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Vijay CS, Nield TR, Nield LS. Paraplegia After Basketball Play: A Case of Spinal Cord Infarction Secondary to Fibrocartilaginous Embolization. Pediatr Emerg Care 2021; 37:e401-e403. [PMID: 30399067 DOI: 10.1097/pec.0000000000001666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pediatric emergency medicine providers must be astute at generating the differential diagnosis and performing the appropriate evaluation to promptly determine the underlying cause of new onset paraplegia. Spinal cord infarction (SCI) is a potential etiology of paraplegia in children, and fibrocartilaginous embolization is a rare underlying cause of SCI. We present an illustrative case of SCI secondary to fibrocartilaginous embolization in an otherwise healthy adolescent who developed symptoms of spinal cord dysfunction after basketball play.
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Affiliation(s)
- Chickajajur S Vijay
- From the Department of Pediatrics, Section of Hospital Medicine, West Virginia University School of Medicine
| | - Timothy R Nield
- From the Department of Pediatrics, Section of Hospital Medicine, West Virginia University School of Medicine
| | - Linda S Nield
- Departments of Medical Education and Pediatrics, Section of General Pediatrics, West Virginia University School of Medicine, Morgantown, WV
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Putzeys CC, Batra M, Maertens P, Sharma K. 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. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1731397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractClinical features of cervical spontaneous spinal cord infarctions (SSCIs) remain poorly described in the literature. The goal of this article was to improve recognition of cervical SSCI, a rare but life-threatening condition. We presented a 15-year-old adolescent male patient who developed neck pain with weakness and numbness in all four limbs half an hour after returning from a hike in the late afternoon. The next morning, he was brought to the emergency room due to persistent weakness, vomiting, and progressive respiratory distress. He was promptly intubated for airway protection. Pupils were 2 mm, sluggishly reactive, and all four extremities were flaccid. He was found to have anterior spinal cord syndrome. Light touch (brush) was normal down to the posterior aspect of shoulders. Cervical magnetic resonance imaging (MRI) showed increased T2/short-tau inversion recovery and decreased T1 signal of the anterior spinal cord from C3 to C7. Four days later, MRI of the spinal cord showed restricted diffusion of anterior spinal cord consistent with radicular artery territory infarction. The work-ups for infection, thrombosis, and cardioembolism were all negative. Three months later, he still had incomplete Brown-Séquard's syndrome, as position sense was preserved. There was in addition bilateral loss of pain and temperature sensations below the clavicles. MRI showed cervical myelomalacia most severe between C3 and C5. Furthermore, MRI showed changes in C3–C4 intervertebral disc, consistent with a fibrocartilaginous embolism via retrograde arterial route into the anterior spinal artery. This article demonstrates the importance of recognizing subtle clinical clues leading to cervical SSCI diagnosis.
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Affiliation(s)
| | - Mansi Batra
- Department of Pediatrics, University of South Alabama, Mobile, Alabama, United States
| | - Paul Maertens
- Division of Child Neurology, Department of Neurology, University of South Alabama, Mobile, Alabama, United States
| | - Kamal Sharma
- Division of Pediatric Critical Care, Department of Pediatrics, University of South Alabama, Mobile, Alabama, United States
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Rodrigues M, Beça G, Almeida A, Natário I, Vilabril F, Pereira M, Barreto J, Dias L, Gandarez F. Spinal cord infarction in children: Can gymnastics be a cause? J Pediatr Rehabil Med 2021; 14:97-101. [PMID: 33164960 DOI: 10.3233/prm-200684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Spinal cord infarction (SCI) in children is rare and difficult to diagnose. Fibrocartilaginous embolism (FCE) is probably the underlying cause for some unexplained cases of spinal cord infarcts. Abrupt back pain followed by a progressive syndrome of myelopathy appears to be the typical presentation, with a close temporal relationship between the onset of symptoms and preceding minor trauma. Supportive care and rehabilitation are essential in the treatment of children with SCI. CASE REPORT A previously healthy 12-year-old girl who practiced acrobatic gymnastics was admitted to a rehabilitation centre 14 days after being diagnosed with an acute anterior SCI with no identified cause. Sensory modality of pin prick and light touch were impaired, with the former more significantly affected. She was not able to run and had difficulty on monopodal standing and performing motor sequencing. Additionally, she mentioned ineffective cough along with flatus incontinence and normal bladder function. After a 4-week multidisciplinary rehabilitation program her neurologic deficits improved. DISCUSSION Given the patient's age and clinical presentation, a literature review led to the consideration of FCE as the most likely definitive diagnosis. It should be recognized as a cause of SCI especially in those involved in sport activities, even if previous trauma is denied.
