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Anterior spinal cord syndrome (ACS) is a lesion affecting the anterior two-thirds of the spinal cord with loss of motor control below the lesion with intact crude sensation (1, 2). A true ACS results from a vascular lesion at the anterior spinal artery (ASA) resulting in ischemic injury to the respective area of the spinal cord. Patients present with complete motor defects below the lesion, along with sensory defects affecting pain and temperature sensation. The intensity of the sensory deficits depends on the level of involvement in the spinal cord. Herein we present the cases of ACS in two 13-year-old boys.
CASE 1
At the end of a class period, a 13-year-old boy was unable to get up from his chair. He was taken to the community hospital and found to have bilateral lower-extremity paralysis, without any signs or symptoms of infection. Computed tomography of the head and laboratory results were within normal limits, and he was transferred to a tertiary care pediatric hospital. Examination demonstrated absent deep tendon reflexes and 0/5 muscle strength in his bilateral lower extremities with a sensory level of T8. He had intact proprioception and vibration, with absent pain and temperature sensation. Diagnostic studies, including hematological workups and blood and spinal fluid cultures, were all negative except for elevated Factor VIII, Protein S, and Protein C, which was attributed to an acute inflammatory reaction. Magnetic resonance imaging (MRI) of the spine showed increased T2 signal intensity in the anterior aspect of the spinal cord from approximately the T5 to T6 level through the mid-T8 level (). The patient was treated with a tapering schedule of high-dose corticosteroids. Upon stabilization, he was transferred to a pediatric specialty hospital for further rehabilitation and training.
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Figure 1.
On admission, he had 0/5 muscle strength and absent deep tendon reflexes in his lower extremities. His sensation to light touch and pinprick was altered below T5 with an absence of sensation around the perianal region. On the American Spinal Injury Association Impairment Scale (AIS), he was diagnosed as T5 grade C.
Over the course of his rehabilitation stay, the patient regained full control of his bladder function along with some lower-extremity muscle strength and was ambulating with moderate to maximum...