Attending Faculty Memorial Healthcare System Hollywood, Florida, United States
Case Diagnosis: Cauda Equina Syndrome
Case Description: 40 year old male patient who presented to the Emergency Department with chief complaint of bilateral lower extremity weakness, saddle anesthesia and urinary retention approximately 2 hours after he was tased during taser training in the police academy. Lumbar MRI was done with findings of disc herniation with disc extrusion at L4-L5 level extending inferiorly in the canal. Patient underwent L4-L5 laminectomy, discectomy and fusion and was then admitted to our acute inpatient rehabilitation facility. Initial physical exam revealed asymmetric weakness involving L4, L5 and S1 innervated muscles, absent sensation to both soft touch and pinprick symmetrically in L4-S5 dermatomes as well as absent patellar and achillean tendon reflexes. Rectal exam revealed a flaccid rectal tone with absent deep anal pressure, absent voluntary anal contraction and absent anal wink. Patient completed inpatient rehabilitation with functional improvement with the assistance of orthotics and assistive devices, but residual neurogenic bladder and bowel.
Discussions: As part of the police academy experience recruits need to undergo specialized training including conductive electrical weapon (Taser) training. Per the literature, conductive electrical weapons (CEW) have been associated with several medical complications including contusions, abrasions, lacerations, rhabdomyolysis, ocular injuries, miscarriages, cardiovascular complications and testicular torsion. We present a unique case of acute lumbar disc herniation resulting in paraplegia, neurogenic bowel, neurogenic bladder and sexual dysfunction as a result of a CEW with no associated fall or trauma; and how a good athletic premorbid physical condition helped achieve functional and self care independence after completing a comprehensive acute inpatient rehabilitation.
Conclusions: In conclusion this case brings awareness of additional medical complications associated with the use of an electric weapon including neurological injuries, and the implications this injuries can have in the victim's quality of life and future performance especially when it is used during training sessions.