurt more than they help.

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3. The benefits of an on-line neurology clinical course for 4th year clerkship students

Ilya Grinberg

Key points:

The on-line video course used by the Monmouth neurology clerkship led to improved test scores on an on-line clinical test compared to students who did their clerkship at other sites.  The on-line clinical test is a low cost but effective method of evaluating students’ clinical skills in neurology over multiple clerkship sites.