Ramírez Natalia Betances, Arias-Berríos Rafael E, López-Acevedo Carmen, Ramos Edwardo
Department of Physical Medicine, Rehabilitation, and Sports Medicine, University District Hospital, University of Puerto Rico-School of Medicine , San Juan, Puerto Rico.
Spinal Cord Ser Cases. 2016 Dec 15;2:16014. doi: 10.1038/scsandc.2016.14. eCollection 2016.
Traumatic central cord syndrome (CCS) is the most frequently encountered incomplete spinal cord injury (SCI). The patient presents weakness, which is usually greater in the upper extremities than in the lower extremities, secondary to damage to the cervical spinal cord and anatomic distribution of the corticospinal tracts. CCS is seen commonly after a hyperextension mechanism in older patients with spondylotic changes. There are few literature reports regarding CCS in pediatric patients. We present an unusual case of traumatic CCS in a pediatric patient.
A 15-year-old male patient, victim of bullying at school, received cervical blunt trauma with a plastic tube. Within 3 h, the patient developed generalized weakness, which was greater in the upper extremities than in the lower extremities. Upon evaluation, the patient was found with marked upper extremity weakness compared to the lower extremities, with a Manual Muscle Test difference of 11 points. Imaging studies showed contusive changes in the C4-C7 central spinal cord. After rehabilitation therapies the patient gained 23 points in MMT at the day of discharge.
Different etiologies of CCS have previously been described in pediatric patients. However, this is the first case that describes a bullying event with cervical blunt trauma and subsequent CCS. In this case, history and physical examination, along with imaging studies, helped in the diagnosis, but it is important to be aware of the possibility of SCI without radiographic abnormalities, as it is common in the pediatric population. CCS occurs rarely in pediatric patients without underlying pathology. Physicians must be aware of the symptoms and clinical presentation in order to provide treatment and start early rehabilitation program.
创伤性中央脊髓综合征（CCS）是最常见的不完全性脊髓损伤（SCI）。由于颈脊髓损伤和皮质脊髓束的解剖分布，患者表现为上肢无力通常比下肢更明显。CCS常见于患有脊柱退变的老年患者发生过伸机制损伤后。关于小儿患者CCS的文献报道很少。我们报告一例小儿创伤性CCS的罕见病例。
一名15岁男性患者，在学校受欺凌，被塑料管颈部钝性创伤。3小时内，患者出现全身无力，上肢比下肢更明显。评估发现，与下肢相比，患者上肢明显无力，徒手肌力测试差异为11分。影像学检查显示C4 - C7节段脊髓中央有挫伤改变。经过康复治疗，患者出院时徒手肌力测试增加了23分。
先前已描述小儿患者CCS的不同病因。然而，这是第一例描述因颈部钝性创伤和随后发生CCS的欺凌事件的病例。在本病例中，病史、体格检查以及影像学检查有助于诊断，但重要的是要意识到无放射学异常的脊髓损伤的可能性，因为这在小儿人群中很常见。无潜在病理改变的小儿患者很少发生CCS。医生必须了解其症状和临床表现，以便进行治疗并启动早期康复计划。
