Cervical Spinal Cord Injury Without Radiographic Evidence of Trauma (SCIWORET) in an Adult: A Rare Diagnosis in the Intensive Care Unit.

Spinal cord injury without evidence of trauma (SCIWORET) is an uncommon clinical entity in adults, typically associated with pre-existing degenerative spinal conditions, as well as vascular susceptibility. Its diagnosis in the intensive care unit (ICU) is challenging due to the confounding effects of sedation and post-arrest encephalopathy. A 67-year-old man suffered a cardiac arrest triggered by severe hyponatremia (Na+ 115 mmol/L ) during colonoscopy preparation. After resuscitation, he exhibited spastic tetraparesis. While CT was negative for acute trauma, MRI revealed a hyperintense T2-signal from the bulbomedullary junction to C3, with a characteristic "H-sign" in the anterior horns, confirming spinal cord infarction or transverse myelitis of undetermined etiology, favoring the diagnosis of SCIWORET. Following intensive rehabilitation, the patient achieved near-total functional recovery. SCIWORET should be suspected in post-arrest patients with "neurological mismatch." Early MRI is essential to differentiate focal spinal ischemia from global hypoxic brain injury, facilitating early multidisciplinary rehabilitation.