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.