Acute non-neoplastic myelopathies in pediatric age: a decade of experience from a pediatric center

Abstract

Introduction: Pediatric myelopathies encompass a broad range of non-traumatic and non-neoplastic etiologies, including inflammatory, vascular, and infectious causes. Despite their low prevalence, the differential diagnosis and management of these conditions remain challenging due to the diversity of clinical manifestations and progression patterns. Methods: A retrospective observational study was conducted, including children up to 18 years of age diagnosed with acute non-neoplastic myelopathy at our pediatric center between 2010 and 2021. Clinical data, complementary examinations, treatments, and functional outcomes were analyzed from hospital records, with a comparison across different etiologies.   Results: Thirty-six cases were included (50% male), with a mean age at diagnosis of 10.8 years (SD±5.3 years). The identified etiologies were: demyelinating and inflammatory (16 cases), vascular (13), infectious (3), and idiopathic (4). Muscle weakness was the most frequent initial symptom (68.9%), followed by sensory complaints (48.3%). Pain as a presenting symptom was reported in 20% of cases and was associated with idiopathic etiology (p=0.05)(p=0.05). Hyperacute onset was characteristic of vascular myelopathies (p<0.001)(p<0.001) whereas 75% of demyelinating and inflammatory myelopathies presented with subacute onset. Magnetic resonance imaging (MRI) findings revealed that brain lesions were more associated with demyelinating and inflammatory etiologies (p=0.003)(p=0.003), while anterior spinal cord lesions in axial sections were linked to vascular etiologies (p=0.018)(p=0.018). A worse functional outcome was observed in cases with hyperacute symptom onset (p=0.024)(p=0.024).   Conclusion: Pediatric myelopathies exhibit distinct clinical and radiological features depending on the etiology. Symptom onset and imaging findings play a critical role in both etiological identification and functional prognosis. The sample from this study displays characteristics consistent with the existing literature. Understanding the particularities of these conditions, particularly in the pediatric population, is essential for defining an effective clinical approach with the potential to positively impact the quality of life of patients and their families.