Traumatic Spinal Cord Infarction Associated With Elevated Intracranial and Intraspinal Pressure in a Pediatric...

Spinal cord ischemia (SCI) in the pediatric population is rare and not well characterized. Initial diagnosis is often delayed, and there are no standardized, evidence-based management strategies. Risk factors and etiologies vary and include trauma, thrombotic or embolic disease, infection, vasculitis, cerebellar herniation, arteriovenous malformation, cardiovascular interventions, scoliosis correction, sickle cell disease, and idiopathic causes. We present a case of an 11-year-old girl with anterior spinal artery (ASA) syndrome who presented four days after a fall with back pain, bilateral lower extremity weakness, and numbness. On examination, she demonstrated objective weakness and decreased pain and temperature sensation (worse on the left than the right) in her lower extremities. Diagnostic workup revealed a thoracic ASA infarction, thoracic transverse process fracture, lumbar paraspinal muscle strain, and elevated intracranial and intraspinal pressure potentially resulting from the recent fall. Notably, the patient's opening pressure during a fluoroscopy-guided lumbar puncture was markedly elevated, a finding not previously documented in the literature or followed clinically. Owing to the rarity of SCI and its imaging similarities with early-phase myelitis, considerable workup is required for patients presenting with objective weakness to ensure accurate diagnosis and prevent adverse outcomes. Unfortunately, accurate diagnosis of SCI is frequently delayed until irreversible damage has occurred. The ASA infarct and paraspinal muscle strain presented here were diagnosed by MRI.