Neuropediatrics 2003; 34(1): 45-51
DOI: 10.1055/s-2003-38621
Short Communication

Georg Thieme Verlag Stuttgart · New York

Cervical Spinal Cord Atrophy in the Atraumatically Born Neonate: One Form of Prenatal or Perinatal Ischaemic Insult?

F. Ebinger 1 , R. Boor 2 , K. Brühl 3 , B. Reitter 2
  • 1Kinderklinik, Abt. Pädiatrische Neurologie, Klinikum der Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
  • 2Kinderklinik, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
  • 3Institut für Neuroradiologie, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
Further Information

Publication History

Received: August 9, 2002

Accepted after Revision: December 10, 2002

Publication Date:
11 April 2003 (online)

Abstract

After atraumatic birth, three neonates presented with muscle hypotonia and weakness. Flaccid paresis of the upper extremities, spasticity of the lower extremities, dissociate sensory loss and autonomic dysfunction developed later. This ruled out the initial, tentative diagnoses of cerebral palsy, spinal muscular atrophy or hereditary neuropathy. Diagnostic imaging revealed marked thinning of the cervical spinal cord in all patients. The possible aetiology of these lesions is considered. In all cases, an antenatal or perinatal infarction is thought to be the most probable cause. Different clinical pictures following intrauterine spinal cord ischemia are discussed. Spinal cord lesion must be considered even after atraumatic birth.

