NAME : RISMA RAHMAWATI

NIM : P1337420216019
CLASS : 2 A

Traumatic Spinbal Cord Infarction In A 16 Month Child Complicated By Suspected Child

Abuse.

Spinal cord infection usually occurs in adults, but can befall children when considered
from cause of trauma. As for example this occurs in 16-month-olds who are brought in by his
biologicall father and nanny families to the pediatric emergency department after more than 24
hours from the fall incident. Before being taken to the pediatric emergency department the father
left his son alone to take the paper in his car. On returning the boy lay on the kitchen floor crying
with his head and body between his outstretched legs. The father initially voiced concern the boy
was vomiting and "did not act right."

Initial evaluation by emergency personnel no external injuries or bruises on the head,

chest, abdomen or extremities. Spinal examination does not show any tenderness, or deformity.
The patient has an active movement in the upper extremities with normal tone, and full reflex.
Bilateral lower extremities were noted to be flaccid, areflexic, and did not respond to pain. Given
the history and presentation there was initial concern that this was another case of non-accidental
trauma and a proclivity to pursue a cranial injury considered a suspected fall from a height and
subsequent vomiting. Computed tomography scan of brain without contrast showed not acute
intracranial pathology. Magnetic resonance imaging of the spine shows: "extensive acute /
subacute infarction involving the thoracic spinal cord extending from the mid-inferior t6 level
with associated edema that rises superiorly to the T3-T4 level.

The patient is treated in a pediatric ward and is recommended to rest for 6 days. The
patient was discharged from the pediatric ward after several weeks and transferred to inpatient
rehab. Patients continue to get therapy 3 times a week. The term SCIWORA (Spinal Cord Injury
Without Radiographic Abnormality) was introduced by pang et al. In 1982. According to them
SCIWORA as a mark of traumatic myelopathy without evidence of ligament injury or fractures
in ordinary x-ray film or tomography studies. Unless it has experienced trauma, congenital spinal
anomaly, birth injury and complications and electric shock (Bansal KR et al, 2016). The
traumatic mechanisms proposed in SCIWORA are hyperfection / hyperextension, ischemia, and
disorders. The most frequent etiologies include MVA, falling from a height, and a direct blow to
the thoracic area.

It is a devastating injury that can change the course of a child’s life. In the case of this 16-
month old child, the initial appreciation of his injuries was not completely known. Investigation
by child protective services determined father neglected to seek care for >24 hours after the
accident. The father imprisoned on charges of child abuse.