A Hemimotor Deficit in an 18-Month-Old Boy Revealing Acute Myelitis

Acute transverse myelitis, a rare inflammatory lesion of the spinal cord, causes band like sensory disturbance, motor deficits, pain, numbness, and loss of bowel or bladder control. Usually the damage is complete and symmetric. Spinal magnetic resonance imaging (MRI) confirms the diagnosis, with lesions typically showing T2 hyper intensity signal of the gray matter and the neighboring white matter, and extending longitudinally, concerning3 vertebral segments.[1] [2] [3]

We present an unusual case of an 18-month-old boy who suffered from an acute hemimyelitis with hemideficit of the left arm and leg, associated with pain, left Babinski's sign, disappearance of muscle tendon reflexes, and abolition of the abdominal reflex. No bladder control issue was observed. At first we suspected a cerebral etiology, such as a stroke or a brain tumor. But the cerebral computed tomography (CT) scan and MRI were normal, as was lumbar puncture. The initial spinal MRI showed a T2 hyper-intensity of the hemi left spinal cord from C5 to C7 associated with a swelling of the cord ([Figs. 1] [2]). We excluded a vascular etiology because the lesions did not correspond with a vascular territory. Antiaquaporin 4 antibodies in the cerebrospinal fluid and viral pathogens in blood, stools, and cerebrospinal were not found. The symptoms declined following a treatment of corticosteroids. However, lesions persisted in the control MRI 3 months later ([Fig. 3]).

Fig. 1 Sagittal T2 magnetic resonance imaging (MRI) with a hyper-intensity of the hemi left spinal cord from C5 to C7 associated with a swelling of the cord.

Fig. 2 Axial T2 magnetic resonance imaging (MRI) with a hyperintensity of the hemi left spinal cord (C6 level).

Fig. 3 Follow-up sagittal T2 magnetic resonance imaging (MRI; 3 months later) with a persisting spinal cord hyperintensity.

• References

• 1 Absoud M, Greenberg BM, Lim M, Lotze T, Thomas T, Deiva K. Pediatric transverse myelitis. Neurology 2016; 87 (09) (Suppl. 02) S46-S52
• 2 Pidcock FS, Krishnan C, Crawford TO, Salorio CF, Trovato M, Kerr DA. Acute transverse myelitis in childhood: center-based analysis of 47 cases. Neurology 2007; 68 (18) 1474-1480
• 3 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002; 59 (04) 499-505