Neurologic Abnormalities in Children Presenting With Diskitis

Nussinovitch, Moshe; Sokolover, Nir; Volovitz, Benjamin; Amir, Jacob

doi:10.1001/archpedi.156.10.1052

Cited by 27 publications

(8 citation statements)

References 13 publications

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“…[10][11]15 Cervical discitis has a different clinical picture from lumbar or lower thoracic discitis, which typically presents as pain on flexing the thighs, back pain, pain on walking (young children may refuse to walk), and a progressive limp. 16 In cervical discitis, symptoms include limitation of or painful neck movements, torticollis, and pain on flexion, extension, or rotation of the head, and more profound neurologic deterioration than in lumbar discitis. 16 In cervical discitis, symptoms include limitation of or painful neck movements, torticollis, and pain on flexion, extension, or rotation of the head, and more profound neurologic deterioration than in lumbar discitis.…”

Section: Discussionmentioning

confidence: 99%

“…3 Neurologic findings include decreased muscle strength and hypotonicity. 16 Like in lumbar discitis, however, body temperature and laboratory markers of inflammation (white blood cell count, C-reactive protein, and erythrocyte sedimentation rate) may be normal or only mildly elevated. 16 Like in lumbar discitis, however, body temperature and laboratory markers of inflammation (white blood cell count, C-reactive protein, and erythrocyte sedimentation rate) may be normal or only mildly elevated.…”

Section: Discussionmentioning

confidence: 99%

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Cervical Discitis in Children

Scheuerman

Landau

Schwarz

et al. 2015

Pediatric Infectious Disease Journal

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Cervical discitis, though rare, should be included in the differential diagnosis of torticollis, neck pain and neurodevelopmental regression in motor skills in children and infants. Magnetic resonance imaging is the diagnostic method of choice. Treatment should be conservative with antibiotics only. The aim of this study was to describe the 10-year experience of a tertiary pediatric medical center with cervical discitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cervical Discitis in Children

Scheuerman

Landau

Schwarz

et al. 2015

Pediatric Infectious Disease Journal

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“…5,6 Disc-related pain is generally exacerbated by forward flexion and, in children, generally radiates no further than the thigh or upper leg. 7,8 Except for ESR, which is elevated in 90% of cases with mean values ranging from 43 to 87 mm/h, laboratory studies are rarely helpful. 7,8 Except for ESR, which is elevated in 90% of cases with mean values ranging from 43 to 87 mm/h, laboratory studies are rarely helpful.…”

Section: Discussionmentioning

confidence: 99%

A Toddler Refuses to Walk

Lamb

Starr

Steele

2014

Clin Pediatr (Phila)

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A 15-month-old white female was initially seen by her primary care physician with abnormal gait and fussiness of 5 days' duration. She had gradually stopped walking over the previous 3 days.Initial laboratory examination in the primary care physician's office included a white blood cell count of 10 600/mm 3 , hemoglobin 10.8 g/dL, hematocrit 32.2%, and platelets of 426 000/mm 3 . Electrolytes were normal and the C-reactive protein (CRP) was mildly elevated at 1.6 mg/dL (normal 0-0.5 mg/dL). She was referred to our neurology service and admitted for diagnostic evaluation and management.She had been walking for 3 to 4 months, but now refused to stand or ambulate on her own. When made to stand, her legs would tremble and she would not take any steps. Her mother thought she was primarily favoring her left lower extremity. She cried and had a head lag when being pulled to a sitting or standing position but was comfortable on her parent's lap. The parents thought that she was more comfortable when her back was supported. Two days prior to admission she was unable to sit without support. She had a decreased appetite and decreased urine output along with a 3-day history of constipation. She had no vomiting. Her sleep patterns had changed as well, with frequent waking in the night, worsening over 5 days. The patient had been afebrile and had no history of trauma. She received an influenza vaccine, including H-1, and her 15-month immunizations 16 days earlier.Her most recent viral illness was 5 months prior to admission. Her growth and development were normal. She had a past medical history of eczema, which was being treated with hydrocortisone cream, and an allergy to peanuts manifesting with urticaria (type 1 cutaneous anaphylaxis). She had a 4-year-old brother in preschool who was not ill and she spent weekdays at a babysitter's house with 5 other children who were healthy.On physical examination, her temperature was 99.1°F, pulse 132 beats/min, respirations 24 breaths/ min, and blood pressure 116/61 mm Hg. She was fussy and appeared tired but was in no acute distress. HEENT (head, eyes, ears, nose, and throat) examination showed no decrease in the range of motion of her neck. Her oral cavity and pharynx were normal and there was no significant adenopathy. There was no bone or joint pain and no rashes. On neurologic examination, she was irritable, but alert and responsive for her age. Cranial nerves were intact. There was a head lag. She was unable to maintain posture and stand but could sit with support. However, muscle strength was judged to be 5+ in the upper and lower extremities. Reflexes were brisk and she had negative Brudzinski and Kernig signs. The remainder of the physical examination was normal.Additional laboratory evaluation included an erythrocyte sedimentation rate (ESR) of 65 mm/h (normal 0-20 mm/h) and CRP of 20 units (normal 0-8.2 units). Plain radiographs were negative for fractures; hip ultrasound was negative and a magnetic resonance imaging (MRI) of the brain, spine, and lower extremities was negat...

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“…Childhood spondylodiscitis is an extremely rare entity that often presents as a nonspecific clinical picture that may delay the diagnosis [1][2][3]. It is a combination of discitis which means inflammation of one or more intervertebral disc spaces and spondylitis which means inflammation of one or more vertebrae.…”

Section: Introductionmentioning

confidence: 99%

“…It is a combination of discitis which means inflammation of one or more intervertebral disc spaces and spondylitis which means inflammation of one or more vertebrae. It is also known to extend into the paravertebral soft tissues, the epidural space, meninges, and spinal cord [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Spondylodiscitis with Bronchopneumonia in Infancy: A Rare Entity

Pai¹,

Krishnamurthy²,

Umapathy³

et al. 2015

J Interdiscipl Histopathol

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Childhood spondylodiscitis is an extremely rare entity and accounts for 2-4% in neonates. Respiratory and other site infections are identified as sources of hematogenous spread. A 5-week-old male child was brought to the emergency department with respiratory distress and convulsions. On the evaluation, he had bilateral bronchopneumonia with septicemia and kyphosis. Computed tomography scan demonstrated spondylodiscitis with destruction of T 5-T 6 vertebrae with abscess of right lower lobe of the lung. Subsequently, thoracotomy was done, and a biopsy sent from apical and posterior segments of the lower lobe of the right lung revealed bronchopneumonia, abscess with entrapped dead bony spicules and collapse. Early diagnosis and treatment of respiratory infections are critical as delay may result in vertebral destruction as seen in this case and could lead to potentially life-threatening complications.

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Neurologic Abnormalities in Children Presenting With Diskitis

Abstract: Neurologic impairment does not exclude the diagnosis of diskitis and may be a common manifestation of the disease in children. Nevertheless, when neurologic findings are present, advanced imaging studies are needed to exclude intraspinal involvement.

Cited by 27 publications

References 13 publications

Cervical Discitis in Children

Cervical Discitis in Children

A Toddler Refuses to Walk

Spondylodiscitis with Bronchopneumonia in Infancy: A Rare Entity

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