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

Year 2015, Volume: 9 Issue: 1, 62 - 65, 01.04.2015

Mehmet Canpolat Hüseyin Per Hakan Gümüş Volkan Yılmaz Serkan Özsoylu Hatice Gamze Poyrazoğlu Başaknur Akyıldız Abdulhakim Çoşkun Sefer Kumandaş

Abstract

SCIWORA (Radyolojik bulgu olmaksızın spinal kord injurisi), travma sonrası klinik olarak miyelopati bulguları olmasına rağmen omurganın direkt radyografilerinde, tomografilerinde ve miyelografilerinde kırık ve dislokasyon bulgusu olmaması şeklinde tanımlanabilir. Bu çalışmada spinal kord injurisinde erken tanı ve tedavinin önemini vurgulamak için SCIWORA tanısı konan 2 olgu sunuldu. Olgu1; 12 yaşında kız hastanın oyun esnasında kardeşinin boyun bölgesine vurması sonucu ellerinde uyuşma, kol ve bacaklarında güçsüzlük gelişmesi ve yürüyememe nedeni ile travmanın 12. saatinde hastanemize başvurduğu öğrenildi. Nörolojik muayenede flask tetraparezi saptandı. Çekilen spinal manyetik rezonans görüntüleme (MRG)’de C 3-4 den C-7 ya kadar uzanan spinal kord anteriorunda simetrik aksonal injuri ile uyumlu tutulum olduğu gözlendi. Hastaya intravenöz (IV) yüksek doz metilprednizolon tedavisi verildi. Tedavi sonrası fonksiyonel iyleşme gözlendi. Olgu 2; 5 aylık erkek hasta araç içi trafik kazası nedeni travmanın 18. saatinde çocuk nöroloji kliniğine refere edildi. Nörolojik muayenede parapleji saptandı. Spinal MRG incelemesinde Th1-Th2 disk mesafesinden Th3’e kadar uzanan yaklaşık 1.5 cm lik segment boyunca spinal kordu tutan T1 hipointens T2A hiperintens aksonal injuri ile uyumlu görünüm saptandı. Hastaya IV yüksek doz metilprednizolon tedavisi verildi. Tedavi sonrası anlamlı fonksiyonel iyleşme gözlenmedi. Sonuç olarak, fizik muayene ve spinal MRG, spinal travma ile başvuran hastalarda önemlidir. Torakal bölge tutulumu kötü nörolojik prognozla ilişkilidir. Spinal MRG’de SCIWORA saptanan olgularda erken dönemde yüksek doz metilprepnizolon tedavisi mortalite ve morbidite için hayati öneme sahiptir.

Keywords

Çocuk, SCIWORA, Spinal kord, Spinal travma

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

Abstract

Spinal cord injury without radiographic abnormality (SCIWORA) refers to spinal injuries, in the absence of identifi able bony or ligamentous injury on complete, technically adequate plain radiographs or computed tomography. In this study, Two cases diagnosed with SCIWORA have been presented to emphasize the importance of early diagnosis and treatment for spinal cord injury. Case 1: A 12-year-old girl presented at the hospital complaining of numbness in her hands due to being hit on the neck while playing with her brother. She presented at our hospital 12 hours after the trauma. Neurological examination revealed fl accid tetraparesis. Magnetic resonance showed symmetrical axonal injury in the anterior spinal cord anterior from C 3-4 to C-7. IV high-dose methylprednisolone was administered and functional improvement 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 accid paraparesis, The spinal MRI investigation performed taking the clinical fi ndings into account revealed a T1 hypointense and T2A hyperintense appearance consistent with axonal injury of the spinal cord along a segment around 1,5 cm length from the Th1-Th2 intervertebral space to Th3. IV high-dose methylprednisolone was administered but signifi cant functional improvement was not observed. In conclusion, spinal magnetic resonance imaging is important along with the physical examination when trying to make a correct diagnosis in cases with a spinal trauma history. The involvement of the thoracic spine is associated with a poor neurological outcome. High-dose methylprednisolone treatment initiated in the early period may be life saving for patients identifi ed as having SCIWORA

Keywords

Child, SCIWORA, Spinal cord, Spinal trauma

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