A 5-year-old previously healthy male presented to the emergency department of our hospital with a 2-hour history of progressive weakness in the lower limbs.
On arrival, the child was unable to stand or remain standing.
In the initial moment, the family did not refer any trauma nor were there any signs of having suffered it in the exploration.
From the neurological point of view, the child was conscious, but very irritable and uncooperative, so the examination was performed with great difficulties.
The cranial nerves, strength, tone and sensitivity of the upper limbs were normal.
Lower limbs showed hypotonia and marked weakness (1-2/5), together with asymmetric hyporeflexia.
In the following hours, the patient began to present urinary retention and fecal incontinence.
At the time of admission, radiographs of the lumbar region were taken, which were normal.
72 hours later, the patient had a history of trauma, so was diagnosed a possible acute demyelinating polyneuropathy (Guilla normal in performing cephalorachideal inflammatory parameters), so a lumbar nerve puncture was not performed.
After 48 hours from admission, the patient's family reported the existence of a previous trauma.
The boy had fallen from an approximate height of 1.5 meters when trying to climb a wall.
This information was not previously agreed upon by family members because the child or guardian valued the fact that his or her parents might be punished by a punishment for climbing the wall.
At this time and with the suspicion of a possible SCIWORA, a spinal magnetic resonance imaging (MRI) was urgently requested, showing a hyperintense lesion at the level of the medullary cone, suggestive of contusion.
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The patient was treated conservatively, since neuroimaging showed no evidence of mechanical compression.
Corticosteroid treatment was not administered more than 48 h after the trauma.
Urine sampling, rectal cleaning enemas and physiotherapy were required.
For proper monitoring we evaluated our patient with various scales for spinal cord injury.
On the one hand, from a functional and practical point of view, with the Hoffer classification ; according to it, our patient was admitted with the qualification of "not walking" and discharged as "domestic walker".
There is another more complete and objective classification, proposed by the American Spinal Injury Association (ASIA) American Spinal Injury Association, ASIA. 9.10 High ASIA score / 100 scale In our patient, the following score was obtained initially.
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One year after the episode, the patient remained in a rehabilitation program, with evident clinical improvement.
Nevertheless, the physical examination revealed mild spastic paraparesis, claw feet, hypersensitivity in the toes, mild muscle weakness and lower limb strength reduction.
He had recovered fecal continence, but not entirely urinary continence.
