INTRODUCTION
Pediatric non-traumatic spinal cord infarction is very uncommon condition and difficult to diagnose. The spinal cord infarction can be either ischemic or hemorrhagic. There are some etiologic causes for non-traumatic spinal cord infarction such as cardiovascular cause, thrombosis or embolism, infection, and vascular inflammation. The reporting case is about pediatric non-traumatic spinal cord infarction and following successful rehabilitation process.
CASE REPORT
A 12-year-old female began to feel abrupt low back pain for two days and subsequent weakness and pain of both lower extremities. She was not able to stand independently and voided unintentionally. She previously had upper respiratory infection with cough and rhinorrhea a month before the symptoms onset. She had no genetic family history or previous medication history. Initial physical examination at first visit to hospital indicated weak motor grades as poor grades in hip flexors, both knee extensor and ankle dorsiflexors, but normal sensory. Bilateral knee jerks and ankle jerks were hypoactive, however there was no pathologic reflex elicited in both legs. She underwent an extensive work-up for infection diseases and demyelinating diseases. Lumbar puncture study was unremarkable. With a presumptive diagnosis of either transverse myelitis or acute inflammatory demyelinating polyneuropathy, pediatric neurologist started methylprednisolone pulse therapy for three days. Following MR imaging study revealed T2 hyperintensity with diffusion restriction in T12 to conus medullaris which indicated spinal cord infarction in high probability (Fig 1. and Fig 2.). After 26 days after admission to the clinic, she was transferred to rehabilitation unit. Follow-up motor grades of both legs were as follows: L2 3/3, L3 3/3, L4 4/4, L5 3/4 and S1 1/1. Anal sense was positive bilaterally, but voluntary anal contraction was absent. Neither anal reflex nor clitocavernous reflex were absent. Neurologic level of injury was L3 paraplegia AIS D. Urodynamic study revealed acontractile detrusor function, and the patient start intermittent catheterization for void (Fig 3.). She discovered newly onset of neuropathic pains of both legs, which were well controlled with low dose of gabapentin. Calcaneal gait pattern was obvious, and the rehabilitation was focus on gait training with strengthening of both lower extremities. With rapid recovery, she uses walking aids, walker or bilateral Lofstrand crutches, for ambulation.
COMMENTS
Although average prognosis of spinal cord infarction is very severe, pediatric spinal cord infarction seems to be quite reversible on account of unknown reason. Plasticity after infarction might give a rough explanation.
|
