A 32-year-old man presented with sudden loss of consciousness after passing urine with resultant trauma to the back of his neck. There were no palpitations prior. Examination revealed flaccid paralysis of all 4 limbs with priapism. Electrocardiogram demonstrated atrial fibrillation with rapid ventricular response. Laboratory showed normal potassium, magnesium, calcium, thyroid stimulating hormone and troponin I levels. Magnetic resonance imaging of the cervical spine demonstrated left C4 facet dislocation with grade 1 spondylolisthesis of C4 over C5, with moderate to severe narrowing of the spinal canal with cord compression and oedema. Transthoracic echocardiogram demonstrated an ejection fraction of 60% and no valvular abnormalities. Left atrium size was normal. The atrial fibrillation subsequently spontaneously reverted to sinus rhythm without treatment. Clinicians should be aware that atrial fibrillation can occur in the context of traumatic spinal cord injury due to disruption of the autonomic pathways in the cervical spine.
Credits: Ting-Wei Teo, Benjamin Yong-Qiang Tan, Ching-Hui Sia