Spinal cord infarction is a well-known entity in adult medicine, but remains exceedingly rare in children quite more so when considered by causation of trauma. This is the case of a 16-month old Hispanic child who presented to the emergency department greater than 24 hours after an unwitnessed fall from a table found to have a traumatic spinal cord infarction. The father initially voiced concern of the child vomiting and “not acting right.” The child had a previous history of non-accidental trauma and initial plan of care reflected a suspicion of head injury in the absence of obvious external injuries. Subsequent examination and history would yield that the child had paraplegia with MRI showing acute/subacute infarction of thoracic spinal cord without obvious extraneural pathology. The patient had no worsening or improvement in symptoms and at 7 months after presentation would remain a paraplegic. Investigation by child protective services determined father neglected to seek care for >24 hours after the accident. The child was removed from his home and the father imprisoned on charges of child abuse. This case highlights the importance of early recognition of injury, detailed and specific history taking, and completeness of exam in setting of suspected abuse.
Jonathan Burgess Cardwell
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