Acute flaccid neonatal paraplegia

Haldeman, Scott; Fowler, Glenn W.; Ashwal, Stephen; Schneider, Sanford

doi:10.1212/wnl.33.1.93

Cited by 22 publications

(4 citation statements)

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“…Umbilical artery catheters can cause spinal cord infarction in neonates [33][34][35][36], usually due to disruption of the artery of Ademkiewitcz, a major artery of the thoracic cord. Damage to this artery with resulting spinal cord infarction has also been reported in one child during the removal of a thoracic neuroblastoma [37].…”

Section: Causes Of Spinal Cord Infarction In Childrenmentioning

confidence: 99%

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Nance

Golomb

2007

Pediatric Neurology

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Spinal cord infarction in children is a rare condition which is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treament 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 inujury, 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 MRI. 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 which highlight the difficulties and controversies in the management of this condition.

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Section: Causes Of Spinal Cord Infarction In Childrenmentioning

confidence: 99%

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Nance

Golomb

2007

Pediatric Neurology

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“…Catheters in these positions have been associated with refractory hypoglycemia (infusion into the celiac axis) [42], paraplegia (infusion into the artery of Adamkievicz) [43], and thromboses that affect the kidneys (infusion into the renal arteries) or the gut (infusion into the mesenteric arteries). A catheter that is found in this intermediate position should be pulled to a ''low'' position or removed.…”

Section: Umbilical Artery Cathetersmentioning

confidence: 99%

Intravascular Catheter Complications in the Neonatal Intensive Care Unit

Hermansen

2005

Clinics in Perinatology

192

117

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“…In the present group there was a possible causal association between UAC and SCI in only three of the 12 patients in whom this procedure was performed; in the others, the cord symptoms predated the UAC insertion. Among the 10 patients reported previously with paraplegia as a potential complication of UAC (Aziz et al 1973, Dulac and Aicardi 1975, Krishnamoorthy et al 1976, Haldeman et al 1983, Brown and Phibbs 1988, Munoz et al 1993), the following events were recorded before catheter placement: acute respiratory distress syndrome (N=6), sepsis (N=1), cardiac arrest (N=2), ABO incompatibility (N=2), severe congenital heart disease (N=1), and rhesus haemolytic disease (N=1). Although emboli from an umbilical catheter may have produced the myelopathy in these infants, the distribution of their lesions as determined clinically (corresponding to the region of maximum vulnerability to hypoxic-ischaemic insult) and the events preceding the UAC placement suggest that spinal cord infarcts and UAC placement are not always causally associated.…”

Section: Discussionmentioning

confidence: 99%

Spinal cord insults in the prenatal, perinatal, and neonatal periods

Ruggieri¹,

Pike

1999

Develop Med Child Neuro

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We investigated the features of children with spinal cord insults (SCI) occurring in the pre‐, peri‐, and neonatal periods by sending 340 questionnaires to all paediatric neurologists, paediatric urologists, and neonatologists in the UK and Ireland. We requested information about timing, nature, and level of SCI in their patients; family and maternal history; pregnancy, delivery, and neonatal period; clinical presentation, imaging, laboratory studies, and outcome. Two‐hundred and sixty‐one questionnaires were returned with data on 58 patients with SCI. Seven out of the 58 children with SCI had pure dysraphic cord syndromes and were excluded. Fifty‐one patients (33 males, 17 females, one unknown), born between 1972 and 1996, remained. Clinical presentations included severe respiratory failure (N=20; five of whom died neonatally) and hypotonia or weakness recognized either during the neonatal period (N=12) or after 28 days (N=10). Data on clinical presentation were not given in nine cases. Lesions were cervical (N=22) and thoraco‐lumbar (N=29). SCI was ascribed to ischaemia (N=12), trauma (N=4), and other associated underlying conditions (N=11), whilst the aetiology was unknown in 24 cases. Mean gestational age (36.2 weeks) and birthweight (2.6 kg) were lower than previously reported with the lowest figures associated with thoraco‐lumbar and ischaemic lesions. More males were affected by lesions than females and the incidence of preterm delivery, multiple pregnancy, breech presentation, forceps delivery, and caesarean delivery were higher than average. Forceps delivery was associated with cervical lesions. Outcome data were given in 47 children, nine of whom died either neonatally or within the first 20 months of life. Motor disability ranged from a complete recovery in one out of 40 to paraparesis in 26 out of 40, and tetraparesis in 13 out of 40 patients: 17 out of 39 were ambulant. Sphincter dysfunction was present in 22 out of 38 patients and scoliosis in 16 out of 37. Learning difficulties were present in 10 out of 39, behavioural problems in five out of 39 and seizures in four out of 39 patients. SCI in the pre‐, peri‐, and neonatal periods are rare but probably under‐diagnosed and are heterogeneous in aetiology, presentation, and outcome. Boys appear to be more susceptible than girls.

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Acute flaccid neonatal paraplegia

Cited by 22 publications

References 0 publications

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Ischemic Spinal Cord Infarction in Children Without Vertebral Fracture

Intravascular Catheter Complications in the Neonatal Intensive Care Unit

Spinal cord insults in the prenatal, perinatal, and neonatal periods

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