A confounding pediatric spinal cord injury: Anterior, central, or both?

IF 0.8 Q4 PEDIATRICS
Mara Martinez-Santori, Anthony Kennedy, Autumn Atkinson, Stuart Fraser, Simra Javaid
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Abstract

Pediatric spinal cord injury (SCI) most commonly affects the cervical region. Central cord syndrome most often occurs in the lower cervical injury due to hyperextension injury, while anterior cord syndrome is primarily due to vascular infarction after hyperextension injury. An unusual case of a pediatric patient who physically presented with central cord syndrome but radiologically had evidence of anterior spinal artery syndrome is described. A two-year-old male presented after a fall from three feet with flaccid upper extremities and dysesthesias but maintained functional strength in bilateral lower extremities. Although his clinical presentation was that of central cord syndrome, he was found to have an anterior spinal artery infarct spanning from C2-T3 with a ligamentous injury at C3 and an incidental finding of Chiari I malformation on MRI. Given the negative evaluation for a cardiac or hematologic source of embolus and normal angiography, it was theorized that compression of vertebral arteries by previously undiagnosed Chiari I malformation in the setting of trauma could have made the patient more vulnerable to this complication. During inpatient rehabilitation, he regained scapular movement and shoulder flexion. However, he regained distal movement in supination, wrist extension, and finger flexion instead of the more usual proximal-to-distal motor recovery observed in SCI. While he had a relative sparing of strength in his legs, he had impaired proprioception and balance, leading to gait impairment. This case highlights the complexity of pediatric cervical SCI diagnosis and prognostication. While classic SCI subtypes are well described, many pediatric and adult patients will present and recover in unexpected ways. All with SCI should be evaluated thoroughly for common etiologies and transitioned to rehabilitation therapies to assist in recovery.

令人困惑的小儿脊髓损伤:前部、中部还是两者都有?
小儿脊髓损伤(SCI)最常影响颈椎区域。中央型脊髓综合征最常发生在下颈部损伤,是由于过度伸展损伤所致,而前部型脊髓综合征主要是由于过度伸展损伤后的血管梗塞所致。本报告描述了一例不寻常的小儿患者,该患者身体上表现为脊髓中央综合征,但放射学上却有脊髓前动脉综合征的证据。一名两岁男童从三英尺高处摔下后出现上肢弛缓和疼痛,但双下肢仍保持功能性力量。虽然他的临床表现是中央脊髓综合征,但他被发现患有脊髓前动脉梗塞,范围从C2到T3,C3处有韧带损伤,核磁共振检查偶然发现Chiari I畸形。鉴于对栓子来源的心脏或血液学评估结果为阴性,且血管造影检查结果正常,因此推断在创伤情况下,先前未确诊的Chiari I畸形对椎动脉的压迫可能使患者更容易发生这种并发症。在住院康复期间,他恢复了肩胛骨活动和肩关节屈曲。但是,他恢复了上举、腕关节伸展和手指屈曲等远端运动,而不是 SCI 患者常见的从近端到远端的运动恢复。虽然他的腿部力量相对恢复,但本体感觉和平衡能力受损,导致步态障碍。这个病例凸显了小儿颈椎 SCI 诊断和预后的复杂性。虽然经典的 SCI 亚型已得到很好的描述,但许多儿童和成人患者会以意想不到的方式出现和康复。所有患有 SCI 的患者都应接受全面的常见病因评估,并接受康复治疗以帮助康复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.30
自引率
5.30%
发文量
139
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