References

  • 1 Adamkiewicz A. Die Blutgefässe des menschlichen Rückenmarkes. Sitzungsber Kaiserl Akad Wissensch Wien math-naturw Cl III. Abt.  1881; 83: 469 - 502;. 1882;  85 101-130
  • 2 Adams J H, Cameron H M. Obstetrical paralysis due to ischaemia of the spinal cord.  Arch Dis Child. 1965;  40 93-96
  • 3 Ahmann P A, Smith S A, Schwartz J F, Clark D B. Spinal cord infarction due to minor trauma in children.  Neurology. 1975;  25 301-307
  • 4 Alvord E C, Shaw C M. Congenital difficulties with swallowing and breathing associated with maternal polyhydramnios: Neurocristopathy or medullary infarction?.  J Child Neurol. 1989;  4 299-306
  • 5 Aziz E M, Robertson A F. Paraplegia: a complication of umbilical artery catheterization.  J Pediatr. 1973;  82 1051-1052
  • 6 Barkovich A J. Pediatric Neuroimaging. 3rd ed. Philadelphia, Baltimore, New York; Lippincott Williams & Wilkins 2000
  • 7 Beevor C E. A case of congenital spinal muscular atrophy (family type) and a case of haemorrhage into the spinal cord at birth, giving similar symptoms.  Brain. 1902;  25 85-108
  • 8 Bode H, Bubl R, Rutishauser M, Nars P W. Congenital tetraplegia, respiratory insufficiency, and hypoplasia of medulla oblongata.  Pediatr Neurol. 1994;  10 161-163
  • 9 Bucher H U, Boltshauser E, Friderich J, Isler W. Birth injury to the spinal cord.  Helv Paediatr Acta. 1979;  34 517-527
  • 10 Chapman G P, Weller R O, Normand I CS, Gibbens D. Spinal cord transection in utero.  Brit Med J. 1978;  2 398
  • 11 Cheshire W P, Santos C C, Massey E W, Howard J F. Spinal cord infarction: Etiology and outcome.  Neurology. 1996;  47 321-330
  • 12 Clancy R R, Sladky J T, Rorke L B. Hypoxic-ischemic spinal cord injury following perinatal asphyxia.  Ann Neurol. 1989;  25 185-189
  • 13 Conover P T, Roessmann U. Malformation complex in an infant with intrauterine influenza viral infection.  Arch Pathol Lab Med. 1990;  114 535-538
  • 14 Crothers B, Putnam M C. Obstetrical injuries of the spinal cord.  Medicine. 1927;  6 41-126
  • 15 Darwish H, Sarnat H, Archer C, Brownell K, Kotagal S. Congenital cervical spinal atrophy.  Muscle Nerve. 1981;  4 106-110
  • 16 De León G A, Radkowski M A, Crawford S E, Swisher C N, Uzoaru I, de León W. Persistent respiratory failure due to low cervical cord infarction in newborn babies.  J Child Neurol. 1995;  10 200-204
  • 17 Di Chiro G, Harrington T, Fried L C. Microangiography of human fetal spinal cord.  Am J Roentgenol Radium Ther Nucl Med. 1973;  118 193-199
  • 18 Duggal N, Lach B. Selective vulnerability of the lumbosacral spinal cord after cardiac arrest and hypotension.  Stroke. 2002;  33 116-121
  • 19 Dulac O, Aicardi J. Paraplegie compliquant le catheterisme arteriel ombilical.  Arch Franç Péd. 1975;  32 659-664
  • 20 Ferszt R. Kreislaufstörungen des Nervensystems. Cervós-Navarro J, Ferszt R Klinische Neuropathologie. Stuttgart, New York; Thieme 1989: 87-149
  • 21 Gillilan L A. The arterial blood supply of the human spinal cord.  J Comp Neurol. 1958;  110 75-103
  • 22 Gordon N, Marsden B. Spinal cord injury.  Neuropädiatrie. 1970;  2 112-118
  • 23 Hageman G, Ramaekers V T, Hilhorst B GJ, Rozeboom A R. Congenital cervical spinal muscular atrophy: a non-familial, non progressive condition of the upper limbs.  J Neurol Neurosurg Psychiat. 1993;  56 365-368
  • 24 Hausbrandt F, Meier A. Zur Kenntnis der geburtstraumatischen und extrauterin erworbenen Schäden des Zentralnervensystems bei Neugeborenen.  Frankf Zschr Pathol. 1936;  49 21-62
  • 25 Hlavin M L, Kaminski H J, Ross J S, Ganz E. Spinal epidural abscess: a ten-year perspective.  Neurosurgery. 1990;  27 177-184
  • 26 Jellinger K, Schwingshackl A. Birth injury of the spinal cord.  Neuropädiatrie. 1973;  4 111-123
  • 27 Jensen M C, Brant-Zawadzki M N, Jacobs B C. Ischemia. Stark DD, Bradley WG Magnetic Resonance Imaging. 3rd ed. St. Louis, Baltimore, Boston; Mosby 1999: 1255-1275
  • 28 Kaiboriboon K, Hayat G R. Congenital cervical spinal atrophy: An intrauterine hypoxic insult.  Neuropediatrics. 2001;  32 330-334
  • 29 Kanellopoulos G K, Xu X M, Hsu C Y, Lu X, Sundt T M, Kouchoukos N T. White matter injury in spinal cord ischemia.  Stroke. 2000;  31 1945-1952
