A confounding pediatric spinal cord injury: Anterior, central, or both?
Mara Martinez-Santori, Anthony Kennedy, Autumn Atkinson and 2 others
PMID 39269860WHAT IT FOUND
A two-year-old with a cervical spinal cord injury recovered distal arm function before proximal strength.
This atypical pattern, combined with conflicting imaging and clinical signs, makes standard adult prognostic models unreliable for predicting long-term recovery in young children.
Key findings
01The patient presented with flaccid paralysis and sensory loss in the upper extremities but preserved spontaneous movement in the lower extremities, a pattern clinically resembling central cord syndrome but radiographically consistent with anterior spinal artery infarction.
02Recovery followed an unusual distal-to-proximal pattern, with finger flexor activation returning before elbow flexion, contradicting the typical proximal-to-distal progression seen in standard central cord syndrome cases.
03Standardized neurological classification (ISNCSCI) could not be performed due to the patient's age and developmental level, limiting the ability to formally quantify the severity of the spinal cord injury.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a single case report, so the findings cannot be generalized to other pediatric patients. Standardized neurological assessments (ISNCSCI) were not possible due to the patient's age, making the severity of the injury and the extent of recovery less precisely quantifiable. The diagnosis of anterior spinal artery infarction was based on initial MRI findings, but a follow-up MRI to confirm the evolution of the infarct was not performed due to the risks of anesthesia. The presence of Chiari I malformation introduces uncertainty about whether it contributed to the vascular injury or was an incidental finding. The clinical presentation mixed features of central cord syndrome and anterior spinal artery syndrome, complicating the application of existing prognostic models.
Declared interests
The authors have no conflicts of interest to report.
The easy way to misread this
Do not assume this patient's recovery timeline applies to other children. The distal-to-proximal return of motor function was atypical and occurred in the context of a complex diagnosis involving both vascular infarction and a congenital malformation. Standard central cord syndrome prognoses do not fit this case.