The Spine and the Child Who Stopped Walking

What this deck covers

The Spine and the Child Who Stopped Walking in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. A line across the abdomen, and a bladder that will not empty
2. Weakness that started in the feet and climbed
3. The back pain that wakes him at night
4. Fever, a stiff back, and a child who will not sit up
5. Where the examination says the lesion is
6. The dimple that was always there
7. The child with Down syndrome who has stopped running
8. Normal bones, and legs that will not move
9. One arm that stopped working after a cold
10. The toddler who will not sit and will not say why
11. Numb where she sits, and unable to pass urine
12. The back pain that needs a picture

What this deck teaches

• A sensory level is a cord sign. No nerve, root or muscle can produce one, so a sensory level moves the whole search into the cord or the column before any scan is booked.
• The three flaccid weaknesses separate on three findings. Transverse myelitis has a level and a bladder; Guillain-Barre has neither and enhances the roots; acute flaccid myelitis is asymmetric with intact sensation and grey matter signal.
• The clinical level is an upper bound. It is the highest the lesion can be, not where it is, which is why the whole spine is imaged rather than the segment the examination predicted.
• Night pain and age under five are red flags. Mechanical pain is worse with activity and better at rest. Pain that wakes a child, or any back pain under five, belongs to infection or tumour until imaged.
• Fever plus spinal pain plus a deficit is an abscess. Blood cultures and antistaphylococcal antibiotics start without waiting, and a child with a deficit is drained.
• CT clears the bone, MRI clears the cord. A young spine can stretch far enough to injure the cord and recoil into normal alignment, so normal radiographs and a normal CT do not exclude a cord injury.

Exam pearls from this deck

• A sensory level is a cord sign. No nerve and no muscle can make one.
• Watch the vital capacity, not the saturation. Saturation falls last.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all neurology illustrated case decks · neurology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.