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Delayed-onset paraplegia from improper seat belt use
1Department of Emergency Medicine, Tuality Community Hospital, Hillsboro, Oregon.
Insights
A toddler developed paraplegia after a car crash due to improper seatbelt use causing spinal cord injury. Subtle symptoms like foot pain and delayed onset highlight the importance of recognizing spinal cord injury without radiographic abnormality.
Area of Science:
- Pediatric neurology
- Trauma surgery
- Spinal cord injury research
Background:
- Motor vehicle accidents are a leading cause of pediatric trauma.
- Spinal cord injury (SCI) can occur even without obvious radiographic abnormalities.
- Delayed onset of neurological deficits is a recognized, albeit less common, presentation of SCI.
Observation:
- A toddler experienced delayed-onset paraplegia following a motor vehicle accident.
- The injury was potentially linked to an adult lap belt used improperly.
- Initial subtle symptom was foot pain, preceding the development of paraplegia.
Findings:
- The case suggests a vascular event causing ischemic injury to the distal spinal cord as a likely cause.
- Occult spinal instability was considered a possible contributing factor to recurrent cord injury.
- This presentation underscores the subtle and delayed nature of spinal cord injury without radiographic abnormality (SCIWORA).
Implications:
- Highlights the need for vigilance in diagnosing SCIWORA in pediatric trauma patients.
- Emphasizes that initial subtle symptoms like pain can precede significant neurological deficits.
- Demonstrates the potential for good neurological recovery even in cases with delayed diagnosis and treatment.
Abstract:
Presented is the case report of a toddler who suffered delayed-onset paraplegia after a motor vehicle accident. An improperly used adult lap belt is postulated as the etiology causing a probable vascular event with ischemic injury to the distal cord; however, recurrent cord injury from presumed occult spinal instability was a possible explanation. This case highlights that the syndrome of spinal cord injury without radiographic abnormality can present subtly (in this case, foot "pain"), that full neurologic manifestations can be delayed, and that good neurologic recovery is possible.