Correspondence
Case 35-2006: A Newborn Boy with Hypotonia
N Engl J Med 2007; 356:874February 22, 2007
- Article
To the Editor:
Brown et al. (Nov. 16 issue)1 report on a newborn boy with hypotonia and present a list of diagnoses to consider in the floppy infant syndrome, including spinal cord disorders. However, spinal cord lesions caused by injuries and tumors are not mentioned. Kobayashi et al. recently described a case of intrauterine spinal cord injury and reviewed the literature.2 We report on a boy born at term with muscular hypotonia, a bell-shaped chest, and respiratory distress with retractions after birth. He had a normal sucking reflex and normal eye motility. Magnetic resonance imaging (MRI) of the brain and a thorough laboratory and electrophysiological workup were normal. At 5 weeks of age, he had some spontaneous movement of his fingers but no movement or response to painful stimuli in his legs. His subcostal retractions gradually became more pronounced. MRI of the spine showed a cyst compressing the spinal cord at the level of C7–T1. Vigorous use of diaphragmatic musculature in an otherwise hypotonic infant strongly suggests the presence of a cervicothoracic spinal cord lesion.
2 ReferencesNils Thomas Songstad, M.D.
Claus Klingenberg, M.D., Ph.D.
Per Ivar Kaaresen, M.D.
University Hospital of North Norway, N-9038 Tromsø, Norway
nils.songstad@unn. no 1
Case Records of the Massachusetts General Hospital (Case 35-2006). N Engl J Med 2006;355:2132-2142
Full Text | Web of Science | Medline2
Kobayashi S ,Kanda K ,Yokochi K ,Ohki S . A case of spinal cord injury that occurred in utero. Pediatr Neurol 2006;35:367-369
CrossRef | Web of Science | Medline
Author/Editor Response
In our patient, the elevated creatine kinase levels and the myopathic electromyogram pointed strongly to a primary muscular disorder. However, the general point that a spinal cord lesion might predispose a patient to congenital floppiness is of interest.
Robert H. Brown, Jr., D.Phil., M.D.
Massachusetts General Hospital, Boston, MA 02114
