Drunk driving strikes again

A few months ago, I mentioned a case in which a dog was injured during a drunk driving accident. It actually turned out to be a really interesting case with a surprisingly happy ending (at least, for the patient - not sure about the driver).

We received a call very late one night after a very busy night in the ER. It was a police dispatcher, asking us if we could drive to the scene of an accident and pick up an injured dog. She explained that it was wedged under the dashboard, and no one could remove it. I explained that unfortunately, we had no pick-up service, but if they could get the car towed to us, we could help with sedating and removing the dog. She informed me she would call me back. Moments later, she notified us that the dog had been freed and was on the way to our ER.

When the patient arrived, we were confronted with a 90 pound German shepherd. "Cora" was lying on the stretcher, barely responsive. Her gums were pale, and she was obviously in shock. She'd also suffered head trauma, as evidenced by her minimally responsive state. Her eyes were open, but she barely responded to us. Her pupils were slightly unequal in size, another sign of head trauma.

More concerning to me was her posture. Cora's front legs were rigidly outstretched, while her back legs were flaccid. She would not lift or turn her head to look at us. Initially, I was concerned based on her posture that her back had been broken in the accident.

We started stabilizing her with IV fluids, oxygen, pain medications, and mannitol for her head trauma. Her mentation remained very dull. I quickly surveyed the rest of her body for signs of other injuries - lacerations, broken bones, evidence of internal bleeding. I found none, all in her favor. Then, I went to talk to her owner and deliver the grave news about possible spinal trauma. As the story unfolded, the owner's husband was driving drunk and hit a telephone pole. Cora was thrown into/under the dashboard and wedged there. The owner's wife had driven to the scene, then brought the dog to us. She was beside herself with grief and probably a healthy dose of humiliation, as well.

I carefully explained to her that I was very concerned about her dog's spine. The possibilities were a few - spinal fracture, severe blunt trauma to the spine causing "spinal shock," and a disc that had popped out of place and hit the spinal cord. Our diagnostics were limited to xrays, I explained. A disc would need CT or MRI of the spine. The owner elected to continue with testing.

To my delight (and a little surprise, I won't lie), the back was not broken. I was left thinking blunt spinal trauma or an acutely extruded disc. As the night progressed, Cora became more responsive. She wagged her tail when her mom came back to say goodnight, but she still did not lift or move her head. Even more curiously, she did not move her front legs, but she did move her back legs.

I was confused. Her front end seemed to be the badly damaged end, less so than her rear legs. When she initially came in, I thought she was exhibiting Schiff-Sherrington posture (rigid extension of the front legs, flaccid back legs), which is always an indicator of trauma to the middle of the spine. If that were the case however, her front legs would be working, and her back legs would not. As the night worn on, it became apparent that she did NOT have SS posture - as intermittently, her back legs would become rigid too. Cora remained unable to lift or turn her head.

My brain started to churn and I realized that she must have suffered injury to her cervical spine (neck, in layman's terms). That explained the reluctance to lift/move her head, the stiffness of her front limbs, and the intermittent weirdness in her back legs.

The next morning, Cora tried to sit up frantically. Her back legs would paddle, paddle, paddle - but her front limbs did nothing. This confirmed my suspicion. I recommended to the owner's that they take the patient to the neurologist for imaging of the spine. My suspicion was that a disc had popped out of place, damaging the cervical spine. An MRI of the spine would give the best image of the damage, as well as allow the neurologist to determine if surgery was necessary, and help with prognosis.

As it turned out, the patient did pop a cervical disc out of place - causing spinal trauma. Based on the kind of disc extrusion it was, surgery was not indicated. The patient was discharged home with instructions for pain medications and physical therapy. Her prognosis was given as very good with time.

The owner sent us a goody basket the other day stuffed with fudge and other delights thanking us for all we had done, and letting us know that Cora was doing great. It was nice to get a happy ending to a sad story for a change!