Introduction:

Fibrocartilaginous embolism and spinal cord infarction may resemble transverse myelitis with antecedent minor trauma (sporting activity or minor falls) or with hyperacute (<12-hour) presentation.

Methods:

Diagnostic criteria for fibrocartilaginous embolism and spinal cord infarction were applied to a 10-year (2007-2016) cohort of children aged 1 month to 16 years with transverse myelitis and clinical, laboratory, neuroimaging, and outcome data compared between those with and without antecedent minor trauma.

Results:

Thirty-two children of median age 8.9 (range 2.7-15.8) years were included; 19 (59%) were female. Falls at home, school, or play (6 children, 60%), swimming (2, 20%), physical education (1, 10%), and caning (1, 10%) were antecedent events in 10 (31%) children. Six (19%) had hyperacute presentations. One patient met spinal cord infarction criteria; none had fibrocartilaginous embolism. Children with transverse myelitis and antecedent minor trauma had single, short spinal cord lesions (median 3 vertebral bodies) but without a specific neuroimaging lesion pattern. None had intervertebral disc abnormalities or brain involvement and were negative for myelin oligodendrocyte and aquaporin 4 antibodies. Twenty-five (86%) of 29 had cerebrospinal fluid inflammation, and 30 (94%) received immunotherapy. Thirty (97%) were followed for a median of 3.6 (0.1-10.2) years, with good outcome (modified Rankin Scale score 0-1) in the majority (80%). Four (75%) with hyperacute presentation had a good outcome (modified Rankin Scale score 0-1), but the patient with spinal cord infarction was the most disabled (modified Rankin Scale score 4).

Conclusion:

Minor trauma or hyperacute presentations does not always indicate fibrocartilaginous embolism or spinal cord infarction. Children with minor trauma preceding transverse myelitis have a distinct clinicoradiologic syndrome, with good outcome following immunotherapy.

中文翻译：

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儿童横贯性脊髓炎的先前轻微创伤和超急性表现

介绍：

纤维软骨栓塞和脊髓梗死可能类似于横贯性脊髓炎，既往有轻微创伤（运动活动或轻微跌倒）或超急性（<12 小时）表现。

方法：

纤维软骨栓塞和脊髓梗塞的诊断标准适用于 1 个月至 16 岁的横贯性脊髓炎儿童的 10 年（2007-2016 年）队列，并比较有和没有前因的儿童的临床、实验室、神经影像学和结果数据轻微的创伤。

结果：

包括 32 名中位年龄 8.9（范围 2.7-15.8）岁的儿童；19 人（59%）是女性。在家、学校或游戏中跌倒（6 个孩子，60%）、游泳（2 个，20%）、体育课（1 个，10%）和鞭打（1 个，10%）是 10 个（31%）的先决事件孩子们。六人（19%）有超急性表现。一名患者符合脊髓梗死标准；没有人患有纤维软骨栓塞。患有横贯性脊髓炎和先前轻微创伤的儿童有单个短脊髓损伤（中位数 3 个椎体），但没有特定的神经影像学病变模式。无椎间盘异常或脑受累，髓鞘少突胶质细胞和水通道蛋白 4 抗体均为阴性。29 人中有 25 人 (86%) 患有脑脊液炎症，30 人 (94%) 接受了免疫治疗。30 人 (97%) 被跟踪，中位数为 3.6 (0.1-10. 2) 年，大多数（80%）结果良好（改良 Rankin 量表评分 0-1）。4 名 (75%) 有超急性表现的患者预后良好（改良 Rankin 量表评分 0-1），但脊髓梗死患者的残疾最严重（改良 Rankin 量表评分 4）。

结论：

轻微创伤或超急性表现并不总是表明纤维软骨栓塞或脊髓梗塞。横贯性脊髓炎前有轻微创伤的儿童有明显的临床放射学综合征，免疫治疗后预后良好。