Mehmet CANPOLAT, Hatice Gamze POYRAZOĞLU, Sefer KUMANDAŞ, Hüseyin PER, Hakan GÜMÜŞ, Serkan ÖZSOYLU, Abdullhakim COŞKUN, Volkan YILMAZ, Başak Nur AKYILDIZ

Çocukluk Yaş Grubunda Radyograﬁ k Anomali Olmaksızın Spinal Kord Hasarı Kord Hasarı (SCIWORA SCIWORA): Olgu Sunumu

SCIWORA (Radyolojik bulgu olmaksızın spinal kord injurisi), travma sonrası klinik olarak miyelopati bulguları olmasınarağmen omurganın direkt radyograﬁ lerinde, tomograﬁ lerinde ve miyelograﬁ lerinde kırık ve dislokasyon bulgusu olmamasışeklinde tanımlanabilir. Bu çalışmada spinal kord injurisinde erken tanı ve tedavinin önemini vurgulamak için SCIWORAtanısı konan 2 olgu sunuldu. Olgu1; 12 yaşında kız hastanın oyun esnasında kardeşinin boyun bölgesine vurması sonucuellerinde uyuşma, kol ve bacaklarında güçsüzlük gelişmesi ve yürüyememe nedeni ile travmanın 12. saatinde hastane- mize başvurduğu öğrenildi. Nörolojik muayenede ﬂ ask tetraparezi saptandı. Çekilen spinal manyetik rezonans görün- tüleme (MRG)de C 3-4 den C-7 ya kadar uzanan spinal kord anteriorunda simetrik aksonal injuri ile uyumlu tutulumolduğu gözlendi. Hastaya intravenöz (IV) yüksek doz metilprednizolon tedavisi verildi. Tedavi sonrası fonksiyonel iyleşmegözlendi. Olgu 2; 5 aylık erkek hasta araç içi traﬁ k kazası nedeni travmanın 18. saatinde çocuk nöroloji kliniğine refereedildi. Nörolojik muayenede parapleji saptandı. Spinal MRG incelemesinde Th1-Th2 disk mesafesinden Th3e kadaruzanan yaklaşık 1.5 cm lik segment boyunca spinal kordu tutan T1 hipointens T2A hiperintens aksonal injuri ile uyumlugörünüm saptandı. Hastaya IV yüksek doz metilprednizolon tedavisi verildi. Tedavi sonrası anlamlı fonksiyonel iyleşmegözlenmedi. Sonuç olarak, ﬁ zik muayene ve spinal MRG, spinal travma ile başvuran hastalarda önemlidir. Torakal bölgetutulumu kötü nörolojik prognozla ilişkilidir. Spinal MRGde SCIWORA saptanan olgularda erken dönemde yüksek dozmetilprepnizolon tedavisi mortalite ve morbidite için hayati öneme sahiptir.

Spinal Cord Injury without Radiographic Abnormality (SCIWORA) in Chilhood: Case Report

Spinal cord injury without radiographic abnormality (SCIWORA) refers to spinal injuries, in the absence of identiﬁ ablebony or ligamentous injury on complete, technically adequate plain radiographs or computed tomography. In thisstudy, Two cases diagnosed with SCIWORA have been presented to emphasize the importance of early diagnosisand treatment for spinal cord injury. Case 1: A 12-year-old girl presented at the hospital complaining of numbness inher hands due to being hit on the neck while playing with her brother. She presented at our hospital 12 hours after thetrauma. Neurological examination revealed ﬂ accid tetraparesis. Magnetic resonance showed symmetrical axonal injuryin the anterior spinal cord anterior from C 3-4 to C-7. IV high-dose methylprednisolone was administered and functionalimprovement was observed. Case 2: A 5-month-old male patient was brought to the hospital after a trafﬁ c accident.He was referred to our child neurology clinic 18 hours after the trauma. Neurological examination revealed ﬂ accidparaparesis, The spinal MRI investigation performed taking the clinical ﬁ ndings into account revealed a T1 hypointenseand T2A hyperintense appearance consistent with axonal injury of the spinal cord along a segment around 1,5 cmlength from the Th1-Th2 intervertebral space to Th3. IV high-dose methylprednisolone was administered but signiﬁ cantfunctional improvement was not observed. In conclusion, spinal magnetic resonance imaging is important along withthe physical examination when trying to make a correct diagnosis in cases with a spinal trauma history. The involvementof the thoracic spine is associated with a poor neurological outcome. High-dose methylprednisolone treatment initiatedin the early period may be life saving for patients identiﬁ ed as having SCIWORA.

PDF

___

1. Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal injuries in children. J Pediatr Surg 2004;39:607-12.
2. Keleş I. Pediyatrik medulla spinalis yaralanmalarında epidemiyoloji ve patoﬁ zyoloji. Turkiye Fiziksel Tıp ve Rehabilitasyon Dergisi 2008; 54:4650.
3. Vogel CL, Betz RR, Mulcahey MJ. Pediatric spinal cord disorders. In: Joel A. DeLisa Denise Campagnolo Steven Kirshblum (eds). Spinal Cord Medicine. Philadelphia: Lippincott Williams & Wilkins, 2002:438-70.
4. Jackson AB, Dijkers M, Devivo MJ, Poczatek RB. A demographic proﬁ le of new traumatic spinal cord injuries: Change and stability over 30 years. Arch Phys Med Rehabil 2004;85:1740-8.
5. Caviness AC. Evaluation of cervical spine injuries in children and adolescents. In: UpToDate, Rose, BD (ed), UpToDate, Waltham, MA, 2008.
6. Pang D. Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery 2004;55:1325-42.
7. Proctor MR. Spinal cord injury. Crit Care Med 2002;30:489-99.
8. Launay F, Leet AI, Sponseller PD. Pediatric spinal cord injury without radiographic abnormality: A meta-analysis. Clin Orthop Relat Res 2005:166-70.
9. Kıymaz N, Mumcu Ç. Erişkinde servikal künt travma sonrası gelişen SCIWORA olgusu. Van Tıp Dergisi 2005;12:167-9.
10. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev 2012;1:CD001046.
11. Yamaguchi S, Hida K, Akino M, Yano S, Saito H, Iwasaki Y. A case of pediatric thoracic SCIWORA following minor trauma. Childs Nerv Syst 2002;18:241-3.
12. Pang D, Wilberger JE Jr. Spinal cord injury without radiographic abnormalities in children. J Neurosurg 1982;57:114-29.
13. Pang D, Pollack IF. Spinal cord injury without radiographic abnormality in children-the SCIWORA syndrome. J Trauma 1989;29:654-64.
14. Rekate HL, Theodore N, Sonntag VK, Dickman CA. Pediatric spine and spinal cord trauma. State of the art for the third millennium. Childs Nerv Syst 1999;15:743-50.
15. Ergun A, Oder W. Pediatric care report of spinal cord injury without radiographic abnormality (SCIWORA): Case report and literature review. Spinal Cord 2003;41:249-53.
16. Arora B, Suresh S. Spinal cord injuries in older children: Is there a role for high-dose methylprednisolone? Pediatr Emerg Care 2011;27:1192-4.