814 - Central Cord Syndrome in a Toddler After a Fall: A Case Report

Case Diagnosis: Central Cord Syndrome in a Developmentally Delayed Toddler

Case Description: A 19-month-old male with a past medical history of global developmental delay secondary to neglect presented after his foster parent observed that he was unable to move his bilateral upper extremities upon waking that morning. The night prior, he was dropped by his foster sibling, striking his posterior head and neck on a fireplace hearth. Immediately after the incident, he was consolable, and family did not notice any deficits. X-ray and CT cervical spine were unremarkable; however, MRI showed diffuse edema and expansion of the cervical cord from C2-C7, concerning for spinal cord injury without radiographic abnormality.

Discussions: Central cord syndrome is rare in the pediatric population, and literature search reveals only a handful of case reports. In adults, it is associated with hyperextension of the cervical spine due to a fall onto the chin with underlying cervical spondylosis. Some pediatric case reports have identified central cord syndrome after injuries involving hyperflexion of the neck. In this case, the patient was reported to have fallen backwards, striking the posterior head and neck on the fireplace, and mechanism of injury is unclear. The head size of young children is out of proportion to the body, which puts them at risk of different injuries compared to older children. This case is also further confounded by the history of neglect and global developmental delay. We hypothesize that weak musculature and possible poor head control may have placed him at higher risk for central cord syndrome.

Conclusions: Little is known about central cord syndrome in pediatric patients. Symptoms, deficits, and long-term effects can vary widely among adults. Young children, especially toddlers, often struggle with communicating their symptoms. Continued documentation of pediatric cases, interventions and their outcomes would be beneficial to help identify risk factors and guide treatment.