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Permanent flaccid paraplegia in children with thoracic spinal cord injury
Insights
Four children with traumatic spinal cord injury developed permanent flaccid paralysis, indicating a lower motor neuron lesion. This rare complication, potentially vascular, differs significantly from typical spastic paralysis in pediatric spinal cord injury patients.
Area of Science:
- Pediatric Neurology
- Spinal Cord Injury Research
- Neurotraumatology
Background:
- Spinal cord injury (SCI) in children presents unique challenges.
- Traumatic SCI can lead to various neurological deficits.
- Understanding the spectrum of SCI complications is crucial for effective management.
Observation:
- A study reviewed 25 children with traumatic SCI from 1960-1979.
- Twelve patients had complete thoracic spinal cord lesions.
- Four of these patients developed permanent flaccid paralysis.
Findings:
- These four pediatric patients exhibited lower motor neuron signs, including muscle atrophy and areflexia.
- Neurophysiological studies showed absent motor nerve conduction velocities and H-reflexes.
- Radiological findings suggested myelomalacia, consistent with a vascular-induced extensive longitudinal cord lesion.
Implications:
- Flaccid paraplegia is a rare but distinct complication of pediatric traumatic SCI.
- This presentation suggests a lower motor neuron lesion, potentially due to vascular insult.
- Further research is needed to estimate the incidence and understand the pathophysiology of flaccid SCI in children.
Abstract:
From January 1960 to March 1979 25 children with spinal cord injury were admitted to our hospital (10 newborns with birth injury to the spinal cord were excluded). Among 12 patients with complete thoracic lesions four remained permanently flaccid. These four cases who had sustained relatively minor trauma showed marked muscular atrophy of the lower limbs, areflexia, absence of anal and cremasteric reflexes, no response to plantar stimulation and no foot deformities. In contrast to children with spastic traumatic paraplegia, motor nerve conduction velocities and H-reflexes were not measurable in these flaccid patients. Myelography was performed in two, this showing myelomalacia below the level of injury. All four patients had clinically an autonomous bladder and voided by gentle manual pressure. The clinical, neurophysiological and radiological findings are consistent with a lower motor neurone lesion below the level of cord injury, resulting presumably from an extensive longitudinal cord lesion on a vascular basis. Judging from Guttmann's experience, flaccid paraplegia occurs in about 12 per cent of adults with complete thoracic cord lesions. The literature is too scant to give an estimate of this complication in children with traumatic paraplegia.