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Affiliation(s)
| | - Gustavo Beça
- Centro de Reabilitação do Norte, Vila Nova de Gaia, Portugal
| | - Ana Almeida
- Centro de Reabilitação do Norte, Vila Nova de Gaia, Portugal
| | - Inês Natário
- Centro de Reabilitação do Norte, Vila Nova de Gaia, Portugal
| | - Filipa Vilabril
- Serviço de Medicina Física e de Reabilitação, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | | | - José Barreto
- Serviço de Medicina Física e de Reabilitação, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Leonor Dias
- Serviço de Neurologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fátima Gandarez
- Centro de Reabilitação do Norte, Vila Nova de Gaia, Portugal
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Ke W, Chen C, Li S, Wang B, Lu S, Yang C. Clinically suspected fibrocartilaginous embolism: a case report and literature review. Int J Neurosci 2020; 132:378-383. [PMID: 32870064 DOI: 10.1080/00207454.2020.1817008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spinal cord infarction (SCI) occurs rarely and is characterized by abrupt onset of neck or back pain and neurologic deterioration. Fibrocartilaginous embolism (FCE) of the spinal cord is a rare but possible cause of acutely progressive spinal cord symptoms. Here, we report the case of an older woman who developed acute paraplegia with SCI on the 10th day after thoracic spine surgery. Although definitive FCE diagnosis can be confirmed only histologically, the characteristic clinical and radiological features were highly suggestive of FCE. Furthermore, 40 clinically suspected cases of FCE are reviewed.
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Affiliation(s)
- Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saideng Lu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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D’Amico S, Pavone P, Testa G, Greco F, Marino L, Smilari P, Pavone V. Secondary Scoliosis as a Complication of Acute Transverse Myelitis in a Child. J Funct Morphol Kinesiol 2020; 5:jfmk5020039. [PMID: 33467256 PMCID: PMC7739325 DOI: 10.3390/jfmk5020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 11/26/2022] Open
Abstract
Acute transverse myelitis (ATM) is a rare neurological condition that affects the spinal cord. Several events, including infections, autoimmune conditions, inflammatory, and drug-induced factors, may cause this disorder. Correct and rapid etiological diagnosis is necessary in order to start appropriate treatment that mainly consists of immunomodulating therapy, high dose intravenous corticosteroids, and in plasma exchange in noninfectious cases. The outcome is varied and depends on several factors. In children, the prognosis is usually good. We report a case of an 11-year-old boy who presented with interscapular pain, right leg steppage, homolateral hyposthenia of the upper limb, and signs of autonomic dysfunction. After performing specific and instrumental exams, a diagnosis of transverse myelitis was reached, and appropriate therapy was performed. A few days post-treatment, the child developed a secondary scoliosis, involving a thoracolumbar curve with loss of cervical and lumbar lordosis. After rehabilitative treatment was undertaken for 12 months, a complete recovery and normal restoration of spinal physiological curves was obtained. The pediatric cases of ATM have a good response to steroid therapy combined with physiotherapy. Collaboration among the various specialists is worthwhile, in order to lead to a correct and rapid diagnosis.
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Affiliation(s)
- Silvia D’Amico
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Gianluca Testa
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy;
| | - Filippo Greco
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Lidia Marino
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Pierluigi Smilari
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (S.D.); (P.P.); (F.G.); (L.M.); (P.S.)
| | - Vito Pavone
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy;
- Correspondence: ; Tel.: +39-095-378-2273; Fax: +39-095-378-2320
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Abstract
BACKGROUND Fibrocartilaginous embolism (FCE) is a rare cause of pediatric ischemic myelopathy. The pathology is thought to result from fragmentation with embolization into the microvasculature of the radicular artery often secondary to high axial force. While most cases arise in the setting of vigorous activity, our case reveals that FCE can also occur during relative physical inactivity. Additionally, while a majority of cases are associated with neck or back pain, our case also reveals that FCE can present without concurrent pain episodes. We describe a rare case of spinal cord infarction (SCI) likely due to FCE in a 14 year old male. Our patient was sitting with his feet elevated, playing a video game, when he developed sudden difficulty moving his arms. Initially presenting with a negative MRI scan and la belle indifference, our patient was suspected to exhibit functional quadraparesis secondary to psychosomatization/adjustment disorder. Repeat MR imaging 7 days later revealed typical findings for FCE with SCI (irregular, pencil-like T2 hyperintensity in the ventral cervical/upper thoracic cord and owl's eye pattern on axial images). Six months later, the diagnosis of FCE remains predominant. Our patient continues to improve with occupational and physical therapy. Ambulatory efforts and bladder function continue to progress. To improve functional gains, the patient is being considered for a chemodenervation procedure. CONCLUSION Our case reveals that FCE can occur during physical inactivity and present without concurrent pain. Outcome regarding pediatric fibrocartilaginous embolism is highly variant; however, the two largest outcomes reported were either patient death or discharge.
