Introduction- Post-traumatic tetra paresis with trivial mechanism of injury myelitis vs embolic spinal cord infarction in a pre-school age child. Methods- A 3-year-old with chicken pox infection three weeks previously presented with reduced GCS after falling off a chair. Examination demonstrated flaccid tone in upper and lower limbs with absent reflexes power of 0/5, and loss of abdominal reflexes. Bladder and bowel dysfunction present Cranial CT, cervical spine x-ray and CSF are normal. Initial MRI showed longitudinally extensive cervical cord T2 hyperintensity involving the central grey matter with patchy enhancement (Fig 1).

Fig 1: Sagittal STIR (a), post-contrast T1 (b), axial T2 (c) and post-contrast T1 (d) MRI showing extensive central cord T2 hyperintensity (a, c) with patchy intramedullary enhancement (b) centred around the central grey matter (d) Repeat MRI after one week showed evolution of T2 signal change from centre of cord to periphery with diffusion restriction (Fig 2).

Fig 2: Sag STIR (a), axial T2 (b), T1 post-contrast (c), DWI (c) and ADC map (d) well-defined cervical cord signal abnormality (arrows, a) migrated to involve periphery of the spinal cord (arrow, b) with new peripheral patchy enhancement (arrow, c). DWI shows peripheral diffusion restriction. Results-Instant neurological deficit, maturation of signal change and DWI findings suggested spinal cord infarction, most likely due to fibrocartilagenous disc embolization. Conclusion-Fibrocartilagenous disc material embolization should be considered in children with evidence of spinal cord infarction, despite the trivial mechanism of trauma and lack of any other associated traumatic imaging findings. Disclosures: None

Krupa Torne
Nottingham University Hospitals NHS Trust
United Kingdom

Georgina Harlow
Nottingham University Hospitals NHS Trust
United Kingdom

Adam Thomas
Nottingham University Hospitals NHS Trust
United Kingdom