Paediatric spinal cord infarction-a review of the literature and two case reports

Abstract

Ischemic spinal cord infarction is rare in the paediatric population, and when it does occur, it is usually associated with traumatic injury. Other potential causes include congenital cardiovascular malformations, cerebellar herniation, thromboembolic disease and infection. Magnetic resonance imaging (MRI) findings can be subtle in the early evaluation of such patients. The outcome is variable and depends on the level and extent of the spinal cord infarct and subsequent rehabilitation. Here, we present two cases of ischemic spinal cord infarction in children.

Keywords: Infarction; Ischaemic; Spinal cord.

Fig. 1

CT Multiplanar reconstruction (MPR) demonstrating the postoperative remodelled calvarium following craniosynostosis surgery

Fig. 2

Initial MRI imaging obtained 2 days following surgical intervention. Imaging assessment was significantly degraded by motion artefact; however, the T2 imaging clearly shows abnormal cord expansion and T2 signal change extending between C2/3 and T2

Fig. 3

Repeat MRI assessment 2 days later confirmed the cord signal abnormality on standard T2 imaging (a) and showed concomitant apparent restriction on HASTE diffusion weighted imaging (DWI) (b) supporting a suspected acute ischaemic insult

Fig. 4

a T2 and b T1 Sagittal MRI of the cervical spine demonstrating diffuse swelling (a, b) and increased T2 signal (a) of the cervical cord substance. Confirmed on axial T2 assessment at the C5 level (c)

Fig. 5

Follow-up MRI at 6 weeks confirms interval volume loss and established myelomalacia on sagittal (a) and axial (b) T2 imaging