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Stingray spear injury to the pediatric spinal cord: case report and review of the literature

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A Correction to this article was published on 25 June 2020

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Abstract

Stingray injuries are rare, mostly causing injuries to the lower extremities but occasionally fatal if there is direct puncture of the thorax, abdomen, or neck. Direct combined stingray injury to the central nervous system has not been reported in the literature. Herein we present the case of a 12-year-old boy who, while wading at the seashore of the Costa Rica’s Pacific Ocean, sustained a combined oblique penetrating injury to the C6 vertebra caused by a Stingray. He initially presented to the hospital with a complete asymmetric right C6/left T1 ASIA A examination, priapism, and loss of anal sphincter tone. Imaging revealed fracture of the posterior elements of C6 with an oblique trajectory into the left radicular foramen. T2W images did not reveal anatomical section but rather edema and minor bleeding in the epidural space. The patient underwent medical management and serial imaging. During the next 3 months, there was recovery of sensation on the right hemi body, bilateral paresthesias and asymmetric progressive improvement in strength on both legs. Acute care management and midterm term follow up are provided, along with a review of the literature for salient management considerations when evaluating and treating combined penetrating and envenomation injuries caused by stingrays. To our knowledge, this is the first report of such injury to the spine.

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Change history

  • 25 June 2020

    The original version of this article unfortunately contained an error in the spelling of the last name of one of the co-authors. The corresponding author did not notice that the last name of one of the co-authors, Nathan Shlobin, was misspelled as “Schlobin”. The correct spelling of his last name is “Shlobin”. Given in this article is the corrected author name.

References

  1. Meyer PK (1997) Stingray injuries. Wilderness Environ Med 8:24–28. https://doi.org/10.1580/1080-6032(1997)008[0024:SI]2.3.CO;2

    Article  CAS  PubMed  Google Scholar 

  2. Diaz JH (2008) The evaluation, management, and prevention of stingray injuries in travelers. J Travel Med 15:102–109

    Article  PubMed  Google Scholar 

  3. Hawdon GM, Winkel KD (1997) Venomous marine creatures. Aust Fam Physician 26:1369–1374

    CAS  PubMed  Google Scholar 

  4. López-Garro A, Zanella I (2015) Capturas de la raya Dasyatis longa (Myliobatiformes: Dasyatidae) en las pesquerías artesanales de Golfo Dulce. Rica, Costa

    Google Scholar 

  5. Aigle L, Lions C, Mottier F, Ollivier L (2010) Management of bluespotted stingray injuries in Djibouti from July 2008 to July 2009. Med Trop (Mars) 70:259–263

    CAS  Google Scholar 

  6. Aetobatus narinari, Whitespotted eagle ray : fisheries, gamefish. https://www.fishbase.de/summary/Aetobatus-narinari.html. Accessed 28 Feb 2020

  7. Rhinoptera steindachneri, Pacific cownose ray : aquarium. https://www.fishbase.de/summary/Rhinoptera-steindachneri.html. Accessed 28 Feb 2020

  8. Moyles BG, Wilson RC (1989) Stingray spine foreign body in the foot. J Foot Surg 28:30–32

    CAS  PubMed  Google Scholar 

  9. Rensch GP, Elston DM (2019) Aquatic antagonists: stingray injury update. Cutis 103:138–140

    PubMed  Google Scholar 

  10. Myatt T, Nguyen BJ, Clark RF, Coffey CH, O'Connell CW (2018) A prospective study of stingray injury and envenomation outcomes. J Emerg Med 55:213–217. https://doi.org/10.1016/j.jemermed.2018.04.035

    Article  PubMed  Google Scholar 

  11. Clark AT, Clark RF, Cantrell FL (2017) A retrospective review of the presentation and treatment of stingray stings reported to a poison control system. Am J Ther 24:e177–e180. https://doi.org/10.1097/MJT.0000000000000365

    Article  PubMed  Google Scholar 

  12. Srinivasan S, Bosco JIE, Lohan R (2013) Marine stingray injuries to the extremities: series of three cases with emphasis on imaging. J Postgrad Med 59:309–311. https://doi.org/10.4103/0022-3859.123163

    Article  CAS  PubMed  Google Scholar 

  13. Trickett R, Whitaker IS, Boyce DE (2009) Sting-ray injuries to the hand: case report, literature review and a suggested algorithm for management. J Plast Reconstr Aesthetic Surg 62:e270–e273. https://doi.org/10.1016/j.bjps.2007.12.022

    Article  CAS  Google Scholar 

  14. Cooper NK (1991) Stone fish and stingrays--some notes on the injuries that they cause to man. J R Army Med Corps 137:136–140

