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Updated: Jun 13, 2025
A Contusive Model of Unilateral Cervical Spinal Cord Injury Using the Infinite Horizon Impactor
Published on: July 24, 2012
A confounding pediatric spinal cord injury: Anterior, central, or both?
Mara Martinez-Santori1, Anthony Kennedy2, Autumn Atkinson2,3
1Department of Physical Medicine and Rehabilitation, McGovern Medical School at UTHealth, Houston, Texas, USA.
Insights
This case details an unusual pediatric spinal cord injury (SCI) with central cord syndrome symptoms but radiological signs of anterior spinal artery syndrome. Recovery patterns were atypical, highlighting diagnostic complexity in pediatric SCI.
Area of Science:
- Neurology
- Pediatric Medicine
- Traumatology
Background:
- Pediatric spinal cord injury (SCI) predominantly impacts the cervical region.
- Central cord syndrome (CCS) typically results from hyperextension injuries in the lower cervical spine.
- Anterior cord syndrome (ACS) is often caused by vascular infarction following hyperextension injuries.
Purpose of the Study:
- To describe an unusual case of pediatric cervical SCI presenting with central cord syndrome clinically but radiological evidence of anterior spinal artery syndrome.
- To explore potential etiologies for this atypical presentation, including the role of Chiari I malformation.
- To highlight the complexities in diagnosing and predicting outcomes for pediatric SCI.
Main Methods:
- Case report of a two-year-old male following a fall.
- Clinical assessment of motor function and sensory deficits.
- Magnetic Resonance Imaging (MRI) to evaluate spinal cord and associated structures.
- Diagnostic workup for embolic sources (cardiac, hematologic) and angiography.
- Observation of patient's recovery during inpatient rehabilitation.
Main Results:
- The patient presented with flaccid upper extremities and dysesthesias, but preserved lower extremity strength, mimicking CCS.
- Radiological findings revealed an anterior spinal artery infarct (C2-T3) with a C3 ligamentous injury and incidental Chiari I malformation.
- Negative workup for emboli and normal angiography suggested trauma-induced vertebral artery compression by Chiari I malformation as a potential factor.
- Motor recovery was atypical, with distal regaining of function (supination, wrist/finger flexion) rather than proximal-to-distal.
- Impaired proprioception and balance affected gait, despite relative leg strength sparing.
Conclusions:
- Pediatric cervical SCI diagnosis and prognostication are complex, with presentations and recovery patterns often deviating from classic descriptions.
- This case underscores the importance of thorough evaluation for underlying conditions like Chiari I malformation in pediatric SCI.
- Early transition to rehabilitation therapies is crucial for optimizing recovery in patients with SCI, regardless of atypical presentations.
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.
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