A Case of Hypoxic – Ishemic Spinal Cord Lesions in Cerebral Palsy

Abstract

Aims: To focus attention of physicians on spinal cord examination at cerebral palsy, as spinal cord lesions contribute to clinical picture of spastic diplegia, and thereby to improve the treatment outcome of cerebral palsy. Presentation of Case: We report the case of 4-year-old male with lower paraplegia and speech delay. Clinical examination has revealed the muscle tonus to be increased bilaterally in gastrocnemius muscles and thigh adductors. The muscle tonus was decreased bilaterally in iliopsoas to such extent that he could not hold passively rised legs. Electrophysiological Electrophysiological examination has revealed signs of decreased excitability of motoneurons at the level L 2 – S 2. MRI has confirmed lesions of spinal cord at that level in addition to injury at thoracic level and brain lesions. MRI spinal angiography has detected tortuous anterior spinal artery. The patient benefited from the electrophoresis with theophylllinum, applied on lower thoracic and first lumbar vertebrae with improvement of his legs motor function. Discussion and Conclusion: The first explorer of cerebral palsy, Dr. Little, based his view of cerebral palsy on thorough postmortem examination, performed by himself and by his colleges. In accordance with data, obtained from the section, he reported the cerebral palsy to result from perinatal injury of either brain or spinal cord. However, his follower, Dr. Freud, limited his pathlogoanatomic research exlusively to brain cuts, diverting attention of neurologists from the spinal cord. Nevertheless, our presentation proves involvement of spinal cord in pathogenesis of Cerebral Palsy and benefits from therapy applied on spine and, thus, confirms Little’s point of view.