title: Acute complete paraplegia of 8-year-old girl caused by spinal cord infarction following minor trauma complicated with longitudinal signal change of spinal cord.
abstract: Spinal cord infarction followed by minor trauma in pediatric patients is rare and causes serious paralysis. Fibrocartilaginous embolism (FCE) is a possible diagnosis and there have been no consecutive magnetic resonance imaging (MRI) reports. Here, we report a case of an acute complete paraplegia with spinal cord infarction and longitudinal spinal cord signal change following minor trauma in an 8-year-old girl.
  
  
  
  An 8-year-old girl presented to our hospital emergency services with total paraplegia 2 h after she hit her back and neck after doing a handstand and falling down. She completely lost pain, temperature sensation, and a sense of vibration below her bilateral anterior thighs. Four hours later on MRI, the T2-weighted sequence showed no spinal cord compression or signal change in vertebral bodies. The patient was treated with rehabilitation after complete bed rest. A week after the trauma, the T2-weighted sequence indicated longitudinal extension of the lesion between T11 and C6 vertebral level with ring-shaped signal change. In addition, the diffusion-weighted MRI showed increased signal below C6 vertebral level. Two weeks after the trauma, we performed the T2 star sequence images, which showed minor bleeding at T11 vertebral area and spinal cord edema below C6. Four weeks after the trauma, MRI showed minor lesion at C6 vertebral level, but spinal cord atrophy was observed at T11 vertebral level without disc signal change. Thirteen weeks after the trauma, her cervical spinal cord became almost intact and severe atrophy of the spinal cord at T11 vertebral level. At 1 year following her injury, complete paraplegia remained with sensory loss below T11 level.
  
  
  
  Her clinical presentation, lack of evidence for other plausible diagnosis, and consecutive MRI findings made FCE at T11 vertebral level with pencil-shaped softening the most likely diagnosis. In addition, consecutive cervical MRI indicated minor cervical spinal cord injury. This Grand Round case highlights the consecutive MRI in a case with double spinal cord lesion with longitudinal spinal cord signal change.
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan. knagata-tky@umin.ac.jp.
authors.forename: Kosei
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanai
authors.affiliation: Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oshima
mesh_terms: D001284:Atrophy; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007238:Infarction / Q000150:complications*; D010264:Paraplegia / Q000209:etiology*; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology
keywords: Fibrocartilaginous embolism; Magnetic resonance imaging; Pencil-shaped softening; Spinal cord infarction