Ischemic spinal cord infarction in children without vertebral fracture

Pediatr Neurol, 2007 · DOI: · Published: April 1, 2007

Spinal Cord Injury Cardiovascular Science Pediatrics

Simple Explanation

Spinal cord infarction in children is a rare condition that can have devastating long-term consequences. It is caused by obstruction of blood flow, vascular injury, or thrombosis. Diagnosis is often difficult due to the small size of the spinal cord and limitations of MRI. Treatment primarily involves physical therapy and supportive care. This review article summarizes the existing literature on spinal cord infarction in children without vertebral fracture and presents two additional cases, highlighting the diagnostic and management challenges associated with this condition. The causes of spinal cord stroke in children are diverse and different from those commonly seen in adult patients, including cardiovascular issues, trauma, and thrombotic events. However, in many children, the cause remains unknown even after thorough investigation.

Study Duration

1997 to 2005

Participants

Two cases of ischemic spinal cord infarction in children

Evidence Level

Not specified

Key Findings

1
Spinal cord infarction in children can be difficult to distinguish from other myelopathies, such as transverse myelitis, due to similar clinical presentations and MRI findings.
2
MRI allows for increased sensitivity in detecting infarction within the spinal cord. Correct diagnosis of spinal cord infarction requires that the entire spine be imaged in suspicious cases, and that T2- weighted axial and sagittal views are obtained, as well as diffusion-weighted images early in the course to document ischemia.
3
The etiologies of spinal cord infarction in children are diverse, including hypotension, vascular injury, and thrombosis or embolization, but the underlying causes differ from those in adults.

Research Summary

This paper reviews the literature on ischemic spinal cord infarction in children without vertebral fracture and presents two case studies to highlight the difficulties in diagnosis and management. Spinal cord infarction is rare in children and can be caused by various factors, including cardiovascular compromise, trauma, and thrombotic disorders. Diagnosis of spinal cord infarction can be challenging due to the small size of the spinal cord and the limitations of MRI. It is often difficult to differentiate from other myelopathies like transverse myelitis. MRI with axial and sagittal views, along with diffusion-weighted imaging, is crucial for accurate diagnosis. Treatment primarily involves supportive care and physical therapy. Outcomes vary, with some patients showing improvement while others experience death or minimal recovery. Recognizing and addressing the physical and psychosocial complications of spinal cord infarction is essential for optimizing patient outcomes.

Practical Implications

Early Diagnosis

Prompt and accurate diagnosis using advanced MRI techniques (axial, sagittal, and diffusion-weighted imaging) is critical for timely intervention.

Differential Diagnosis

Clinicians should consider spinal cord infarction in children presenting with acute myelopathy, even in the absence of vertebral fracture, and differentiate it from other conditions like transverse myelitis.

Multidisciplinary Management

Comprehensive management involving neurologists, radiologists, physical therapists, and psychosocial support is essential to optimize outcomes for children with spinal cord infarction.

Study Limitations

1
The rarity of pediatric spinal cord infarction limits the availability of large-scale studies and evidence-based treatment guidelines.
2
Diagnostic challenges due to the small size of the spinal cord and potential for MRI artifacts can lead to delayed or missed diagnoses.
3
The study relies on case reports and literature review, which may be subject to publication bias and limited generalizability.

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