Spinal Cord Infarction in Hemoglobin SC Disease as an Amusement Park Accident

Abstract

Spinal cord infarction (SCI) is extremely rare in children, and only 2 other reports have described the occurrence of SCI in patients with hemoglobin SC disease (HbSC). Amusement park accidents are serious injuries. Patients with preexisting conditions, such as hypertension, cardiac disease, and recent back or neck injuries, may be at an increased risk. We report the case of a 12-year-old girl with HbSC with a past history of only 2 admissions for pain crises, who presented to the emergency department with symptoms of SCI after riding a roller coaster. Fibrocartilaginous embolism (FCE) is an increasingly recognized cause of SCI after events that put strain on the axial skeleton, such as many amusement park rides. Although radiologic criteria for FCE have been proposed, FCE remains a diagnosis of exclusion. To the best of our knowledge, this is the first documented case of SCI in a patient with HbSC and the first case of FCE after an amusement park accident. This case report highlights that HbSC may confound the differential diagnosis of SCI and aims to document an association with FCE in pediatric patients.

Fibrocartilaginous Embolism of the Spinal Cord in Children: A Case Report and Review of Literature

“…years of age, including our case, were reviewed [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] .…”

“…FCE is often misdiagnosed with transverse myelitis, like in our patient 3 . Although a definitive diagnosis of FCE can only be made after an autopsy, diagnosis by clinical and radiological features is considered possible [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . The number of clinically diagnosed cases has been exceeding the number of autopsy-proven cases, and we found only 3 pediatric cases of FCE of the spinal cord that were pathologically defined 17,19,20 .…”

“…FCE is well described in veterinary literature; recently, it has also been increasingly recognized in humans [3][4][5][6][7] . However, it is currently not well recognized among pediatricians due to its rarity.…”

A Curious Case of Progressive Respiratory Failure Due to Anterior Spinal Cord Infarction in an Adolescent Boy: A Case Report and Review of the Literature

“…We only find eight cases of cervical SSCI reported in the pediatric population (younger than 18 years) including our case. 13,[20][21][22][23][24] Age is between 8 and 17 years (average 12 years) with three males and five females. None has antecedent of trauma, surgery, or meningitis.…”

“…Follow-up is available in seven out of eight patients. Interestingly, most cervical SSCIs due to FCE on long-term follow-up display some degree of recovery with asymmetric weakness of the extremities 13,[20][21][22] or return to an ambulatory status. 13,23 On follow-up, in our patient, the functional improvement of the clinical status is consistent with the predominantly asymmetric involvement of the spinal cord and is characterized by an incomplete Brown-Séquard's syndrome, as position sense is preserved.…”