Firework discharge leading to cerebral contusion and motor paraplegia

A 57-year-old male sustained a blunt head injury after discharging a mortar firework off the vertex of his head. Physical examination revealed a stellate scalp lesion and pure bilateral leg paraplegia. Initial spinal computed tomography and magnetic resonance imaging were negative for pathology. Initial head computed tomography revealed open, nondisplaced, frontal, and parietal skull fractures with underlying subdural and subarachnoid hemorrhage. Follow-up magnetic resonance imaging one week later showed bilateral precentral gyri frontal lobe contusions involving the lower extremity motor cortices and subcortical white matter extending anteriorly into the region of the supplementary motor areas. The patient's complete paraplegia informed the subsequent hospital rehabilitation. However, motor recovery was more rapid than anticipated, with the patient regaining ambulatory function before inpatient rehabilitation discharge after 27 days of hospitalization. He continued to have issues with spasticity after discharge. We discuss the current literature surrounding paraplegia secondary to head trauma and the recovery that follows. Firework misuse is a known cause of head injury but has not been recorded as a cause of isolated bilateral paraplegia. Isolated precentral gyri contusion must be considered in patients presenting with paraplegia following trauma to the vertex of the head and normal spinal imaging. We show the importance of repeat imaging to follow the evolving nature of traumatic head injuries presenting with paraplegia. We also illustrate the variability in rehabilitation planning and the need for adjustment in rehabilitation planning for paraplegic patients following head trauma.