Spinal cord infarction in a sick neonate from predominant haemorrhagic aetiology: a case report

Abstract

Introduction: Spinal cord injuries in new born infants following a traumatic delivery or umbilical cord catheterisation due to thromboembolism are well known. Cases with atraumatic acute onset of neonatal paraplegia have also been described in preterm babies or babies born small for gestational age with a stormy postnatal course related to ischaemic aetiology. We describe a rare case of infarction of the spinal cord from a predominant haemorrhagic aetiology.

Case presentation: A term female baby, first child of unrelated parents, was born by normal vaginal delivery. She had meconium aspiration at birth, leading to severe respiratory distress, requiring neonatal intensive care admission. At 2 weeks, she developed new flaccid paraplegia. MRI scan of the spine showed haemorrhagic infarction of the spinal cord from the level of thoracic inlet, vertebral level C7-T1. A follow-up MRI scan at 11 months revealed severe atrophy of the cord distal to C6. At 3 years of age, she had good upper-limb function, diaphragmatic breathing and flaccid paralysis of lower limbs.

Discussion: In an acutely unwell term infant with symptoms of paralysis or spinal cord damage, haemorrhagic infarction needs to be considered in the differential diagnosis. To our knowledge, this is the first reported case of spinal cord injury in a term infant with a haemorrhagic lesion, and it helps to understand the pathogenesis of nontraumatic insult.

Keywords: Acute inflammation; Risk factors.

Figure 1

MRI features of the spinal cord. (1a) Sagittal T2W, (1b) T1W and (1c) Gadolinium enhanced T1W MR images 24 h post paralysis show a swollen cord at the cervicothoracic junction. The post contrast image (1c) also shows an abrupt junction between viable and infarcted cord at the C7 level (arrow). (1d) The axial T2W MR image at T3 (thoracic) level shows a swollen cord with intramedullary high signal. The appearances are consistent with infarction at the cervicothoracic junction. On the (1b) T1W weighted images there is high signal in the spinal canal at multiple thoracic and lumbar levels, which could be due to haemorrhage. (2a) Sagittal T1W, (2b, 2c) consecutive sagittal T2W MR images 11 months later show atrophic change and abrupt termination of cord (arrow) at the C6 level. Below this level, no cord tissue can be seen. Also note that there is low signal along the dura throughout the thoracic and lumbar spine suggestive of hemosiderin possibly a result of old haemorrhage.