Lumbar spinal cord injury without radiological abnormality in a child: an exceptional form of presentation

SCIWORA is an uncommon syndrome affecting mainly children and is defined as the occurrence of acute spinal cord injury despite normal plain radiography and normal computed tomography (CT). Lumbar SCIWORA is very rare in children, and to our knowledge, there is only one report of lumbar SCIWORA in the literature. We present the case of a 5 year-old boy who suffered acute bilateral lower limbs paralysis, associated to urinary and bowel incontinence following a 1.5 meter fall. Lumbar cord contusion could be demonstrated on MRI without other radiologic abnormalities, which confirmed SCIWORA diagnosis. Our case report illustrates the potential seriousness of this disease and the importance of a thorough and accurate clinical history for diagnosis.     

Traumatic spinal epidural hematoma-unusual cause of torticollis in a child

Traumatic spinal epidural hematoma is rare in children. The presentation could be nonspecific, leading to a delay in diagnosis. We present an infant who sustained an epidural hematoma after a "trivial" injury. The delay in diagnosis led to minor neurological deficit at 6-week follow-up. Irritability and torticollis after a neck trauma in an afebrile child should alert to the possibility of spinal cord compression. Early imaging and early decompression will minimize morbidity.     

Chronic spinal epidural hematoma in hemophilia A in a child

A case of chronic spinal epidural hematoma in a thirteen-year-old male, subsequently found to have hemophilia A is reported. Following myelography, surgery was undertaken with clotting factor replacement with relief of cord compression. The patient made an uneventful recovery.     

In utero spontaneous cervical thoracic epidural hematoma imitating spinal cord birth injury

A neonate male born cesarian due to a breech presentation was noted to have no spontaneous movements of the limbs after delivery. Radiographs were not demonstrative of pathology. However, MRI revealed a large intraspinal mass with significant distortion of the cervicothoracic spinal cord. At operation, a brown, fibro-gelatinous, moderately adherent mass was evident extradurally dorsal to the spinal cord. It was noted to extend anterolaterally to the left such that the cord was deviated anteriorly and to the right. There was no indication of the mass being under pressure but the cord was not pulsatile. There was sufficient mass to the anterolateral component of the cord that it appeared rotated to the right within the canal. The right cervical roots exited dorsally, with a markedly lengthened course through the spinal canal before exiting above their respective pedicles. Histology was that of blood clot. The patient clinically demonstrated no neurologic improvement post-operatively. Now, six months after surgery, the patient has still had no significant change in clinical function. To our review, this is the first reported case of a spontaneous spinal epidural hematoma mimicking a birth-related spinal injury.     

Corticosteroid-induced spinal epidural lipomatosis in the pediatric age group: report of a new case and updated analysis of the literature

Spinal epidural lipomatosis is a rare complication of chronic corticosteroid treatment. We report a new pediatric case and an analysis of this and 19 pediatric cases identified in the international literature. The youngest of these combined 20 patients was 5 years old when lipomatosis was diagnosed. Lipomatosis manifested after a mean of 1.3 (+/- 1.5) years (SD) (median, 0.8 years; range, 3 weeks - 6.5 years) of corticosteroid treatment. The corticosteroid dose at the time of presentation of the lipomatosis ranged widely, between 5 and 80 mg of prednisone/day. Back pain was the most common presenting symptom. Imaging revealed that lipomatosis almost always involved the thoracic spine, extending into the lumbosacral region in a subset of patients. Predominantly lumbosacral involvement was documented in only two cases. Although a neurological deficit at presentation was documented in about half of the cases, surgical decompression was not performed in the cases reported after 1996. Instead, reducing the corticosteroid dose (sometimes combined with dietary restriction to mobilize fat) sufficed to induce remission. In summary, pediatric spinal epidural lipomatosis remains a potentially serious untoward effect of corticosteroid treatment, which, if recognized in a timely manner, can have a good outcome with conservative treatment.     

Birth injury to the spinal cord

11 cases of children with birth injury to the spinal cord born between 1960 and 1970 are presented in review and compared to about 200 previously published cases. 8 children presented at delivery with one or both feet and 2 with breech. 9 of these infants were born by difficult extraction and needed resuscitation due to primary asphyxia. One child had an easy vertex delivery without evident risk. Diagnosis was established within the first days of life, based on flaccid motor and sensory paralysis below a defined level, mostly in the cervical or upper thoracic spine, with bladder and bowel paralysis, and confirmed by autopsy or by follow-up study. One child with disruption of the spinal cord above C4 survived only a few hours despite artificial ventilation. 4 children died within the first three years of life, 3 of them due to acute pneumonia. 5 of 6 surviving children were followed regularly and are now 10 to 18 years old. They are ambulant with crutches and are well integrated in their families. 4 children attend normal school, and one girl gets special training for mentally retarded children.     

A dumbbell spinal lipoma presenting as a neck mass: CT and MR demonstration

A case of histologically confirmed spinal lipoma without associated spinal dysraphism is presented. This tumor appeared lobulated, extending through an enlarged neuroforamen to form a so-called dumbbell tumor. In a review of the literature, there were found to be only four case reports of a dumbbell spinal lipoma. Our case was unique in that it manifested as a neck mass without neurological deficits. The fatty nature of the tumor allowed easy detection by computed tomography (CT), as well as by magnetic resonance (MR) imaging. MR is judged to be superior to CT for preoperative planning by virtue of its superb intraspinal capability, and should be the procedure of choice for evaluating spinal lipomas.     

