Neonatal Spinal Cord Injury: Not To be Missed

Introduction: Although very rare, spinal cord injury can mimic other causes of floppiness in neonates. We present a rare case of cervical spinal cord injury, which was diagnosed only at six months of age.

Case: A male infant was born at term via Emergency C-section due to a breech presentation and fetal tachycardia. He was initially floppy and was intubated at three hours of age due to poor respiratory effort. He was not encephalopathic but had no antigravity movements of his limbs and underwent an MR brain, which was normal. Metabolic, neuromuscular and genetic investigations were normal. He was extubated on Day 16 of life and discharged thereafter. He presented with recurrent urosepsis and vesicoureteric reflux requiring a vesicostomy at six months of age. He failed extubation and a paediatric neurology review was requested when he was admitted to intensive care. He had increased tone and clonus in both lower limbs and mild anti-gravity movements of all four limbs. An MR spine confirmed C1 spinal cord injury. Reviewing the initial neonatal MR brain in hindsight, the high cord injury was visible. He was gradually extubated onto non-invasive ventilatory support and continues to use nocturnal support at home post-discharge.

Conclusion: In a neonate who presents with significant hypotonia without encephalopathy, spinal cord damage should be considered. An early MR scan to include the spinal cord will clinch the diagnosis and avoid unnecessary investigations and also help to tailor appropriate management.
Keywords: Spinal cord injury, Neonates, Birth