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456 Segmental Acute Spinal Cord Syndrome: “As A Bomb”
  1. MI Alves1,2,
  2. C Patraquim2,
  3. F Correia3,
  4. S Martins2,
  5. A Antunes2,
  6. T Pontes2,
  7. R Maré4,
  8. H Antunes2,5
  1. 1Serviço de Pediatria, Centro Hospitalar São João, Porto
  2. 2Unidade Adolescentes, Serviço de Pediatria, Hospital de Braga, Braga
  3. 3Serviço de Pediatria, Centro Hospitalar Alto Ave, Guimarães
  4. 4Serviço de Neurologia, Hospital de Braga, Braga
  5. 5Instituto de Ciências da Vida e da Saúde (ICVS), Escola de Ciências da Saúde da Universidade do Minho, Laboratório Associado ICVS/3B’s, Braga/Guimarães, Portugal

Abstract

Background The segmental spinal cord syndrome is defined clinically as a neurological injury (incomplete or complete) sensory, motor and autonomic.

Results 13 year old female, previously healthy with a sudden onset of severe pain in the inferior limbs, with loss of strength and sensitivity. No history of fever, recent trauma, infection, vaccination or similar episode. The physical examination revealed areflexic flaccid paraplegia, abolished postural sensitivities, painful hypoesthesia with sensitive level at T8, bilateral indifferent cutaneous plantar reflex response and vesical globe.

A brain and spinal cord magnetic ressonance imaging (MRI) study showed a discreet hyperintensity of the conus, and cerebrospinal fluid analysis was normal. She was hospitalized admitting a possible diagnosis of transverse myelitis and medicated with methylprednisolone intravenously. Due to the absence of clinical improvement, at day five MRI was repeated showing extensive hyperintensity of the conus with restricted diffusion, which extended to the level of T10, diagnostic hypothesis of acute transverse myelitis or acute ischemic injury was made. An etiological study was conducted presenting heterozygosity for Factor V Leiden. On day 32, after submission to physiotherapy, with slight improvement of proximal weakness in the lower limbs, a new MRI showed spinal cord atrophy.

Conclusions In this case, the main challenge is to establish the diagnosis and its etiology. Clinically, transverse myelitis is the most probable diagnosis although by imaging, one cannot exclude spinal cord infarction. Regardless of this issue, the overall prognosis, conditioned by severe initial dysfunction and no recovery in the first 24 hours, is unfavorable.

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