Delayed Diagnosis of Tethered Cord Syndrome Leads to Persistent Neurologic Deficits

Case Overview

This case involves a teenage individual who presented to a pediatric neurologist with symptoms of lower extremity weakness, muscle atrophy, and urinary retention that began in early 2020. Initially, the individual was diagnosed with a functional neurologic disorder. However, in February of 2022, a physical examination revealed progressive scoliosis, which prompted further investigation. An MRI examination subsequently disclosed the presence of occult tethered cord syndrome. Despite undergoing spine neurosurgery for the untethering of the filum, the patient continues to experience persistent neurologic deficits. The focus of this case is to evaluate the standard of care provided by the medical professionals involved.

Questions to the Pediatrics expert and their responses

How often do you see patients who have been diagnosed with tethered cord syndrome?

I am a board-certified neurologist with over 15 years of experience. I have reviewed several cases involving tethered cord syndrome in the past, and even though it is not a common disorder, I do see several patients a year who have it.

What are the most pertinent measures that pediatric neurologists can perform to promptly recognize and appropriately manage tethered cord syndrome in children who present with lower extremity symptoms?

Some of the most important measures to take when this is suspected are to have an MRI done and test for the level of responsiveness. A physical examination is also important, in case there are other signs that were possibly missed.

About the expert

This expert has nearly 15 years of experience in the field of pediatric neurology. He earned his BS from California Polytechnic University, his PhD in biomedical sciences from the University of California, Riverside, and his MD from the University of California, San Diego. He then completed a residency in pediatrics at Wilford Hall Medical Center and a fellowship in child neurology at Stanford University. Today, this expert is board certified in neurology, child neurology, and epilepsy, as well as pediatrics, and is an active member of numerous professional societies, including the Child Neurology Society and the American Pediatric Society. He has been the lead or co-investigator on over a dozen funded trials and has presented widely on topics such as autism, epilepsy, and traumatic brain injuries. He previously was an assistant professor of pediatrics and an associate professor of pediatrics, neurology, neurosurgery, and psychiatry at Tulane University, the director of pediatric neurology and neuro-diagnostics at Tulane Medical Center and Lakeside Hospital, and the co-director of the developmental neurogenetics center at Tulane University School of Medicine. He also served as the director of child neurology at the Uniformed Services University of the Health Sciences and as a pediatric neurologist at Ocean Springs Hospital. Currently, he is a professor of pediatrics, neurology, neurosurgery, and psychiatry, the director of the pediatric neurology clerkship, and the medical director of the center of autism and related disorders at a top medical school in Louisiana. In addition, he is a pediatric neurologist and epileptologist at a university-affiliated medical center, a professor of neurology at a well-known medical school, and a telemedicine pediatric neurologist for two hospitals, all in Louisiana.

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Specialties:

Pediatrics