Delayed Traumatic Spinal Cord Injury in a Pediatric Patient: A Case Report

Case Diagnosis: 3 year old male with acute flaccid cervical quadriplegia

Case Description or Program Description: Prior to presentation, the patient was standing on a chair and had a mechanical fall to the floor witnessed by his mother. He did not have loss of consciousness and immediately following the event, he remained at baseline. He went to sleep supine and upon waking six hours later, he was unable to move his extremities. He presented to the ED with flaccid upper extremities and some return of lower extremity movement. CT Head and C-Spine were negative for any acute process. MRI Brain and C-Spine revealed increased T2 signal from the cervical medullary junction extending to T1.

Setting: Tertiary Care Pediatric Hospital

Assessment/Results: It was determined by Neurology and Neurosurgery teams that MRI findings were most consistent with spinal cord contusion in the context of a sudden hyperextension event. However, he was treated empirically for possible transverse myelitis with steroids and IVIG given his abnormal presentation. He was admitted to inpatient rehabilitation service for one month where he demonstrated continued progress in physical and occupational therapies. During this time, tone increased and spasticity developed. At 10 month follow up, he continued to gain independence in ADLs and demonstrate functional progress in all four extremities, though remains wheelchair dependent.

Discussion (relevance): Delayed traumatic spinal cord injury is characterized by the onset of new neurologic deficits hours to days after the initial injury. Literature regarding this diagnosis in the pediatric population remains limited, with only a few reported cases to date.

Conclusions: Delayed traumatic spinal cord injury is a rare but serious condition that can lead to permanent neurologic deficits. Prompt recognition and treatment are essential for improving outcomes. Further research is needed to better understand the pathophysiology and optimal management of this condition in children.