  • 30 Kennedy E. Observations on cerebral and spinal apoplexy, paralysis and convulsions of new-born infants.  Dublin J Med Sci. 1836;  10 419-444
  • 31 Lapchak P A, Araujo D M, Song D, Zivin J A. Neuroprotection by the selective cyclooxygenase-2 inhibitor SC-236 results in improvements in behavioral deficits induced by reversible spinal cord ischemia.  Stroke. 2001;  32 1220-1225
  • 32 MacKinnon J A, Perlman M, Kirpalani H, Rehan V, Sauve R, Kovacs L. Spinal cord injury at birth: Diagnostic and prognostic data in twenty-two patients.  J Pediatr. 1993;  122 431-437
  • 33 Mamelak A N, Cogen P H, Barkovich A J. The “filum intermedium” sign: focal in utero spinal cord infarct and extraspinal thecal sac.  J Neurosurg. 1994;  81 941-946
  • 34 Mills J F, Dargaville P A, Coleman L T, Rosenfeld J V, Ekert P G. Upper cervical spinal cord injury in neonates: The use of magnetic resonance imaging.  J Pediatr. 2001;  138 105-108
  • 35 Muñoz M E, Roche C, Escribá R, Martínez-Bermejo A, Pascual-Castroviejo I. Flaccid paraplegia as complication of umbilical artery catheterization.  Pediatr Neurol. 1993;  9 401-403
  • 36 Norman M G, Widderburn L CW. Fetal spinal cord injury with cephalic delivery.  Obstet Gynecol. 1973;  42 355-358
  • 37 Parrot J. Note sur un cas de rupture de la moelle chez un nouveau-né par suite des manoeuvres pendant l'accouchement.  Bull Mém Soc Méd Hopit Paris. 1869;  6 38-45
  • 38 Popova N I. Patomorfologija spinnogo mozga nedonošennych detej pri vnutriutrobnych infekzijach.  Pediatrija. 1975;  10 66-67
  • 39 Ramesh V, Gardner-Medwin D, Gibson M, Colquhoun I. Severe segmental narrowing of the spinal cord: an unusual finding in congenital spastic paraparesis.  Dev Med Child Neurol. 1989;  31 670-681
  • 40 Rehan Vk, Seshia M MK. Spinal cord birth injury - diagnostic difficulties.  Arch Dis Child. 1993;  69 92-94
  • 41 Rüdiger K D, Wöckel W. Morphologische Spätbefunde nach geburtstraumatischer Rückenmarksläsion.  Schweiz Med Wschr. 1972;  102 545-548
  • 42 Ruggieri M, Smárason A K, Pike M. Spinal cord insults in the prenatal, perinatal, and neonatal periods.  Dev Med Child Neurol. 1999;  41 311-317
  • 43 Schievink W I, Mokri B, Piepgras D G. Spontaneous dissections of cervicocephalic arteries in childhood and adolescence.  Neurology. 1994;  44 1607-1612
  • 44 Schneider H. Kreislaufstörungen und Gefäßprozesse des Rückenmarks. Doerr W, Seifert G Spezielle pathologische Anatomie Bd. 13/I: Pathologie des Nervensystems I. Berlin, Heidelberg, New York; Springer 1980: 511-649
  • 45 Schneider H, Ballowitz L, Schachinger H, Hanefeld F, Dröszus J U. Anoxic encephalopathy with predominant involvement of basal ganglia, brain stem and spinal cord in the perinatal period.  Acta Neuropath. 1975;  32 287-298
  • 46 Sie L TL, van der Knaap M S, Oosting J, de Vries L S, Lafeber H N, Valk J. MR patterns of hypoxic-ischemic brain damage after prenatal, perinatal or postnatal asphyxia.  Neuropediatrics. 2000;  31 128-136
  • 47 Singer R, Joseph K, Gilai A N, Meyer S. Nontraumatic, acute neonatal paraplegia.  J Ped Orthopaed. 1991;  11 588-593
  • 48 Sladky J T, Rorke L B. Perinatal hypoxic/ischemic spinal cord injury.  Pediatr Pathol. 1986;  6 87-101
  • 49 Spatz H. Pathologische Anatomie der Kreislaufstörungen des Gehirns.  Zschr Ges Neurol Psychiat. 1939;  167 301-351
  • 50 Towbin A. Spinal cord and brain stem injury at birth.  Arch Pathol. 1964;  77 620-632
  • 51 Turnbull I M, Brieg A, Hassler O. Blood supply of cervical spinal cord in man.  J Neurosurg. 1966;  24 951-966
  • 52 Weinstein D, Margalioth E J, Navot D, Mor-Yosef S, Eyal F. Neonatal fetal death following cesarean section secondary to hyperextended head in breech presentation.  Acta Obstet Gynecol Scand. 1983;  62 629-631
  • 53 Yates P O. Birth trauma to the vertebral arteries.  Arch Dis Child. 1959;  34 436-441
  • 54 Young R SK, Towfighi J, Marks K H. Focal necrosis of the spinal cord in utero.  Arch Neurol. 1983;  40 654-655
  • 55 Zellweger H. Über geburtstraumatische Rückenmarksläsionen.  Helv Paediatr Acta. 1945;  1 13-30

Dr. Friedrich Ebinger

Universitätskinderklinik, Abt. Pädiatrische Neurologie

Im Neuenheimer Feld 150

69120 Heidelberg

Germany

Email: friedrich_ebinger@med.uni-heidelberg.de