Diagnostic Challenges in Pediatric Spinal Cord Infarction: A Case of Spinal Shock Mimicking Guillain–Barré Syndrome

Introduction: Spinal cord infarction (SCI) is a rare but serious neurological emergency, accounting for only 1–2% of all neurovascular events and a small fraction of acute myelopathies. Etiologies are diverse and include systemic vascular risk factors, embolic events, and in younger individuals, fibrocartilaginous embolism often triggered by minor trauma, among others. Magnetic Resonance Imaging (MRI) of the spine, particularly Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) sequences, plays a central role in diagnosis when combined with clinical correlation and careful evaluation of potential predisposing factors. Case Presentation: We report a case of a 14-year-old previously healthy female, who presented with acute progressive bilateral lower limb weakness after she was suddenly pushed into a pool. Neurological examination showed complete paraplegia and decreased sensation, including fine touch, pinprick, and proprioception in both lower limbs, in addition to absent lower limb reflexes. Initial diagnosis of Guillain–Barré syndrome was raised; however, it was ruled out based on normal CSF and nerve conduction studies. MRI spine imaging subsequently revealed evidence of anterior spinal cord infarction. Conclusion: Spinal cord infarction with spinal shock is a rare but important differential diagnosis in children presenting with acute flaccid paralysis. This case highlights the importance of maintaining a high index of suspicion, especially when initial investigations are inconclusive