Upper extremity monoparesis in an adololescent without obvious profound etiology

Background nbsp Spinal nbsp cord nbsp injury nbsp in nbsp children nbsp is nbsp associated nbsp with nbsp severe nbsp morbidity and nbsp immense nbsp socioeconomic nbsp burden nbsp In nbsp spinal nbsp cord nbsp injury nbsp without nbsp radiologic nbsp abnormalities nbsp nbsp SCIWORA nbsp nbsp magnetic nbsp nbsp resonance nbsp nbsp imaging nbsp nbsp MRI nbsp nbsp can nbsp nbsp detect nbsp nbsp intramedullary nbsp or nbsp extramedullary nbsp pathologies nbsp or nbsp show nbsp absence nbsp of nbsp neuroimaging abnormalities Pathogenesis of SCIWORA is based on the concept that the inherently elastic paediatric spinal column can afford significant degree of segmental dislocation resulting nbsp in nbsp damage nbsp of nbsp the nbsp spinal nbsp cord nbsp without nbsp any nbsp obvious nbsp spinal nbsp fracture nbsp or ligamentous disruption Case nbsp presentation nbsp The nbsp medical nbsp history nbsp of nbsp the nbsp patient nbsp includes nbsp only nbsp a nbsp delayed nbsp presentation of unilateral upper extremity weakness to a child after violent traction of neck and upper extremity A Guilford type brace was applied to the patient for months and the neurological outcome was eventually relatively uneventful The clinical and radiologic work up combined with the neurological findings established the nbsp diagnosis nbsp of nbsp SCIWORA nbsp and nbsp we nbsp are nbsp highlighting nbsp the nbsp clinical nbsp and nbsp radiological nbsp features Conclusion Review of the literature regarding SCIWORA cases reveals that the recognition of only edema of the spinal cord without evidence of haemorrhage as a positive predictive factor SCIWORA should be included in the differential diagnosis of cases with paresis of the extremities even though the possible traumatic event may manifest a significant time delay from the clinical sequelae as it was the case for our patient nbsp