    Article  CAS  PubMed  Google Scholar 

  15. Fenner PJ, Williamson JA, Skinner RA Fatal and non-fatal stingray envenomation. Med J Aust 151:621–625

  16. Laurent S, Martinet O, Cuq H, Rind A, Durasnel P, Lenne C, Blondé R (2018) Whiptail stingray injury. Wilderness Environ Med 29:243–247. https://doi.org/10.1016/j.wem.2018.01.008

    Article  PubMed  Google Scholar 

  17. Suzuki T, Takada T, Fudoji J (2017) Traumatic pneumothorax associated with penetrating neck injury caused by a stingray: a case report. Wilderness Environ Med 28:119–121. https://doi.org/10.1016/j.wem.2017.02.006

    Article  PubMed  Google Scholar 

  18. Fernandez I, Valladolid G, Varon J, Sternbach G (2011) Encounters with venomous sea-life. J Emerg Med 40:103–112. https://doi.org/10.1016/j.jemermed.2009.10.019

    Article  PubMed  Google Scholar 

  19. Auerbach PS (1984) Hazardous marine animals. Emerg Med Clin North Am 2:531–544

    CAS  PubMed  Google Scholar 

  20. Groen RJM, Kafiluddin EA, Hamburger HL, Veldhuizen EJFH (2002) Spinal cord injury with a stingray spine. Acta Neurochir 144:507–508. https://doi.org/10.1007/s007010200075

    Article  CAS  PubMed  Google Scholar 

  21. Haddad V, Neto DG, de Paula Neto JB et al (2004) Freshwater stingrays: study of epidemiologic, clinic and therapeutic aspects based on 84 envenomings in humans and some enzymatic activities of the venom. Toxicon 43:287–294. https://doi.org/10.1016/j.toxicon.2003.12.006

    Article  CAS  PubMed  Google Scholar 

  22. Charnigo A, Thiele G, Ondrus RJ (2020) Stingray Sting. StatPearls Publishing

  23. Dehghani H, Sajjadi MM, Parto P, Rajaian H, Mokhlesi A (2010) Histological characterization of the special venom secretory cells in the stinger of rays in the northern waters of Persian gulf and Oman Sea. Toxicon 55:1188–1194. https://doi.org/10.1016/j.toxicon.2010.01.010

    Article  CAS  PubMed  Google Scholar 

  24. Dehghani H, Sajjadi MM, Rajaian H, Sajedianfard J, Parto P (2009) Study of patient’s injuries by stingrays, lethal activity determination and cardiac effects induced by Himantura gerrardi venom. Toxicon 54:881–886. https://doi.org/10.1016/j.toxicon.2009.06.023

    Article  CAS  PubMed  Google Scholar 

  25. Antoniazzi MM, Benvenuti LA, Lira MS, Jared SGS, Neto DG, Jared C, Barbaro KC (2011) Histopathological changes induced by extracts from the tissue covering the stingers of Potamotrygon falkneri freshwater stingrays. Toxicon 57:297–303. https://doi.org/10.1016/j.toxicon.2010.12.005

    Article  CAS  PubMed  Google Scholar 

  26. Clark RF, Girard RH, Rao D, Ly BT, Davis DP (2007) Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med 33:33–37. https://doi.org/10.1016/j.jemermed.2007.03.043

    Article  PubMed  Google Scholar 

  27. Hornbeak KB, Auerbach PS (2017) Marine envenomation. Emerg Med Clin North Am 35:321–337

    Article  PubMed  Google Scholar 

  28. Tartar D, Limova M, North J (2013) Clinical and histopathologic findings in cutaneous sting ray wounds: a case report. Dermatol Online J 19

  29. Gurry D (1992) Marine stings. Aust Fam Physician 21:26–34

    CAS  PubMed  Google Scholar 

  30. WCH Clinical Toxinology Resources. http://www.toxinology.com/fusebox.cfm?staticaction=marine_vertebrates/ns-stingray_injuries.html. Accessed 28 Feb 2020

  31. Lau HK, Chua ISY, Ponampalam R (2020) Penetrating thoracic injury and fatal aortic transection from the barb of a stingray. Wilderness Environ Med 31:78–81. https://doi.org/10.1016/j.wem.2019.09.004

    Article  PubMed  Google Scholar 

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Correspondence to A. Caceres.

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The original version of this article was revised: The original version of this article unfortunately contained an error in the spelling of the last name of one of the co-authors. The corresponding author did not notice that the last name of one of the co-authors, Nathan Shlobin, was misspelled as “Schlobin”. The correct spelling of his last name is “Shlobin”. Given in this article is the corrected author name.

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Caceres, A., Shlobin, N.A., Lam, S. et al. Stingray spear injury to the pediatric spinal cord: case report and review of the literature. Childs Nerv Syst 36, 1811–1816 (2020). https://doi.org/10.1007/s00381-020-04629-z

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