Disclosures: Elizabeth Raoof, MEd: No financial relationships or conflicts of interest

Case Diagnosis: Previously healthy 14-year-old female with acute flaccid ascending weakness

Case Description: The patient was admitted to an acute children’s hospital with sudden onset lower extremity weakness. Prior to admission, she reported mild back pain that progressed to intense lower back throbbing. She developed bilateral lower extremity and truncal weakness. Of note, patient fell from 6-feet 8 weeks prior and patient has a family history of maternal family thrombophilia. Her neurological exam was significant for left ankle clonus, weakness of her lower extremities, normal patellar reflexes and normal sensation. Her hospital course was complicated by neurogenic bowel and bladder. Initial MRI was normal. The differential diagnosis included Guillain-Barre syndrome, ascending flaccid myelitis, transverse myelitis, traumatic spinal cord injury (SCI), and SCI infarct. She was treated with 2 doses of IVIG. Repeat MRI showed thoracic cord changes concerning for ischemia. Patient received 5 days of high dose methylprednisolone. EMG studies were normal except for F-wave latency. Later she was started on fluoxetine, which may have correlated with improved motor function.

Setting: Rehabilitation HospitalAssessment/

Results: On rehabilitation admission, patient required a wheelchair and moderate assistance for self-care. During her rehabilitation, she made significant functional gains. On discharge 41 days later, she was able to ambulate 180 feet with forearm crutches/rolling walker and perform all self-care independently. Her bowel and bladder function continued to be impaired.

Discussion: ASA syndrome is caused by infarction of the ASA, usually due to diseases or procedures involving the thoracoabdominal aorta. Such infarctions are uncommon in children but could be due to a wide range of risk factors including infection, autoimmune disorders, thrombotic disorders, and anatomic variants.

Conclusion: This case highlights a rare presentation of ASA infarction in a previously healthy adolescent with no significant risk factors. Further research into ASA infarctions in the pediatric population is needed to know prognosis and risk for future events.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unique-case-of-acute-progressive-flaccid-ascending-weakness-secondary-to-t3-t4-anterior-spinal-artery-asa-infarction-in-a-pediatric-patient/