Fenger-Gron Jesper, Kock Kirsten, Nielsen Rasmus G, Leth Peter M, Illum Niels
Department of Pediatrics, Odense University Hospital, Denmark.
Acta Paediatr. 2008 Jun;97(6):824-6. doi: 10.1111/j.1651-2227.2008.00768.x. Epub 2008 Apr 7.
A case of perinatally acquired spinal cord injury (SCI) is presented. The foetus was vigorous until birth, the breech presented and delivery was performed by a non-traumatic Caesarean section. The infant displayed symptoms of severe SCI but diagnosis was delayed due to severe co-morbidity. Diagnostic considerations are briefly reviewed. Ventilatory support was withdrawn at the age of 20 days when the infant had still not exhibited any respiratory effort or spontaneous movements. Autopsy revealed a serious congenital malalignment of the upper cervical vertebrae and at the histological examination extensive reactive changes were observed in the same area. To our knowledge such findings have not been published previously.
In cases of serious perinatally acquired SCI, claim of malpractice is often apparent. In this case a hidden congenital malformation of the cervical vertebrae was revealed, highlighting the need of careful postmortem examinations in such cases.
本文介绍了一例围产期获得性脊髓损伤（SCI）的病例。胎儿在出生前一直状况良好，臀位分娩，通过非创伤性剖宫产进行接生。婴儿表现出严重脊髓损伤的症状，但由于严重的合并症，诊断被延迟。简要回顾了诊断方面的考虑因素。婴儿在20天时仍未表现出任何呼吸努力或自主运动，于是撤除了通气支持。尸检发现上颈椎存在严重的先天性排列不齐，组织学检查在同一区域观察到广泛的反应性改变。据我们所知，此类发现此前尚未见报道。
在严重的围产期获得性脊髓损伤病例中，医疗事故的索赔往往很明显。在本病例中，发现了颈椎隐藏的先天性畸形，凸显了在此类病例中进行仔细尸检的必要性。
