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길랭-바레증후군으로 오인된 외상 척추경막외혈종에서 신경학적 합병증 없이 회복된 소아 1례

Recovery without neurological sequelae of traumatic spinal epidural hematoma masquerading as Guillain-Barre syndrome in a child

대한소아응급의학회지 2020년 7권 1호 p.49 ~ 52
이준상, 김동현, 권영세,
소속 상세정보
이준상 ( Lee Joon-Sang ) - Inha University School of Medicine Department of Pediatrics
김동현 ( Kim Dong-Hyun ) - Inha University School of Medicine Department of Pediatrics
권영세 ( Kwon Young-Se ) - Inha University School of Medicine Department of Pediatrics

Abstract


Spinal cord lesions could mimic Guillain-Barre syndrome (GBS). Misdiagnosis as GBS can incur severe neurologic sequelae. We report the case of a previously healthy, 14-year-old boy with traumatic spinal epidural hematoma masquerading as GBS. He presented with sudden onset of tingling sensation on both hands and feet, which progressed into motor weakness of both legs. No abnormalities were found in brain magnetic resonance imaging and cerebrospinal fluid study. Despite intravenous immunoglobulin therapy for presumed GBS, the weakness progressed rapidly over 8 hours, resulting in complete loss of sensorimotor function below T4 level and loss of deep tendon reflexes. Whole spine magnetic resonance imaging showed a large epidural hematoma over the C5-T5 level. We found that he had experienced whiplash injury on an amusement ride about 3 weeks before. He underwent emergency decompressive laminectomy and hematoma removal, followed by vigorous rehabilitation treatment. On the fifth week of follow-up, he recovered from the complete loss of sensorimotor function. Thorough review of detailed history in emergency departments is required for children presenting with ascending paralysis. Also, rapid diagnostic and therapeutic interventions are crucial for maximum recovery of neurologic symptoms.

키워드

Diagnosis, Differential; Guillain-Barre Syndrome; Paralysis; Spinal Cord Injuries; Hematoma, Epidural, Spinal

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