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The toddler refusing to weight-bear: a revised imaging guide from a case series.
O J Arthurs1, A C Gomez, P Heinz
1Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
Emergency Medicine Journal : EMJ
|October 24, 2009
Summary
A rare cause of a child refusing to walk is discitis, an infection of the intervertebral disc. Early diagnosis with spinal magnetic resonance imaging (MRI) is crucial for prompt treatment and recovery.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Radiology
- Pediatric Infectious Diseases
Background:
- Refusal to walk or weight-bear in previously mobile children is a common emergency department presentation.
- Lumbosacral discitis is an uncommon but treatable cause of this symptom.
- Diagnosis can be delayed due to the absence of typical symptoms like back pain or neurological deficits.
Observation:
- A case series of three children presenting with non-weight-bearing gait is described.
- None of the children had back pain, spinal symptoms, or abnormal neurological findings.
- Full range of motion in both hips was noted in all patients.
Findings:
- Conventional radiography and ultrasound were performed, but spinal magnetic resonance imaging (MRI) confirmed the diagnosis of discitis.
- There was a mean diagnostic delay of 15.6 days from hospital presentation to MRI.
- All patients recovered well with intravenous antibiotics.
Implications:
- Highlights the importance of considering discitis in children who refuse to bear weight, even without typical symptoms.
- Emphasizes the diagnostic value of spinal MRI for lumbosacral discitis.
- Suggests a need for revised guidelines for radiological investigations in this clinical scenario to reduce diagnostic delays.
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