Dados do Trabalho

Título

ANTERIOR SPINAL ARTERY SYNDROME (ASAS) DUE TO ANTERIOR SPINAL ARTERY ISCHEMIA FOLLOWING PEDIATRIC TRAUMATIC BRAIN INJURY (TBI): CASE REPORT AND LITERATURE REVIEW

Apresentação do caso único

J.P.J.N., 12 years old, a previously healthy, was transferred from another hospital due to complaints of neck pain and weakness in the upper limbs (UL) following a traumatic brain injury (TBI) the previous day. Cervical and cranial tomography performed showed findings within normal limits. The patient experienced sudden onset of flaccid tetraplegia and irregular respiratory pattern shortly after admission to Prontobaby, necessitating orotracheal intubation for neurological protection. The Neurology team suspected Anterior Spinal Artery Syndrome (ASAS) based on history and physical examination findings. Magnetic Resonance Imaging (MRI) revealed a left parietal subgaleal hematoma (cranial MRI) and hyperintensity in the spinal cord affecting all cervical levels (cervical MRI), without cervical compression. Treatment was initiated with pulse therapy using methylprednisolone for 5 days, anti-thrombotic therapy with aspirin and optimized pain management. J.P.J.N. showed significant clinical improvement, remained intubated for 12 days, and demonstrated partial improvement in UL movement by the 14th day of hospitalization. The patient continues to be hospitalized at Prontobaby for support, motor and respiratory physiotherapy.

Discussão

Anterior Spinal Artery Syndrome (ASAS) is a rare neurological complication characterized by sudden onset paraplegia with variable preservation of proprioception. Its etiology is attributed to compromised blood flow through the anterior spinal artery or one of its major collateral vessels. Several factors have been implicated as causes of ASAS, including atherosclerosis,spinal cord tumors, trauma, vertebral canal stenosis and arteriovenous malformations. Clinical features of ASAS include sudden onset of muscle weakness, ranging from monoparesis to quadriplegia, with flaccidity or spasticity of muscles, and a high incidence of sphincter dysfunction when the lower thoracic or lumbar segments are affected. The imaging modality of choice is magnetic resonance imaging (MRI). Treatment focuses on general patient support, identification of the underlying cause, and secondary prevention.

Comentários finais

Anterior Spinal Artery Syndrome (ASAS) is a rare yet significant neurological complication that should be considered in patients with risk factors. Early identification by the pediatric neurologist is crucial for early diagnosis, appropriate treatment, necessary supportive measures, and a more favorable prognosis for the patient.

Referências

.

Fonte de Fomento (se houver)

.

Palavras Chave

ANTERIOR SPINAL ARTERY SYNDROME; ANTERIOR SPINAL ARTERY ISCHEMIA; PEDIATRIC TRAUMATIC BRAIN INJURY