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Abstract
A 4-year-old boy presented with asymmetric acute flaccid paralysis (AFP) of his right arm and both legs. He was alert with no oculobulbar weakness or incontinence. He had fever and diarrhea 5 days earlier. He was fully immunized with no travel history.
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Yamaguchi H, Nagase H, Nishiyama M, Tokumoto S, Toyoshima D, Akasaka Y, Maruyama A, Iijima K. Fibrocartilaginous Embolism of the Spinal Cord in Children: A Case Report and Review of Literature. Pediatr Neurol 2019; 99:3-6. [PMID: 31201068 DOI: 10.1016/j.pediatrneurol.2019.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 12/16/2022]
Abstract
Fibrocartilaginous embolism is assumed to be caused by fibrocartilaginous nucleus pulposus component migration through retrograde embolization to the spinal cord artery. Fibrocartilaginous embolism is currently not well recognized among pediatricians because of its rarity. We describe a previously healthy 15-year-old soccer player who, after kicking a ball, developed progressive weakness in both legs and urinary retention the next day. Magnetic resonance imaging revealed T2 hyperintensity in the anterior horn of the spinal cord at the Th12/L1 level with Schmorl node at the level of L1/2. We also review the previous literature on fibrocartilaginous embolism of the spinal cord in children (less than18 years age); a total of 25 pediatric patients, including our patient, were identified. The median age was 14 years, and 64% of the reviewed patients were female. The most common trigger event was intense exercise or sports. The neurological symptoms started within one day in most cases, and the time to symptom peak varied from a few hours to two weeks. The most common initial neurological symptoms were weakness or plegia (100%), followed by paresthesia or numbness (48%). Affected areas of the spinal cord were distributed evenly from the cervical to thoracolumbar regions. Although steroids and anticoagulants were most commonly used, the prognosis was quite poor (mild to severe sequelae with three deaths). Although fibrocartilaginous embolism is a very rare condition, physicians should be aware of the characteristics and include fibrocartilaginous embolism of the spinal cord in their differential diagnosis, especially for physically active patients.
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Affiliation(s)
- Hiroshi Yamaguchi
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan.
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Shoichi Tokumoto
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Daisaku Toyoshima
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Yoshinobu Akasaka
- Department of Radiology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
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Shah S, Bryant P. Fibrocartilaginous emboli in the pediatric population: The role of rehabilitation in facilitating functional recovery. J Pediatr Rehabil Med 2018; 11:53-56. [PMID: 29630563 DOI: 10.3233/prm-170502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 12 year-old female presented to the emergency department with a right hemiparesis, headache, and neck pain. Initial neural imaging studies were unremarkable. However, a repeat MRI of the cervical spine during her acute hospitalization showed an acute spinal infarct. Neurological workup was consistent with fibrocartilaginous embolism (FCE) as the etiology. After several weeks of intensive inpatient rehabilitation, the patient demonstrated remarkable functional progress. This case report reviews the comprehensive pediatric literature on FCE with focus on the mechanism of injury, role of imaging studies, treatment options and prognosis. Awareness of the typical clinical history, as well as the signs and symptoms characteristic of FCE will improve the identification of this rare cause of abrupt weakness and potentially facilitate functional recovery.
