A Case of Isolated Cervicomedullary Injury With Extensive Wallerian Degeneration: The Multifactorial Nature in Making Decisions to Withdraw Life Support From a Pathology Perspective

Patients suffering from traumatic spinal cord injury (SCI) constitute a unique patient population in critical care medicine due to the high rate of mortality, irrecoverable neurological damage, and dependence on advanced life support measures. In this report, we present a patient who sustained a non-survivable cervicomedullary injury due to motor vehicle collision who became dependent on maximal life support and subsequently expired from multiple complications 11 months after the initial accident. On neuropathological exam, extensive Wallerian degeneration in the spinal cord despite non-traumatic findings in bilateral cortices corroborate the clinical picture. We report in detail the clinical presentation, hospital course, and autopsy findings surrounding this case. Additionally, we discuss the socioeconomic factors, medical complexities, and regulatory guidelines surrounding the decision to withdraw life support when prognoses are guarded.