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

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.