CASE 2
Luca is a 13-year-old boy admitted in the pediatric emergency room,
complaining hypoesthesia of the lower limbs, with increasing difficulty
in walking, during the last seven days.
About 25 days before, the boy reported difficulty in bending the head
after physical activity (weight throw). Due to persistent pain, he
underwent an orthopedic examination with cervical spine x-ray. The
imaging showed vertebral instability characterized by moderate
retrolisthesis of C3-C4 and C4-C5.
After a while, Luca began to complain paresthesiae of the lower limbs
associated with walking difficulties. Taping was removed, with immediate
benefit. After a few hours, however, paresthesiae and difficulties in
walking appeared again. Child neuropsychiatric evaluation was then
performed, but the neurological objective examination was negative.
After 48 hours the boy returned to the PER, complaining inability to
walk, with no pain in the lower limbs. At the physical examination he
was not able to keep the standing position. Lower limbs muscle
contractions were present intermittently for short intervals of time.
These muscles had normal consistency with no tenderness to the
palpation. Deep tendon reflex was present and symmetrical. No sphincter,
nor sensitive deficits were detected. After confirming a worsening of
the motor deficit, we decided for hospitalization.
On the following day, brain and spinal MRI were performed, with evidence
of an expansive intravertebral epidural lesion in the dorsal area,
extending from D1 to D3, which involves and widens the conjugation
foramina of the left side (Figure 2A and 2B). Additionally, there was
also another polylobed formation with similar characteristics in the
right mid-thoracic area along the costal margin line.
The patient therefore underwent an urgent neurosurgical intervention of
laminotomy and removal of the mass compressing the medulla (Figure 2 C
and 2D).
Histological examination showed an anaplastic large-cell ALK-positive
lymphoma. After surgery, the patient presented incomplete paraplegia. A
specific chemotherapy protocol was undertaken, followed by a
rehabilitative management, with the execution of daily exercise
sessions.
After the first discharge from the department of Pediatric
Oncohematology, following about 2 months of physiotherapy, Luca showed
an initial motility of the lower limbs with the possibility of loading.
Over time there has been a progressive improvement of the motor deficit,
until complete resolution. At present, he usually plays tennis.