title: Non-traumatic spinal cord ischaemia in childhood - clinical manifestation, neuroimaging and outcome.
abstract: BACKGROUND
  Spinal cord ischaemia is rare in childhood and information on clinical presentation and outcome is scarce.
  
  
  METHODS
  This is a retrospective analysis of eight patients and 75 additional cases from the literature. Data search included: patient's age, primary manifestation, risk factors, neuroimaging and outcome.
  
  
  RESULTS
  Five female and three male patients gave consent to participate. Mean age was 12.5 years (10-15 years). Six patients presented with paraplegia; this was preceded by pain in four. Brown Sequard syndrome and quadriparesis were the two others' presenting condition. Sensation levels were thoracolumbar in seven cases. Bladder dysfunction only or bladder and bowel dysfunction were reported in eight and five patients respectively. Time to maximal symptom manifestation was <12 h in 7/8. Risk factors included surgery, minor trauma, recent infection, and thrombophilia. Mean follow-up was 3.3 years (0.25-6.3 years). Three patients remained wheelchair-dependent and three patients were ambulatory without aid. Bladder function recovered fully in five children. Most affected aspects of quality of life were physical and mental well-being and self-perception. T2-weighted-MR images showed pencil-like hyperintensity (8/8) in sagittal and H-shaped or snake-eyes-like lesion (6/8) in axial views. Analyses of all 83 patients were in congruence with the above results of the study group.
  
  
  CONCLUSIONS
  Spinal cord ischaemia in childhood presenting with pain, paraplegia, and bladder dysfunction has high morbidity concerning motor problems and quality of life. Acute arterial ischaemic event in children seems similar to adult events with respect to clinical presentation and, surprisingly, also in outcome.
authors.affiliation: Department of Neuropaediatrics, University Children's Hospital Bern, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Stettler
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.forename: Barbara
authors.initials: B
authors.lastname: Ritter
authors.forename: Eugen
authors.initials: E
authors.lastname: Boltshauser
authors.forename: Pierre-Y
authors.initials: PY
authors.lastname: Jeannet
authors.forename: Petra
authors.initials: P
authors.lastname: Kolditz
authors.forename: Andreas
authors.initials: A
authors.lastname: Meyer-Heim
authors.forename: Maja
authors.initials: M
authors.lastname: Steinlin
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D020127:Recovery of Function; D012189:Retrospective Studies; D020760:Spinal Cord Ischemia / Q000150:complications* / Q000209:etiology / Q000473:pathology*