Minor Trauma Causing Spinal Cord Injury in a Child with Chiari Malformation: A Case and Review of the Literature

Pediatric spinal cord injury (SCI) is a rare, life-threatening condition that requires prompt recognition and management. Although such injuries usually require a high-risk mechanism, certain congenital spinal anomalies can increase the risk of experiencing SCI from even minor trauma. Type 1 Chiari malformation (CM1) is a congenital spinal anomaly that is generally asymptomatic until a precipitating event causes sudden deterioration. We present the case of a child with a previously undiagnosed CM1 and syrinx who developed central cord syndrome after minor trauma.

A previously healthy 4-year-old boy developed neck and back pain and arm weakness after a low-level fall. He was found to have central cord syndrome with urinary retention. Emergent neuroimaging identified CM1, syringomyelia, and cervical cord edema. The following day he developed respiratory failure requiring intubation. Pediatric neurosurgery performed a decompression craniectomy with a favorable outcome. He was ultimately discharged to inpatient rehabilitation and has shown steady improvement in motor function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trivial trauma can cause SCI in pediatric patients with congenital spinal anomalies. These anomalies are not always foreknown but should be suspected when focal neurologic deficits are present after minor trauma. Patients with CM1 and neurologic symptoms require emergent neuroimaging and neurosurgical evaluation. Patients with known CM1 and head or neck trauma, but without neurologic symptoms, do not necessarily need imaging or hospitalization but should be counseled on the potential for progressive injury.