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Spinal cord infarction due to minor trauma in children
Insights
Two children developed flaccid quadriplegia after minor trauma. Pathological studies revealed cervical cord ischemic infarction, suggesting arterial spasm as a potential cause of this rare neurological condition.
Area of Science:
- Neurology
- Pediatric Medicine
- Pathology
Background:
- Spinal cord injuries in children can present with diverse neurological deficits.
- Traumatic and non-traumatic etiologies require careful differentiation in pediatric cases.
- Cervical cord lesions can lead to significant motor and autonomic dysfunction.
Purpose of the Study:
- To describe the clinical presentation and pathological findings of a rare spinal cord infarction syndrome in two children.
- To investigate the potential vascular mechanisms underlying cervical cord infarction in pediatric patients.
- To highlight the diagnostic challenges associated with this condition.
Main Methods:
- Case report detailing clinical progression and neurological examination findings in two pediatric patients.
- Review of diagnostic imaging, including myelography, to rule out compressive lesions.
- Post-mortem pathological examination of the spinal cord to identify infarction and associated changes.
Main Results:
- Both patients presented with progressive flaccid weakness, evolving to quadriplegia and sphincter involvement following minor trauma.
- Neither vertebral abnormalities nor external compression of the spinal cord were identified.
- Pathology confirmed ischemic infarction in the cervical cord and medulla, without hematomyelia or extrinsic lesions.
Conclusions:
- The observed pattern of ischemic infarction in the cervical spinal cord may result from vasospasm in terminal arterial branches.
- This syndrome, characterized by infarction without obvious cause, presents a diagnostic challenge in pediatric neurology.
- Further research into the vascular pathology of pediatric spinal cord injuries is warranted.
Abstract:
In two children, ages 22 months and 4 years, after slight trauma, flaccid weakness of both arms developed, followed by flaccid quadriplegia with sphincter involvement. No vertebral fracture or dislocation was found, myelograms were negative, and diagnosis was made only after the full clinical syndrome developed. Pathologic studies revealed ischemic infarction involving the cervical cord and low medulla in one patient, and central gray matter of low cervical cord in the other, without hematomyelia or external compressive lesions. The pattern of infarction may be related to spasm of distal branches of the central sulcal arteries in a terminal arterial bed.