[P2-148] A neonate with bilateral brachial plexus palsy and spinal epidural mass
A neonate born at 31 weeks gestation without birth insult was found to have rapidly progressive bilateral upper limb flaccid weakness at the age of 3 week-old. Her spinal MRI showed extensive epidural lesion from the cervical down to the lumbar spine, with severe cervical spinal cord compression. Because of preceding fever and decreased activity, spinal epidural abscess was considered initially, with administration of broad-spectrum antibiotics and surgical drainage. However, during operation, the neurosurgeon found the epidural lesion more like tumor grossly. After surgery, the baby’s upper limb weakness improved. The pathology showed acute and chronic inflammation with fibrosis and some degree of bony involvement but no tumorous lesion. The follow-up MRI one month later documented no residual or recurrent lesion.
This is the first neonatal case of spinal epidural inflammatory pseudotumor with extensive lesion surrounding the whole spine presenting as bilateral brachial plexus palsy due to cervical spine compression. Inflammatory pseudotumors are benign tumor-like lesions affecting patients of all ages but very rarely reported in the newborn. They can occur in many organs but extension to the CNS is rare. The lesions present on the neuroimaging as contrast-enhancing mass. Surgery is usually required for definite diagnosis and surgical excision is usually the treatment of choice. The diagnosis is made by histology, showing inflammatory cells and sometimes fibrosis, with no nuclear atypia.
This is the first neonatal case of spinal epidural inflammatory pseudotumor with extensive lesion surrounding the whole spine presenting as bilateral brachial plexus palsy due to cervical spine compression. Inflammatory pseudotumors are benign tumor-like lesions affecting patients of all ages but very rarely reported in the newborn. They can occur in many organs but extension to the CNS is rare. The lesions present on the neuroimaging as contrast-enhancing mass. Surgery is usually required for definite diagnosis and surgical excision is usually the treatment of choice. The diagnosis is made by histology, showing inflammatory cells and sometimes fibrosis, with no nuclear atypia.