3 year old boy is brought into ED T:98.9F P:90 R:19 BP:90/64 by parents after being sent by O2:99% pediatrician for new onset lower extremity weakness. Per the parents, the child is normally Gen: well appearing, NAD active, but woke up this morning HENT: no contusion;ecchymosis and was unable to get out of bed Chest/Resp:nml of his own accord. With further questioning, mom relates that MSK:no obvious abnormalities he fell out of his high chair 2 Neuro: 2/5 MS in bil LE with days ago but has been behaving decreased sensation to fine normally since this time. He has touch no history of seizures and mom denies that he struck his head Of note, child is unable to void during the incident.
Standard cervical spine films demonstrate no appreciable abnormality. CT scan of entire c/t/l spine and head=nml. Family receives dx of SCIWORA and child admitted to nsgy for MRI and further work up
ABC’s / standard work up including probable ct scans to r/o obvious osseous abnormalities. Studies have shown that high dose methylprednisolone if administered within 8 hours of injury is beneficial—but pro’s and con’s must be weighed (i.e. immunosuppression, etc.) Will ultimately need an MRI and inpatient evaluation by neurosurgery.
Occurs most often in pediatric population <8yo Thought to be due to elasticity of pediatric cervical spine. Is diagnosis of exclusion and will likely need MRI to evaluate for cord edema vs. ligamental injury May have up to a 4 day delay in presentation Needs an obs admission and nsgy consult. Keep neck immobilized.
http://www.wheelessonline.com/ortho/sciwora_syndr ome_spinal_cord_injury_wo_radiologic_abnormality Hauda, W.E. Tintinalli’s Emergency Medicine: A Comprehensive study Guide. Chapter 252: Pediatric Trauma. Veena, K., et al. SCIWORA-Spinal Cord Injury Without Radiological Abnormality. Indian J Pediatr 2006; 73 (9) : 829-831