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Affiliation(s)
- Supriya Shah
- Physical Medicine and Rehabilitation Department, University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip Bryant
- Division of Rehabilitation Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Bar C, Cheuret E, Bessou P, Pedespan JM. Childhood idiopathic spinal cord infarction: Description of 7 cases and review of the literature. Brain Dev 2017; 39:818-827. [PMID: 28578817 DOI: 10.1016/j.braindev.2017.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/11/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe the clinical course, neuroimaging findings and functional outcome of idiopathic spinal cord infarction (SCI) in adolescents. METHODS Retrospective and descriptive analyses of seven patients with idiopathic SCI and 50 additional cases from the literature were included. Data collected concerned clinical presentation, MRI findings, initial diagnosis, treatments and functional outcome at the last medical visit. RESULTS Mean age at presentation was 13.2years (range 13-15). All patients presented a sudden and painful acute myelopathy with <24h time to maximal symptoms manifestation. A suspected trigger related to a minor effort was reported in 3/7 cases. Six patients presented with paraplegia, one with paraparesis. All had bladder dysfunction needing catheterization. Three patients had an initial misdiagnosis. Initial MRI was considered as normal in 2 cases. In the 5 other cases, T2-weighted-MR images showed hyperintensity within the thoracolumbar spinal cord, affecting mostly the anterior spinal artery territory. Evidence for associated spinal growth dystrophy were present in 6/7 cases. Mean follow-up time was 27.4months (range 3-46): 2 patients recovered autonomous ambulation, 4 patients regained walking ability with aids and one child (the shortest follow-up) remained wheelchair-dependent. A neurogenic bladder was still reported in 6/7 children at the last visit. Complementary analyses with literature cases were consistent with the findings obtained in our cohort. CONCLUSION Idiopathic SCI typically occurs in adolescence with a rapid onset and painful acute myelopathy. The MRI shows a T2-hyperintense signal within the spinal cord and provides evidence for an ischemic mechanism. Etiology remains unclear in most cases even though some specific risk factors for this age must play an important role in the pathogenesis, such as mechanical constraints on the immature spine.
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Affiliation(s)
- Claire Bar
- Service de Neurologie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
| | - Emmanuel Cheuret
- Service de Neurologie Pédiatrique, Hôpital des Enfants, CHU de Toulouse, France
| | - Pierre Bessou
- Service d'imagerie anténatale, de l'enfant et de la femme, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Jean-Michel Pedespan
- Service de Neurologie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
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Eid R, Raj A, Farber D, Puri V, Bertolone S. Spinal Cord Infarction in Hemoglobin SC Disease as an Amusement Park Accident. Pediatrics 2016; 138:peds.2015-4020. [PMID: 27485695 DOI: 10.1542/peds.2015-4020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Ryan Eid
- School of Medicine, University of Louisville, Louisville, Kentucky; and
| | - Ashok Raj
- Divisions of Hematology/Oncology, Department of Pediatrics, and
| | - Darren Farber
- Pediatric Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Vinay Puri
- Pediatric Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky
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Harmsen S, Schramm D, Karenfort M, Christaras A, Euler M, Mayatepek E, Tibussek D. Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water. Pediatrics 2015; 136:e687-90. [PMID: 26260715 DOI: 10.1542/peds.2014-4095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/24/2022] Open
Abstract
Dive-related injuries are relatively common, but almost exclusively occur in recreational or scuba diving. We report 2 children with acute central nervous system complications after breath-hold diving. A 12-year-old boy presented with unilateral leg weakness and paresthesia after diving beneath the water surface for a distance of ∼25 m. After ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. Neurologic examination revealed right leg weakness and sensory deficits with a sensory level at T5. Spinal MRI revealed a nonenhancing T2-hyperintense lesion in the central cord at the level of T1/T2 suggesting a spinal cord edema. A few weeks later, a 13-year-old girl was admitted with acute dizziness, personality changes, confusion, and headache. Thirty minutes before, she had practiced diving beneath the water surface for a distance of ∼25 m. After stepping out, she felt sudden severe thoracic pain and lost consciousness. Shortly later she reported headache and vertigo, and numbness of the complete left side of her body. Neurologic examination revealed reduced sensibility to all modalities, a positive Romberg test, and vertigo. Cerebral MRI revealed no pathologic findings. Both children experienced a strikingly similar clinical course. The chronology of events strongly suggests that both patients were suffering from arterial gas embolism. This condition has been reported for the first time to occur in children after breath-hold diving beneath the water surface without glossopharyngeal insufflation.
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Affiliation(s)
- Stefani Harmsen
- Departments of General Pediatrics, Neonatology, and Pediatric Cardiology and
| | - Dirk Schramm
- Departments of General Pediatrics, Neonatology, and Pediatric Cardiology and
| | - Michael Karenfort
- Departments of General Pediatrics, Neonatology, and Pediatric Cardiology and
| | | | - Michael Euler
- Trauma and Hand Surgery, Heinrich-Heine University, Düsseldorf, Germany
| | - Ertan Mayatepek
- Departments of General Pediatrics, Neonatology, and Pediatric Cardiology and
| | - Daniel Tibussek
- Departments of General Pediatrics, Neonatology, and Pediatric Cardiology and
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