From Sinus Infection to Subdural Empyema: A Pediatric Epileptic Case with Imaging Challenges and Misdiagnosis

Abstract

Background: The unique anatomical and physiological features of the pediatric spine predispose children to a distinct form of spinal cord trauma known as SCIWORA (Spinal Cord Injury Without Radiographic Abnormality). This condition occurs predominantly in children and is characterized by clinical evidence of spinal cord injury in the absence of detectable abnormalities on conventional imaging modalities, including plain radiography and MRI. Recent studies indicate that multilevel spinal cord involvement in pediatric SCIWORA cases may be more frequent than previously recognized, and some patients may ultimately require surgical management.

Methods: A retrospective analysis was performed on 80 children aged 4–18 years who were treated for SCIWORA at the Pediatric Neurosurgery Department in Omsk between 2008 and 2022. The mechanisms of injury were evaluated, and neurological status was assessed using the Frankel scale to determine the severity of neurological deficits. Injury severity was additionally classified according to the criteria proposed by Zwimpfer T.J. (1990). All patients underwent spinal radiography in two standard projections as well as MRI examination. In twenty-eight cases, electromyography (EMG) studies were performed.

Results: In two patients, clinical manifestations of L4–L5 radiculopathy were observed despite the absence of lumbar spinal trauma. All patients demonstrated favorable outcomes following conservative treatment.

Conclusions: Pediatric SCIWORA remains a relatively rare yet potentially severe form of spinal cord injury. In children with SCIWORA syndrome, multifocal spinal cord involvement is possible, and the degree of neurological recovery largely depends on the presence and severity of MRI-detected abnormalities.