Ischemic spinal cord infarction in children without vertebral fracture

Abstract

Spinal cord infarction in children is a rare condition that is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treatment, and prognosis. The risk factors for pediatric ischemic spinal cord infarction include obstruction of blood flow associated with cardiovascular compromise or malformation, iatrogenic or traumatic vascular injury, cerebellar herniation, thrombotic or embolic disease, infection, and vasculitis. In many children, the cause of spinal cord ischemia in the absence of vertebral fracture is unknown. Imaging diagnosis of spinal cord ischemia is often difficult, due to the small transverse area of the cord, cerebrospinal fluid artifact, and inadequate resolution of magnetic resonance imaging. Physical therapy is the most important treatment option. The prognosis is dependent on the level of spinal cord damage, early identification and reversal of ischemia, and follow-up with intensive physical therapy and medical support. In addition to summarizing the literature regarding spinal cord infarction in children without vertebral fracture, this review article adds two cases to the literature that highlight the difficulties and controversies in the management of this condition.

Figure 1

Patient 1.Digitally enhanced MRI (TR3650.0 / TE 104.0) at 6 months after the event, showing T2 hyperintensity (arrows) in the anterior medulla and along the anterior length of the cord from C2-C5 and at T3 consistent with infarction of the anterior spinal artery territory.

Figure 2

Patient 2.Digitally enhanced MRI (TR 4616.7/ TE 101.184) three months after the event, showing

1. ill-defined central T2 hyperintensity is seen in axial view at mid T6-level

2. enlarged sagittal image of thoracic cord demonstrating central T2 hyperintensity from T5-T8 (arrows) and Schmorl’s node (arrowhead). Infarction down to T10 can be seen on other cuts.