Spinal cord ischemia revealed in the context of altered consciousness: A pediatric case report

Sarah Cellauro , Christian Korff , Maria Brunella Cipullo , Maria Isabel Vargas , Angelo Polito , Tiphaine Corbisier
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Abstract

Background

Spinal cord ischemia (SCI) is a rare but often devastating vascular disorder that may be caused by one of several etiologies and may be challenging to diagnose.

Case presentation

The patient exhibited alarming symptoms, including profound fatigue, altered consciousness, and hypercapnia, necessitating intubation. Notably, urinary retention was present, and initial investigations, including a normal brain computed tomography (CT) scan and lumbar puncture, failed to elucidate the underlying issue. Subsequent spinal magnetic resonance imaging (MRI) revealed a cervical spinal cord T2 hyperintensity, accompanied by signal restriction on diffusion-weighted sequences (DWI), leading to the diagnosis of SCI. Following this, the patient developed left hemiplegia. However, the clinical presentation exhibited a swift improvement, and complete resolution occurred within a week under the administration of intravenous steroids.

Discussion/conclusion

This case underscores the diagnostic challenge posed by SCI, particularly in the pediatric population. The swift response to intravenous steroids suggests a potential inflammatory component, implicating vasospasm or a minor spinal artery lesion. The suspected connection to prior microtrauma to the cervical spine during physical activity highlights the importance of considering vascular complications in the context of sports-related injuries. This report contributes to the understanding of SCI in children and emphasizes the need for heightened awareness among healthcare professionals when encountering similar clinical scenarios.

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意识改变时显示脊髓缺血:儿科病例报告
背景脊髓缺血(SCI)是一种罕见但往往具有破坏性的血管疾病,可能由多种病因之一引起,诊断起来很困难。病例介绍患者表现出令人震惊的症状,包括极度疲劳、意识改变和高碳酸血症,因此必须插管治疗。值得注意的是,患者出现了尿潴留,而最初的检查,包括正常的脑部计算机断层扫描(CT)和腰椎穿刺,都未能阐明根本问题。随后的脊髓磁共振成像(MRI)显示颈椎脊髓T2高密度,伴有弥散加权序列(DWI)信号受限,从而诊断为SCI。随后,患者出现左侧偏瘫。然而,患者的临床表现迅速好转,在静脉注射类固醇后一周内症状完全消失。对静脉注射类固醇的迅速反应表明可能存在炎症因素,牵涉到血管痉挛或脊髓小动脉病变。怀疑与之前在体育活动中对颈椎造成的微小创伤有关,这强调了在考虑运动相关损伤时考虑血管并发症的重要性。本报告有助于人们了解儿童 SCI,并强调医护人员在遇到类似临床情况时需要提高警惕。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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