327

Cervical Cord Birth Injury and Subsequent Development of Syringomyelia: A Case Report By T. Yamano,

s. Fujiwara, s. Matsukawa, H. Aotani, Y. Maruo and Morimi Shimada

Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan

A 2830 g full-term baby, born by breech delivery, exhibited weak crying and sucking and severe hypotonia of the extremities after birth. Magnetic resonance imaging (MRI) showed marked thinning of the cervical cord at the level of C4 and C5. This lesion evolved into focal syringomyelia by the fourth month after birth. In this patient' MRI was useful in detecting the initial spinal cord injury, which appeared as marked thinning, and the subsequent syringomyelia as weIl. The role of birth trauma in cervical spinal cord injuries is discussed.

Keywords Birth injury - Cervical cord injury Syringomyelia - Magnetic resonance imaging (MRI)

Introduction There have been a number of reports concerning brain damage, but few concerning spinal cord injuries during the perinatal period (1, 3). This may be a result of the fact that the details on any morphologie changes of the spinal cord have not been available even by computed tomography (CT). Magnetic resonance imaging (MRI), however, provides detailed images of the spinal cord without significant discomfort or risk to the patient. We describe one patient with a cervical cord birth injury in whom partial thinning of the cervical cord later evolved into a localized syringomyelia.

Case report A healthy 24-year-old woman gave birth to her second child by a breech delivery. The woman had an unCOffiplicated pregnancy with no evidence or history of hyperemesis, infection, toxicosis, radiation exposure or trauma. Since the baby was in the breech position, delivery of the shoulder and head was difficult and required extensive manipulation. Birth weight was 2830 g and Apgar scores were 5 at 1 minute and 7 at Received January 23, 1992; accepted May 4, 1992 Neuropediatrics 23 (1992) 327-328 © Hippokrates Verlag Stuttgart

5 minutes. The patient was transferred immediately to the Siga University hospital with a diagnosis of severe birth asphyxia, because she exhibited weak crying and hypotonia. On admission, the patient had spontaneous respirations without retraction. However, the patient's upper extremities were extended flacidly, and the lower extremities were also hypotonie. The Moro, grasping and deep tendon reflexes were absent. Spontaneous movement of the extremities was infrequent. The patient also presented with Escherichia coli sepsis at 6 days of age and was treated successfully with antibiotics intravenously for 1 week. MRI of the brain performed at 29 days showed no abnormalities, but MRI of the spinal cord showed segmental tearing, leaving asIender connection at the levels of C4 and C5 (Fig. 1a). A second MRI examination of the cervical cord at 48 days was essentially unchanged. The third MRI examination on day 120, however, revealed a localized egg-shaped swelling, at least partially fluid-filled, surrounded by a thin segment of the spinal cortex at the same region of the cervical cord (Fig. 1b). This lesion was considered to be a syringomyelia which formed after the initialIesion. Ten months old of age, the patient lay supine with knees and hips flexed, and with the hips externally rotated. No bladder or rectal disorders have been detected to date, although the patient has had recurrent respiratory infections requiring ventilator support.

Discussion Damage to the central nervous system in the perinatal period is caused mainly by asphyxia and birth trauma. Most of this damage, except for spinal cord birth injury, is diagnosed easily using ultrasonography and CT. However, these modalities are not useful for examining spinal cord lesions. Yet MRI can provide detailed images of the spinal cord. Recently, Lanska et al (2) have reported three patients with cervical cord injuries. Their lesions were similar to the present case and were demonstrated by MRI. In the present case, it was difficult to deliver the shoulder and the head. Thus, the lesion may have resulted from this difficult extraction. These results indicate that the cervical cord is one of the most vulnerable portions ofthe central nervous system when extracting the baby during delivery, because other parts of the central nervous system are protected by the scalp and thorax. Thus, a physician must protect the baby's neck from birth trauma. Our case also suggests that cervical cord should be examined by MRI, when babies of difficult breech delivery show severe hypotonia.

Downloaded by: Universite Laval. Copyrighted material.

Abstract

328 Neuropediatrics 23 (1992)

Fig. 1 a) T2-weighted MRI shows segmental marked thinning (arrow) of C4 and C5 at 29 days. b) Tl-weighted MRI reveals egg-shaped syringomyelia (arrow) at the same position 4 months after birth.

The thinned portion of the cervical cord developed into an egg-shaped syringomyelia by 4 months after birth. Syringomyelia is a well-known complication of traumatic injury. Our case shows that cervical birth trauma can result in thinning of the cervical cord as the initial inj ury and develop into posttraumatic syringomyelia. Thus, cervical cord birth trauma should be considered as a possible cause of syringomyelia when it is detected in patients with hypotonia.

References Adams, C., P. S. Babyn, W.]. Logan: Spinal cord birth injury: Value of computed tomographie myelography. Pediatr. Neurol. 4 (1988) 105-109 2 Lanska, M.]., U. Roessmann, M. Wiznitzer: Magnetic resonance imaging in cervical cord birth injury. Pediatrics 85 (1990) 760-764 3 Leventhal, H. R.: Birth injuries of the spinal cord. J. Pediatr. 56 (1960) 1

447-453

Tsunekazu Yamano, M. D. Department of Pediatrics Shiga University of Medical Science Seta, Otsu-shi, Shiga-ken, 520-21, Japan

Downloaded by: Universite Laval. Copyrighted material.

T. Yamano et al

Cervical cord birth injury and subsequent development of syringomyelia: a case report.

A 2830 g full-term baby, born by breech delivery, exhibited weak crying and sucking and severe hypotonia of the extremities after birth. Magnetic reso...
144KB Sizes 0 Downloads 0 Views