Undiagnosed Spinal Cord Injuries in Brain-Injured Children

Sneed, Raphael C.; Stover, Samuel L.

doi:10.1001/archpedi.1988.02150090063023

Cited by 8 publications

(5 citation statements)

References 17 publications

(1 reference statement)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Without careful examinations, symptoms and signs of cord dysfunction may be missed or attributed to the coexistent brain injuries. 2,5 Complicating this, serial examinations are required because cord dysfunction may develop subsequent to brain injury presentation. 1 The children may be too unstable to obtain technically adequate films of the bony spine, and SCIWORA may occur in the absence of bony changes.…”

Section: Discussionmentioning

confidence: 99%

Cervical Spinal Cord Injury in Abused Children

Feldman

Avellino

Sugar

et al. 2008

Pediatric Emergency Care

View full text Add to dashboard Cite

Five infants and toddlers who sustained cervical spinal cord injury as the result of child abuse are described. Three cases are previously unreported. Diagnosis was complicated by coexistent brain injuries and their treatments, subtle and/or evolving paralysis, and central cord syndrome, in which arm function is diminished but leg function is preserved. Definitive spinal imaging by magnetic resonance imaging (MRI), computed tomography, and plain radiographs was delayed because of life support efforts. When completed, the MRI was most sensitive to cord injury. Evidence of associated bony spinal injury was often absent or unapparent until healing occurred; 4 children had spinal cord injury without (or with minimal) radiological abnormality. The 3 children presenting to our hospital with cord injury represent 1% of the estimated cases of inflicted head injury seen during a 23-year period.

show abstract

Section: Discussionmentioning

confidence: 99%

Cervical Spinal Cord Injury in Abused Children

Feldman

Avellino

Sugar

et al. 2008

Pediatric Emergency Care

View full text Add to dashboard Cite

show abstract

“…Positive cervical radiographs 0 10 The current consensus is that a three-view radiograph ic study of the neck (anteroposterior, odontoid, and lateral views) should be conducted in all trauma patients if any of the following risk factors are present: (1) physical signs of neck trauma; (2) neck pain; (3) presence of an abnormal neurologic examination (motor, and/or sensory deficit or brain injury precluding a good neurologic examination), or (4) suspected substance abuse [4,7,10,14,16,19]. This claim is supported by the absence of any docu mented reports of an asymptomatic neck injury [4,12,13,23], As a result, algorithms have been established to effi ciently select those pediatric trauma victims for whom cervical spine radiographics are indicated [6,16,21].…”

Section: Clinical Correlationmentioning

confidence: 99%

Isolated Head Injuries versus Multiple Trauma in Pediatric Patients: Do the Same Indications for Cervical Spine Evaluation Apply?

Laham¹,

Cotcamp²,

Gibbons³

et al. 1994

Pediatr Neurosurg

View full text Add to dashboard Cite

Although the recommendations to evaluate possible cervical spine injuries in patients with isolated head injuries are identical to those with multiple trauma, to date, no such study has confirmed that risk factors are the same for both injuries. We reviewed the charts of 268 pediatric patients with isolated head injuries admitted to the Intensive Care Unit at Children’s Hospital Medical Center (1985–1990) to determine which risk factors were present. In this retrospective study, we divided the patients into two groups: low risk and high risk. The low-risk patients (n = 135) were those capable of verbal communication who did not report cervical discomfort. The high-risk patients (n = 133) either were incapable of verbal communication (preverbal or physically unable due to head injury) or reported neck pain. All patients under 2 years of age were considered preverbal and at high risk. The patients in both groups were indistinguishable by age, sex, mechanism of injury, and type of injury sustained. No patient in the low-risk group suffered cervical spine injury. Cervical spine trauma was present in 10 (7.5%) high-risk patients. Using the method of adjusted odds ratio, we found that high-risk patients had 23 times the likelihood of neck injury when compared with low-risk patients (p = 0.003, 95% confidence limit). Our results indicate that cervical spine X-rays (i.e., anteroposterior, odontoid, lateral views) are indicated only in high-risk pediatric patients with head injuries who either complain of neck pain or cannot voice such complaints because of significant head injury or preverbal age. We conclude that isolated pediatric head trauma patients carry the same risk factors for associated neck injuries as do multiple trauma victims. Therefore, indications for radiographic evaluation of suspected cervical spine injuries are the same and similarly performed.

show abstract

“…Spinal pathology in a brain-injured child is difficult to recognise clinically 15 16. The incidence of clinically significant cord injury is uncertain, as there are only isolated case reports or small case series.…”

Section: Discussionmentioning

confidence: 99%