Multidisciplinary Management of Acute Tetraparesis in an Infant with Achondroplasia, with a Focus on Anesthetic Strategies: A Case Report

Children, 2025 · DOI: https://doi.org/10.3390/children12020164 · Published: January 29, 2025

Simple Explanation

This case report describes the management of a 1-year-old with achondroplasia who developed acute tetraparesis (weakness in all four limbs) after a whiplash injury. The report focuses on the anesthetic strategies used during surgery to address the patient's condition. The infant had a reduced volume of the posterior fossa, foramen magnum stenosis (narrowing of the opening at the base of the skull), and ventriculomegaly (enlarged ventricles in the brain). MRI revealed signal changes in the medulla oblongata and cervical spinal cord. Microsurgical posterior fossa decompression was performed two weeks post-injury. Airway management was achieved using video laryngoscopy and fiberoptic bronchoscopy after an unsuccessful intubation attempt with a fiberoptic bronchoscope.

Study Duration

Not specified

Participants

A 1-year-old boy with achondroplasia

Evidence Level

Level 4: Case Report

Key Findings

1
A multidisciplinary approach is crucial for managing children with achondroplasia, especially those with foramen magnum stenosis and cervical spine injuries.
2
Anesthetic management required meticulously planned airway strategies using advanced techniques like video laryngoscopy and fiberoptic bronchoscopy to reduce airway risks.
3
Conservative therapy paired with timely neurosurgical intervention resulted in the patient’s full recovery.

Research Summary

This report details a rare instance of an infant with achondroplasia developing acute tetraparesis after a cervical whiplash injury, highlighting key multidisciplinary management considerations and specific anesthetic strategies to mitigate potential risks. The patient exhibited complete remission of neurological symptoms by the third postoperative month during follow-up. Anesthetic management required meticulously planned airway strategies using advanced techniques like video laryngoscopy and fiberoptic bronchoscopy to reduce airway risks.

Practical Implications

Multidisciplinary Care

Highlights the importance of a coordinated team approach involving pediatricians, neurosurgeons, anesthesiologists, and other specialists in managing children with achondroplasia.

Airway Management Planning

Emphasizes the need for careful preoperative assessment and planning of airway management strategies, considering the anatomical challenges associated with achondroplasia.

Surgical Timing

Suggests a strategy of delayed surgical decompression, similar to the management of acute traumatic central cord syndrome, to minimize the risk of intraoperative lesioning and allow for edema resolution.

Study Limitations

1
Single case report limits generalizability.
2
Sparse information on the child’s medical management prior to the trauma.
3
Optimal management of patients with acute neurological injury resulting from a stenotic foramen magnum in achondroplasia has yet to be standardized in the literature.

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