Paediatric spinal cord infarction—a review of the literature and two case reports

Sheikh, Asim; Warren, Daniel; Childs, Anne‐Marie; Russell, John L.; Liddington, Mark; Guruswamy, Velupandian; Chumas, Paul

doi:10.1007/s00381-016-3295-8

Cited by 18 publications

(13 citation statements)

References 25 publications

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“…There was 1 instance of excessive blood transfusion (involving a patient with hemophilia A). The only major morbidity was a case of quadriparesis in a patient with unexpected postoperative cervical cord ischemia (described elsewhere 33 ). No patient died.…”

Section: Complicationsmentioning

confidence: 94%

A proposal for a new classification of complications in craniosynostosis surgery

Shastin¹,

Peacock²,

Guruswamy

et al. 2017

PED

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OBJECTIVEComplications have been used extensively to facilitate evaluation of craniosynostosis practice. However, description of complications tends to be nonstandardized, making comparison difficult. The authors propose a new pragmatic classification of complications that relies on prospective data collection, is geared to capture significant morbidity as well as any “near misses” in a systematic fashion, and can be used as a quality improvement tool.METHODSData on complications for all patients undergoing surgery for nonsyndromic craniosynostosis between 2010 and 2015 were collected from a prospective craniofacial audit database maintained at the authors' institution. Information on comorbidities, details of surgery, and follow-up was extracted from medical records, anesthetic and operation charts, and electronic databases. Complications were defined as any unexpected event that resulted or could have resulted in a temporary or permanent damage to the child.RESULTSA total of 108 operations for the treatment of nonsyndromic craniosynostosis were performed in 103 patients during the 5-year study period. Complications were divided into 6 types: 0) perioperative occurrences; 1) inpatient complications; 2) outpatient complications not requiring readmission; 3) complications requiring readmission; 4) unexpected long-term deficit; and 5) mortality. These types were further subdivided according to the length of stay and time after discharge. The overall complication rate was found to be 35.9%.CONCLUSIONSThe proportion of children with some sort of complication using the proposed definition was much higher than commonly reported, predominantly due to the inclusion of problems often dismissed as minor. The authors believe that these complications should be included in determining complication rates, as they will cause distress to families and may point to potential areas for improving a surgical service.

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Section: Complicationsmentioning

confidence: 94%

A proposal for a new classification of complications in craniosynostosis surgery

Shastin¹,

Peacock²,

Guruswamy

et al. 2017

PED

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“…The overall reported outcomes for cases of AFM vary but with most patients suffering from persistent motor deficits. There have been rare reports of recovery 1 2 31 36 40. The time course of recovery is also variable with some patients demonstrating continued improvement even after 12 months of symptom onset 1 2 26 27 40.…”

Section: Discussionmentioning

confidence: 99%

“…AFM is often more asymmetric with the affected limb being persistently areflexic, and sensory symptoms are much less prominent or absent. Acute spinal cord infarction can be differentiated from AFM by the hyperacute onset in stroke as well as the absence of CSF pleocytosis, absence of viral prodrome and the presence of stroke risk factors or trauma 27 31. Spinal cord infarcts are extremely rare in children and, when they do occur, they typically affect the thoracic region of the cord due to tenuous blood supply in this region as opposed to the cervical cord, which is most commonly affected in AFM 31…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Update on acute flaccid myelitis: recognition, reporting, aetiology and outcomes

Hardy

Hopkins

2020

Arch Dis Child

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Acute flaccid myelitis, defined by acute flaccid limb weakness in the setting of grey matter lesions of the spinal cord, became increasingly recognised in 2014 following outbreaks in Colorado and California, temporally associated with an outbreak of enterovirus D68 respiratory disease. Since then, there have been biennial increases in late summer/early fall. A viral infectious aetiology, most likely enteroviral, is strongly suspected, but a definitive connection has yet to be established. Patients typically present with asymmetric weakness, maximal proximally, in the setting of a febrile illness. MRI demonstrates T2/FLAIR abnormalities in the central grey matter of the spinal cord, and cerebrospinal fluid typically shows a lymphocytic pleocytosis with variable elevation in protein. The weakness may be progressive over several days and involve respiratory muscles, making early recognition and close monitoring essential. Other complications in the acute period may include autonomic instability and bowel/bladder involvement. There is no clear recommended treatment at this time, although intravenous immunoglobulin, steroids and plasma exchange have been used. Intensive therapies and rehab services have shown benefit in maximising function, and surgical interventions may be considered in cases without optimal response to therapies. Close attention should also be paid to psychosocial factors. Prognosis is generally guarded, and additional factors that predict final outcome, including host factors and treatment effects, have yet to be elucidated. Multicentre collaborative efforts will be required to provide answers about this rare but serious disorder.

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“…Vasospasm can arise from hyperflexion injuries, which may be complicated by poor spinal cord pressure autoregulation leading to ischemia. 2,6 In adults, the mechanism of infarct is often secondary to traditional vascular/atherosclerotic risk factors, aortic injury, systemic hypotension, or cardioembolic event. [7][8][9] Our patient had a thorough workup to rule out vascular risk factors for spinal cord infarct, which was unrevealing.…”

Section: Discussionmentioning

confidence: 99%

“…Rapidly progressive non-traumatic paraplegia in a child is uncommonly encountered in clinical practice, 1 but is an important presentation to consider given the potential for significant morbidity. 2 The diagnosis highly depends on clinical time course, associated symptoms, and examination findings; which appropriately guides additional clinical management and prognosis.…”

Section: Introductionmentioning

confidence: 99%

Rapidly Progressive Paraplegia in an 11-Year-Old Girl: A Case of Spinal Cord Infarction and Expected Imaging Findings

Neth

Hewitt

Edlund

et al. 2020

Child Neurology Open

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Rapidly progressive non-traumatic paraplegia in a child is uncommonly encountered in clinical practice, but is an important presentation to consider given the potential for significant morbidity. We present the case of an 11-year-old girl who was found to have hyperacute paraplegia due to spinal cord infarction. We discuss the appropriate workup, differential diagnosis in children and how this relates to adults; and describe the prognosis and current state of management options for spinal cord infarction.

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Paediatric spinal cord infarction—a review of the literature and two case reports

Cited by 18 publications

References 25 publications

A proposal for a new classification of complications in craniosynostosis surgery

A proposal for a new classification of complications in craniosynostosis surgery

Update on acute flaccid myelitis: recognition, reporting, aetiology and outcomes

Rapidly Progressive Paraplegia in an 11-Year-Old Girl: A Case of Spinal Cord Infarction and Expected Imaging Findings

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