Recovery without neurological sequelae of traumatic spinal epidural hematoma masquerading as Guillain-Barré syndrome in a child
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Spinal cord lesions could mimic Guillain-Barré syndrome (GBS). Misdiagnosis as GBS can incur severe neurologic sequelae. We report the case of a previously healthy, 14-year-old boy with traumatic spinal epidural hematoma masquerading as GBS. He presented with sudden onset of tingling sensation on both hands and feet, which progressed into motor weakness of both legs. No abnormalities were found in brain magnetic resonance imaging and cerebrospinal fluid study. Despite intravenous immunoglobulin therapy for presumed GBS, the weakness progressed rapidly over 8 hours, resulting in complete loss of sensorimotor function below T4 level and loss of deep tendon reflexes. Whole spine magnetic resonance imaging showed a large epidural hematoma over the C5-T5 level. We found that he had experienced whiplash injury on an amusement ride about 3 weeks before. He underwent emergency decompressive laminectomy and hematoma removal, followed by vigorous rehabilitation treatment. On the fifth week of follow-up, he recovered from the complete loss of sensorimotor function. Thorough review of detailed history in emergency departments is required for children presenting with ascending paralysis. Also, rapid diagnostic and therapeutic interventions are crucial for maximum recovery of neurologic symptoms.
Abstract
Spinal cord lesions could mimic Guillain-Barré syndrome (GBS). Misdiagnosis as GBS can incur severe neurologic sequelae. We report the case of a previously healthy, 14-year-old boy with traumatic spinal epidural hematoma masquerading as GBS. He presented with sudden onset of tingling sensation on both hands and feet, which progressed into motor weakness of both legs. No abnormalities were found in brain magnetic resonance imaging and cerebrospinal fluid study. Despite intravenous immunoglobulin therapy for presumed GBS, the weakness progressed rapidly over 8 hours, resulting in complete loss of sensorimotor function below T4 level and loss of deep tendon reflexes. Whole spine magnetic resonance imaging showed a large epidural hematoma over the C5-T5 level. We found that he had experienced whiplash injury on an amusement ride about 3 weeks before. He underwent emergency decompressive laminectomy and hematoma removal, followed by vigorous rehabilitation treatment. On the fifth week of follow-up, he recovered from the complete loss of sensorimotor function. Thorough review of detailed history in emergency departments is required for children presenting with ascending paralysis. Also, rapid diagnostic and therapeutic interventions are crucial for maximum recovery of neurologic symptoms.
참고문헌 (10)
- Francesco Ciro Tamburrelli, "Etiopathogenesis of Traumatic Spinal Epidural Hematoma", Neurospine, 15(1), pp.101~107 (2018), 대한척추신경외과학회
- Sekhon LH, "Epidemiology, demographics, and pathophysiology of acute spinal cord injury", Spine (Phila Pa 1976), 26(24 Suppl), pp.S2~S12 (2001)
- Rao SK, "Spectrum of imaging findings in hyperextension injuries of the neck", Radiographics, 25, pp.1239~1254 (2005)
- Swartz EE, "Cervical spine functional anatomy and the biomechanics of injury due to compressive loading", J Athl Train, 40, pp.155~161 (2005)
- Domenicucci M, "Spinal epidural hematomas : personal experience and literature review of more than 1000 cases", J Neurosurg Spine, 27, pp.198~208 (2017)
- Yuki N, "Guillain-Barré syndrome", N Engl J Med, 366, pp.2294~2304 (2012)
- Walling AD, "Guillain-Barré syndrome", Am Fam Physician, 87, pp.191~197 (2013)
- Cakir E, "Clinical course of spontaneous spinal epidural haematoma mimicking Guillain-Barré syndrome in a child : a case report and literature review", Dev Med Child Neurol, 46, pp.838~842 (2004)
- 이치형, "Spontaneous Spinal Epidural Hematoma Coexisting Guillan-Barre΄ Syndrome in a Child: A Case Report", Neurospine, 13(3), pp.167~169 (2016), 대한척추신경외과학회[DOI]
- Kondo A, "Spontaneous spinal epidural hematoma mimicking Guillain-Barré syndrome", Brain Dev, 41, pp.392~395 (2019)