Abstract
Introduction
Pediatric spinal cord infarction is a rare entity that presents a diagnostic challenge at the emergency department. Ischemic spinal cord infarction can occur in the setting of trauma, cardiovascular malformation, or postoperatively. We report a case of anterior spinal artery infarction following seemingly minor trauma in an otherwise healthy 14-year-old male.
Case presentation
A 14-year-old male presented with unprovoked sudden-onset stabbing back pain earlier that day. The patient then demonstrated bilateral lower extremities weakness while at the emergency department. After extensive diagnostic workup, the patient was diagnosed with anterior spinal artery territory infarction involving the thoracic spinal cord. Minor trauma to the thoracic spinal cord was detected on imaging and was believed to be the culprit of this event.
Discussion
Given the rarity of spinal cord ischemia, a high index of suspicion and extensive workup of patients presenting with clinical weakness are needed for accurate diagnosis and to avoid the eventual poor outcome. With so few reports in the literature regarding spinal cord ischemia in the pediatric population, accurate diagnosis is often delayed until after irreversible events have already taken place. Our case report of anterior spinal artery distribution thoracic cord infarct following a minor trauma was diagnosed by axial thin-slice DWI MRI with an otherwise negative workup.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Cheshire WP, Santos CC, Massey EW, Howard JF. Spinal cord infarction: etiology and outcome. Neurology. 1996. https://doi.org/10.1212/WNL.47.2.321.
Sheikh A, Warren D, Childs AM, Russell J, Liddington M, Guruswamy V, et al. Paediatric spinal cord infarction—a review of the literature and two case reports. Child’s Nerv Syst. 2017;33:671–6. https://doi.org/10.1007/s00381-016-3295-8.
Sandson TA, Friedman JH. Spinal cord infarction: report of 8 cases and review of the literature. Medicine. 1989. https://doi.org/10.1097/00005792-198909000-00003.
Vargas MI, Gariani J, Sztajzel R, Barnaure-Nachbar I, Delattre BM, Lovblad KO, et al. Spinal cord ischemia: practical imaging tips, pearls, and pitfalls. Am J Neuroradiol. 2015;36:825–30. https://doi.org/10.3174/ajnr.A4118.
Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol. 2006. https://doi.org/10.1001/archneur.63.8.1113.
Nance JR, Golomb MR. Ischemic spinal cord infarction in children without vertebral fracture. Pediatr Neurol. 2007. pp. 209–216. https://doi.org/10.1016/j.pediatrneurol.2007.01.006. Accessed 20 Jul 2020.
Mathias E, Sethuraman U. Ischemic stroke of the spinal cord: a pediatric emergency in an otherwise healthy child. J Emerg Med. 2016;51:73–6. https://doi.org/10.1016/j.jemermed.2016.03.001.
Reisner A, Gary MF, Chern JJ, Grattan-Smith JD. Spinal cord infarction following minor trauma in children: fibrocartilaginous embolism as a putative cause: report of 3 cases. J Neurosurg: Pediatr. 2013;11:445–50. https://doi.org/10.3171/2013.1.PEDS12382.
Abecassis IJ, Osbun JW, Kim L. Classification and pathophysiology of spinal vascular malformations. Handbook of clinical neurology. Elsevier B.V. Amsterdam, Netherlands, 2017. pp. 135–143. https://doi.org/10.1016/B978-0-444-63640-9.00013-8. Accessed 23 Jul 2020.
Flores BC, Klinger DR, White JA, Batjer HH. Spinal vascular malformations: treatment strategies and outcome. Neurosurg Rev. 2017. 15–28. https://doi.org/10.1007/s10143-016-0713-z. Accessed 23 Jul 2020.
JAHAN R, VINUELA F. Vascular anatomy, pathophysiology, and classification of vascular malformations of the spinal cord. Semin Cerebrovasc Dis Stroke. 2002;2:186–200. https://doi.org/10.1053/scds.2002.127656.
Geldmacher DSBB. Vascular disease of the nervous system. In: Bradley WG, Daroff RB, Fenichel GMJJ (ed.) Vascular disease of the nervous system. Neurology in clinical practice. Butterworth Heinemann, London, 4th ed. 2004. pp.1313.
Sladky JT, Rorke LB. Perinatal hypoxic/ischemic spinal cord injury. Fetal Pediatr Pathol. 1986;6:87–101. https://doi.org/10.3109/15513818609025927. Accessed 20 Jul 2020
Singer R, Joseph K, Gilai AN, Meyer S. Nontraumatic, acute neonatal paraplegia. J Pediatr Orthop. 1991;11:588–593. https://doi.org/10.1097/01241398-199109000-00005. Accessed 20 Jul 2020.
Brewer LA, Fosburg RG, Mulder GA, Verska JJ. Spinal cord complications following surgery for coarctation of the aorta. A study of 66 cases. J Thorac Cardiovasc Surg. 1972. https://doi.org/10.1016/S0022-5223(19)39832-0.
Michael Wieting J, Krach LE. Spinal cord injury rehabilitation in a pediatric achondroplastic patient: case report. Arch Phys Med Rehabil. 1994. https://doi.org/10.1016/0003-9993(94)90346-8.
Pang D, Wilberger JE. Spinal cord injury without radiographic abnormalities in children. J Neurosurg. 1982. https://doi.org/10.3171/jns.1982.57.1.0114.
Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery. 2004. https://doi.org/10.1227/01.NEU.0000143030.85589.E6.
Choi JU, Hoffman HJ, Hendrick EB, Humphreys RP, Keith WS. Traumatic infarction of the spinal cord in children. J Neurosurg. 1986;65:608–610. https://doi.org/10.3171/jns.1986.65.5.0608. Accessed 23 Jul 2020.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Morshid, A., Jadiry, H.A., Chaudhry, U. et al. Pediatric spinal cord infarction following a minor trauma: a case report. Spinal Cord Ser Cases 6, 95 (2020). https://doi.org/10.1038/s41394-020-00344-8
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41394-020-00344-8
This article is cited by
-
Idiopathic cervical cord infarction in a young girl presenting with acute neck pain and flaccid paralysis: a case report
Spinal Cord Series and Cases (2024)
-
The utility of diffusion-weighted imaging in patients with spinal cord infarction: difference from the findings of neuromyelitis optica spectrum disorder
BMC Neurology (2022)
-
Fibrocartilaginous embolism of the posterior spinal artery: A case report regarding the responsible intervertebral disc on magnetic resonance imaging
Spinal Cord Series and Cases (2022)