Nontraumatic acute and subacute enhancing spinal epidural hematoma mimicking a tumor in a child

We describe a 10-year-old boy who presented with acute onset of neck pain and neurologic symptoms caused by a spinal epidural hematoma. An enhancing mass, which mimicked a tumor, was seen on MR imaging of the cervical spine. The uptake of gadolinium in the mass and the associated mass effect suggested a tumor etiology. Such spinal epidural hematomas are extremely rare in the pediatric population. Additionally, it is even more uncommon for spinal epidural hematomas to resemble tumors. It is important to consider this entity when an enhancing epidural mass is found on MRI in the setting of an acute presentation.     

Characteristics of pediatric-onset spinal cord injury

Background:  Although children rarely experience spinal cord injuries (SCI), those who do are subject to various lifelong disabilities and morbidities. The aim of the present study was to retrospectively assess the characteristics of pediatric onset SCI patients and their differences among age groups.
Methods:  Clinical characteristics were compared in 48 patients who experienced SCI during childhood and adolescence and who underwent rehabilitation treatment. Clinical characteristics were compared in patients under 4 years old (group A), 4–12 years old (group B), and 13–18 years old (group C) at SCI onset. Radiological findings were compared in 20 patients who were examined on both plain radiograph and computed tomography.
Results:  The overall male : female ratio was 3:2, with SCI due to non-traumatic causes more frequent overall. Of traumatic causes of SCI, vehicle accident was the most frequent. Of non-traumatic causes, congenital anomaly was most frequent in group A, but tumors became dominant as age increased. Overall, thoracic cord level of injury was most frequent. SCI without radiologic abnormalities (SCIWORA) was predominant in group A, but none was observed in group C. Spinal fractures with or without subluxation accounted for >60% of group C SCI.
Conclusions:  Non-traumatic, thoracic cord injury was frequent in the pediatric SCI population. SCIWORA was predominant in younger children.     

Cervical spinal cord injury in abused children

Five infants and toddlers who sustained cervical spinal cord injury as the result of child abuse are described. Three cases are previously unreported. Diagnosis was complicated by coexistent brain injuries and their treatments, subtle and/or evolving paralysis, and central cord syndrome, in which arm function is diminished but leg function is preserved. Definitive spinal imaging by magnetic resonance imaging (MRI), computed tomography, and plain radiographs was delayed because of life support efforts. When completed, the MRI was most sensitive to cord injury. Evidence of associated bony spinal injury was often absent or unapparent until healing occurred; 4 children had spinal cord injury without (or with minimal) radiological abnormality. The 3 children presenting to our hospital with cord injury represent 1% of the estimated cases of inflicted head injury seen during a 23-year period.     

Traumatic spinal cord injury: unusual recovery in 3 children

We report on 3 children with traumatic spinal cord injury. All of them had normal x-rays of the vertebral column. There were no abnormalities of the spinal cord in myelography or magnetic resonance imaging. Although these situations are often associated with a poor neurological prognosis, we observed very unusual recoveries in these 3 cases.     

Case report: injury of the spinal cord at birth.

Spinal cord injury may occur as a severe complication to delivery. In the vast majority of such cases the injury results from a traumatic breech delivery, but cases of injuries after cephalic presentation and fetal malposition have also been described. Two cases were reported. One of the infants died at the age of 8 months and neuropathological examination of the brain and spinal cord was performed. The other child, now 6 years old, is still alive. Incidence, mechanism of injury, clinical and morphological features, and treatment are briefly discussed.     

Symptomatic Langerhans-cell-histiocytosis of the cervical spine in a child: case report

We report on a six year old female presented with a painful torticollis and a hemidysaesthesia caused by destruction of the third cervical vertebra and a paravertebral soft-tissue mass. At diagnostic routine finally a biopsy gives the diagnosis of Langerhans cell histiocytosis. In a second open approach the destructed vertebral body was replaced by a precisely adjusted autologous bone interponate and the patient was maintained in halo vest immobilisation. The outcome is described and an overview of the current literature is given.     

Prothrombin G20210A mutation in a child with spinal cord infarction.

Prothrombin G20210A is a newly described common mutation that is associated with an increased risk of arterial and venous thrombosis. We describe a healthy child heterozygous for this prothrombin mutation who had a spinal cord infarct with no other prothrombotic risk factors.     

Upper cervical spinal cord injury in neonates: the use of magnetic resonance imaging

Neonatal upper cervical spinal cord injury is associated with rotational forceps delivery and presents with quadriparesis and diaphragmatic paralysis. The underlying pathology determines neurologic outcome but is difficult to assess clinically or with simple radiographic techniques. We report 4 cases in which early magnetic resonance imaging demonstrated the extent and severity of the injury and guided management.     

Spinal epidural abscess in a young child

This is a case report of a spinal epidural abscess, caused by Staphylococcus aureus, in a 3-year-old girl. The child presented with fever and hip pain, but without any neurologic deficit. After normal plain films and a normal bone scan were obtained, the diagnosis was made via magnetic resonance imaging (MRI). The neurosurgery and pediatric infectious disease teams evaluated the patient, and the decision was made to forego surgical drainage and to treat medically with appropriate intravenous and then oral antibiotics. Several months later, the child was doing well without any signs of neurologic sequelae. Because of the rarity of this disease in children, the treatment guidelines are controversial. Many suggest that a spinal epidural abscess must be drained surgically. Our experience adds to the literature a case of a child successfully treated with antibiotics alone. We believe that this success is related to the fact that the child was diagnosed by MRI early in the course of the disease and that she never displayed any neurologic deficits.