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Diagnostic Challenges in Pediatric Spinal Cord Infarction: A Case of Spinal Shock Mimicking Guillain-Barré Syndrome
Muhieddine Doughan1, Rita Abdo1, Rosette Jabbour2
1Neurology Division, University of Balamand, Beirut, Lebanon.
Insights
Spinal cord infarction (SCI) is a rare neurological emergency. This case highlights the importance of considering SCI in children with acute flaccid paralysis, even when initial tests are inconclusive.
Area of Science:
- Neurology
- Vascular Neurology
- Pediatric Neurology
Background:
- Spinal cord infarction (SCI) is a rare neurological emergency, representing 1-2% of neurovascular events.
- Diverse etiologies exist, including vascular risk factors, emboli, and fibrocartilaginous embolism, particularly in younger individuals.
- Magnetic resonance imaging (MRI) is crucial for diagnosis, alongside clinical correlation and assessment of predisposing factors.
Introduction:
Spinal cord infarction (SCI) is a rare but serious neurological emergency, accounting for only 1-2% of all neurovascular events and a small fraction of acute myelopathies. Etiologies are diverse and include systemic vascular risk factors, embolic events, and, in younger individuals, fibrocartilaginous embolism often triggered by minor trauma, among others. Magnetic resonance imaging (MRI) of the spine plays a central role in diagnosis when combined with clinical correlation and careful evaluation of potential predisposing factors.
Case Presentation:
We report a case of a 14-year-old previously healthy female who presented with acute progressive bilateral lower limb weakness after she was suddenly pushed into a pool. Neurological examination showed complete paraplegia and decreased sensation, including fine touch, pinprick, and proprioception in both lower limbs, in addition to absent lower limb reflexes. Initial suspicion of Guillain-Barré syndrome was raised; however, it was ruled out based on normal CSF and nerve conduction studies. MRI of the spine subsequently revealed evidence of anterior SCI.
Conclusion:
SCI with spinal shock is a rare but important differential diagnosis in children presenting with acute flaccid paralysis. This case highlights the importance of maintaining a high index of suspicion, especially when initial investigations are inconclusive.
