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.     

儿童无骨折脱位型脊髓损伤临床研究

无骨折脱位型脊髓损伤又称为无放射影像骨折脱位脊髓损伤（spinal cord injury without radiologic abnormality,SCIWORA）,是指有些脊髓损伤并不伴有脊柱的骨折脱位,即外力的作用造成了脊髓损伤而没有影像学可见的脊柱骨折脱位等异常发现。因为儿童脊柱的解剖生理特点,儿童SCIWORA较成人多见,但多被诊断急性脊髓炎。1992年1月-2005年4月,我院收治的SCIWORA的患儿12例,报告如下。     

Neonatal spinal cord injury

Neonatal spinal cord injury (SCI) is well described in the literature, though its diagnosis is often delayed or missed in the neonatal period. We present a neonate who was referred with upper gastrointestinal bleed and a diagnosis of spinal cord injury was subsequently made clinically and confirmed radiologically.     

Neonatal spinal cord injury

Neonatal Spinal Cord Injury (SCI) is well described in the literature, though its diagnosis is often delayed or missed in the neonatal period. We present a neonate who was referred with upper gastrointestinal bleed and a diagnosis of spinal cord injury was subsequently made clinically and confirmed radiologically.     

Ischaemic spinal cord injury after cardiac surgery.

The case records of eight children with an acute spinal cord lesion after cardiac surgery were reviewed. All had been operated on for congenital heart disease over the past 10 years. The prognosis for neurological recovery was poor and scoliosis and bladder dysfunction were common complications. Ischaemic cord injury is usually associated with coarctation of the aorta but may occur when surgery is performed for other cardiovascular defects.     

Long-term follow-up of home mechanical ventilation in young children with spinal cord injury and neuromuscular conditions

OBJECTIVES: To provide outcomes of two decades of experience in home ventilation of children with spinal cord injury and neuromuscular conditions. STUDY DESIGN: Data were collected through chart review and interviews on 39 children who had become ventilator-dependent before their 6th birthday; 23 children had neuromuscular diseases and 16 had spinal cord injuries. RESULTS: Patients required an average of 0.7 rehospitalizations per year. There were 8 deaths. Survival rates were 97% at 1 year, 97% at 3 years, 84% at 5 years, and 71% at 10 years. Thirty children attended school, 13 were in regular school (1 at university level), 5 were home-schooled, 5 were in special education schools, and 5 were in regular school with some special education classes. One graduated high school, and another graduated university and received a graduate degree. Three children had progressive weakness. Two gained significant muscle strength. CONCLUSIONS: Our experience showed that these patients can be discharged to home with low morbidity and mortality rates and successful reintegration into the community.     

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.     

Quality of life in children with epilepsy

Quality of life was assessed in 108 epileptic children (6–15 years) using a hindi translation of Quality of Life in Children with Epilepsy (QOLCE) questionnaire. The questionnaire consist of 76 items with 16 subscales covering five domains of life: physical function, social function, cognition, emotional and behavioral well being. Overall score was 62.62±21.32. Chronbach’s-α for all 13 multi-item subscales was above 0.70, indicating good internal consistency and reliability. Pearson correlation revealed good construct validity. Overall quality of life was affected by age, type of epilepsy, seizure frequency and maternal education (P<0.05). Energy levels, language and attention (P<0.05) were better in older children whereas younger children had better self esteem and lower levels of anxiety. Seizure frequency compromised all fields except stigma, attention, and energy levels (P>0.05).     

Intramedullary spinal cord astrocytomas in children

BACKGROUND: Intramedullary spinal cord astrocytomas are uncommon tumors in childhood. There is little information on therapy and outcome of astrocytomas in this location. PROCEDURE: A retrospective review was performed for the 10 children who were treated between 1996 and 2003 for spinal cord astrocytomas in our institution. Only one had metastatic disease. All ten patients underwent surgical resection, nine partial and one total. Eight had low-grade tumors, and two high-grade tumors. Two had surgery only, four had chemotherapy only, two had radiation only, and two had both radiation and chemotherapy. RESULTS: Progression free survival was 58% and survival was 68% at 4 years. Four patients had disease progression, of which three died. Both children with high-grade astrocytomas died. Two of eight of the children with low-grade astrocytomas of the cord recurred, one having received radiation as initial therapy and the other chemotherapy. The child, who relapsed after radiation, had a spastic quadriplegia from radiation myelitis and no salvage therapy was attempted. The four patients, all with low-grade astrocytomas, who treated with chemotherapy alone, received carboplatin and vincristine. Of these four, three are in continuous remission and one relapsed, but was salvaged with radiation. CONCLUSIONS: Chemotherapy and radiation did not benefit those with high-grade astrocytomas of the spinal cord. Good outcomes can be achieved by conservative surgery for low-grade astrocytomas of the cord when adjuvant therapy is given. Carboplatin and vincristine appeared to be effective, safe therapy for those with low-grade astrocytomas of the cord.     

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.     

Traumatic brain and spinal cord injury

The management of pediatric head injuries has evolved over the past decade,and a number of significant advances have been made. Evidence-based guide-lines and algorithms for the management of severe pediatric head injuries have recently been published, and all pediatricians who care for children with severe head injuries should be familiar with these guidelines. It is hoped the guidelines will streamline the clinical management of these children and stimulate future research into the many areas that require further investigation.     

Lumbar spinal cord motion measurement with phase-contrast MR imaging in normal children and in children with spinal lipomas

We assessed the normal movement of the lumbar spinal cord using phase-contrast MR imaging, and also the movement of the spinal cord in patients with spinal lipoma pre- and postoperatively. Phase-contrast MR imaging proved to be a valuable tool in this context.This paper was selected for publication by an International Committee at the ESPR meeting in Brussels, 1994.