An arterial insufficiency ulcer in an individual with cervical spinal cord injury and hypotension

Abstract

Introduction: Arterial ulcers develop as a complication of tissue hypoperfusion, ordinarily from atherosclerotic disease, but sometimes due to other medical conditions or trauma. While people with spinal cord injury (SCI) may be predisposed to resting hypotension, and, hence, to inadequate peripheral circulation, there are no reports of arterial ulcers as a secondary effect of SCI. Case presentation: A 54-year-old woman with long standing cervical SCI presented with a nonhealing lateral malleolar ulcer that was complicated by osteomyelitis and unresponsive to biweekly debridement. On examination, she was hypotensive with cool extremities and non-palpable pedal pulses but had no evidence of atherosclerotic disease, cardio-metabolic derangement, or vasculopathy. We treated her with Midodrine with improvement in her peripheral circulation then referred her for surgical intervention. Discussion: To our knowledge, this is the first reported case of an arterial ulcer in a person living with SCI that was most likely caused by resting hypotension. It is possible that individuals with SCI—particularly those with higher-level injuries—are at risk for this condition. Clinicians must be alert to arterial ulcers as a potential complication of SCI with concomitant hypotension.