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Updated: May 23, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
A 3-month-old infant with upper extremity weakness
1Division of Hospital Medicine, Children's Hospital Los Angeles, CA, USA. rzipkin@chla.usc.edu
Insights
Pediatric acute neurological changes require thorough history, exam, and imaging. Rare neurenteric cysts/fistulas and epidural abscesses necessitate comprehensive spinal evaluation, especially with gram-negative infections.
Area of Science:
- Pediatric Neurology
- Spinal Cord Imaging
- Infectious Diseases
Background:
- Acute neurological changes in children demand prompt medical attention.
- Neurenteric cysts, fistulas, and epidural abscesses are rare pediatric spinal conditions.
- Understanding the etiology is crucial for effective management.
Observation:
- Neurenteric cysts/fistulas typically occur in the cervicothoracic region, causing cord/brainstem compression.
- Epidural abscesses are found in the thoracic or lumbar regions.
- Infections with S. aureus are common without GI-spinal communication; gram-negative pathogens (E.coli, E. cloacae) suggest neurenteric fistulas.
Findings:
- Prompt neuroimaging aids in determining the extent of neuronal involvement.
- Associated infections can occur with neurenteric anomalies.
- Gram-negative pathogens strongly indicate the need to rule out neurenteric fistulas.
Implications:
- Complete spinal canal evaluation is essential due to potential anomalies associated with neurenteric cysts.
- Early diagnosis and targeted treatment based on pathogen identification are critical.
- This approach improves outcomes for children with rare spinal pathologies.
Abstract:
A detailed history should be obtained for all pediatric patients presenting with acute neurological changes. A thorough physical exam can help narrow the possible etiologies. Prompt imaging can lead to a more precise understanding of the level of neuronal involvement. Neurenteric cysts and fistulas are extremely rare in the pediatric population, with most occurring in the lower cervical and upper thoracic region. Most patients will present with symptoms related to cord or brainstem compression; however, associated infections have been reported. Epidural abscesses are also rare, occurring in the mid-thoracic or lower lumbar region. When there is no communication between the gastrointestinal tract and spinal canal, S. aureus accounts for most of these infections. When gram-negative pathogens, such as E.coli and E. cloacae, are isolated, it is imperative to evaluate for the presence of neurenteric fistulas. Because of numerous anomalies associated with neurenteric cysts, the entire spinal canal should be evaluated completely.
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