Kulshrestha Richa, Chowdhury Joy R, Lalam Radhesh K, Kiely Nigel T
The Midland Centre of Spinal Injuries, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Shropshire, UK.
Spinal Cord Ser Cases. 2017 Jul 6;3:17038. doi: 10.1038/scsandc.2017.38. eCollection 2017.
Spinal cord injuries in new born infants following a traumatic delivery or umbilical cord catheterisation due to thromboembolism are well known. Cases with atraumatic acute onset of neonatal paraplegia have also been described in preterm babies or babies born small for gestational age with a stormy postnatal course related to ischaemic aetiology. We describe a rare case of infarction of the spinal cord from a predominant haemorrhagic aetiology.
A term female baby, first child of unrelated parents, was born by normal vaginal delivery. She had meconium aspiration at birth, leading to severe respiratory distress, requiring neonatal intensive care admission. At 2 weeks, she developed new flaccid paraplegia. MRI scan of the spine showed haemorrhagic infarction of the spinal cord from the level of thoracic inlet, vertebral level C7-T1. A follow-up MRI scan at 11 months revealed severe atrophy of the cord distal to C6. At 3 years of age, she had good upper-limb function, diaphragmatic breathing and flaccid paralysis of lower limbs.
In an acutely unwell term infant with symptoms of paralysis or spinal cord damage, haemorrhagic infarction needs to be considered in the differential diagnosis. To our knowledge, this is the first reported case of spinal cord injury in a term infant with a haemorrhagic lesion, and it helps to understand the pathogenesis of nontraumatic insult.
新生儿因分娩创伤或脐静脉置管导致血栓栓塞而引起脊髓损伤是众所周知的。在早产儿或小于胎龄儿中也有关于非创伤性急性新生儿截瘫发作的病例报道，这些患儿出生后病程凶险，病因与缺血有关。我们描述了一例以出血性病因为主的脊髓梗死罕见病例。
一名足月儿女婴，系非近亲父母的头胎，通过正常阴道分娩出生。她出生时吸入胎粪，导致严重呼吸窘迫，需入住新生儿重症监护病房。2周时，她出现新的弛缓性截瘫。脊柱MRI扫描显示从胸廓入口水平（椎体水平C7 - T1）开始的脊髓出血性梗死。11个月时的随访MRI扫描显示C6以下脊髓严重萎缩。3岁时，她上肢功能良好，可进行膈肌呼吸，下肢弛缓性瘫痪。
在一名病情急性加重的足月儿出现瘫痪或脊髓损伤症状时，鉴别诊断需考虑出血性梗死。据我们所知，这是首例报道的足月儿脊髓损伤伴出血性病变的病例，有助于理解非创伤性损伤的发病机制。
