Hyperacute Transverse Myelitis in a 5-Year-Old Boy Following Minor Trauma

Background/Purpose: Acute transverse myelitis (ATM) is rare, with only 20% of pediatric cases often associated with previous infections or vaccinations.[1] Nevertheless, minor trauma is rarely mentioned in literature as a potential trigger, with only scattered cases of hyperacute presentation.[1] [2]

Methods: This work aims to explore the potential connection between minor trauma and the onset of ATM in children, using a clinical case to highlight its relevance. Studies on ATM in children were identified through databases using keywords like ATM, minor trauma, and children.

Results: The case presentation is based on a 5-year-old boy developing progressive muscle and trunk weakness within an hour after a minor fall during a soccer game. X-rays ruled out fractures, and weakness was initially attributed to compensatory posture. With worsening symptoms, the patient was re-evaluated; MRI revealed ATM. CFS and blood results remained unremarkable. Corticosteroid therapy resulted in rapid recovery with no neurological deficits.

Conclusion: Minor trauma may act as a “second hit” unmasking an underlying immune dysregulation or as a trigger itself. Even mild trauma may trigger neurovascular changes increasing blood–brain or blood–spinal–cord barrier permeability, allowing immune factors to enter the central nervous system and potentially initiate a localized inflammatory response leading to ATM.[2] [3] In children, an immature immune system may lead to exaggerated inflammatory responses, lowering the threshold for autoimmune activation. Although rare, an ATM should be considered in children with persistent neurological deficits after minor trauma. Early corticosteroid therapy can lead to full recovery.

 

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No conflict of interest has been declared by the author(s).

• References

• 1 Pidcock FS, Krishnan C, Crawford TO, Salorio CF, Trovato M, Kerr DA. Acute transverse myelitis in childhood: center-based analysis of 47 cases. Neurology 2007; 68 (18) 1474-1480
• 2 Lim J, Hamouda ES, Fortier MV, Thomas T. Antecedent minor trauma and hyperacute presentations in childhood transverse myelitis. J Child Neurol 2021; 36 (11) 1034-1041
• 3 Sulhan S, Lyon KA, Shapiro LA, Huang JH. Neuroinflammation and blood-brain barrier disruption following traumatic brain injury: pathophysiology and potential therapeutic targets. J Neurosci Res 2020; 98 (01) 19-28

Publication History

Article published online:
26 September 2025