Neonatal spinal cord injury after an uncomplicated caesarean section

Abstract

Abstract Introduction: Spinal cord injury of the newborn is a rare and critical condition which is typically reported after difficult deliveries. The few cases of spinal cord injury after caesarean section reported in literature are usually associated with intrauterine hyperextension of the head. However, in exceptional cases the authors described intrauterine vascular insults as a possible cause for spinal cord lesions during pregnancy. Presentation of the case: A term infant was born after an uncomplicated caesarean section following cephalic presentation. Pregnancy was reported as uneventful. Foetal ultrasounds were normal and showed no evidence of hyperextension of the head. Although the boy was in good general conditions after birth, he showed a flaccid paralysis of both upper extremities with absent deep tendon reflexes and missing pain response. Other neurologic findings like general tonus and reactivity as well as spontaneous movements of both lower extremities were adequate. A spinal MRI performed at 48 h of life showed intact brachial plexuses with evidence of spinal cord lesion compatible with an ischemic injury. Accurate anamnesis revealed that the mother had perceived reduced foetal movements in the last 2 days before birth, suggesting a possible intrauterine origin of the ischaemic event. Conclusion: Our case reinforces the hypothesis that small ischaemic spinal cord lesions may occur during uncomplicated pregnancy. Therefore, such lesions may not always be related to a difficult delivery. Irrespective of the cause, treatment and parental counselling remain challenging due to the rarity of reported cases.