Neff Michael, Xie Nicholas, Fong Joseph, Podolej Gregory
University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, TX.
Ascension Illinois, St. Francis Hospital, Graduate Medical Education, Evanston, IL.
J Educ Teach Emerg Med. 2025 Jul 31;10(3):V22-V26. doi: 10.21980/J8QQ1Q. eCollection 2025 Jul.
Gait disturbances in pediatric patients can be wrought with diagnostic pitfalls given the broad infectious, traumatic, musculoskeletal, and neurological etiologies. Furthermore, children can have difficulty communicating their pain and can be hard to examine. This case highlights the importance of slowing down to obtain a detailed history as well as perform a thorough exam in our pediatric patients, which can be challenging in a busy emergency department. We present a case of acute transverse myelitis (ATM) in a four-year-old male who presented with a one-day history of limp and bilateral leg pain with weight bearing. The caretakers reported a possible remote trauma from roughhousing at daycare. Neurological examination revealed significant abnormalities including bilateral patellar hyperreflexia, bilateral lower extremity weakness, clonus, and gait ataxia. A brain and spinal MRI revealed longitudinally extensive ATM with cord edema. Despite the lack of any evidence of infectious prodrome, cerebrospinal infectious analysis revealed as the causative agent. Treatment with intravenous (IV) methylprednisolone and azithromycin therapy led to eventual resolution of all neurological sequelae within a few weeks of discharge. This report emphasizes the importance of considering ATM in the differential of pediatric patients presenting with gait complaints, as well as the importance of a thorough neurologic exam, without which the diagnosis would have been missed.
Pediatric emergency medicine, pediatric neurology, acute transverse myelitis, pediatric gait disturbance.
鉴于小儿患者步态障碍的病因广泛，包括感染、创伤、肌肉骨骼和神经方面的病因，因此诊断存在陷阱。此外，儿童可能难以表达疼痛，且难以进行检查。本病例强调了在小儿患者中放慢速度获取详细病史并进行全面检查的重要性，而在繁忙的急诊科这可能具有挑战性。我们报告一例四岁男性急性横贯性脊髓炎（ATM）病例，该患儿有一天跛行及双侧负重时腿痛的病史。看护人报告可能在日托中心因打闹玩耍受到过远程创伤。神经系统检查发现明显异常，包括双侧髌阵挛、双侧下肢无力、阵挛和步态共济失调。脑部和脊髓MRI显示纵向广泛的ATM伴脊髓水肿。尽管缺乏任何感染前驱症状的证据，但脑脊液感染分析显示 为病原体。静脉注射甲基强的松龙和阿奇霉素治疗使所有神经后遗症在出院后几周内最终得到缓解。本报告强调了在小儿步态障碍患者鉴别诊断中考虑ATM的重要性，以及全面神经系统检查的重要性，否则该诊断可能会被漏诊。
小儿急诊医学、小儿神经病学、急性横贯性脊髓炎、小儿步态障碍。
