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December 1970


Author Affiliations

Salt Lake City

Am J Dis Child. 1970;120(6):583. doi:10.1001/archpedi.1970.02100110131021

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To the Editor.—I believe that the interesting case report by Linarelli and Prichard (Amer J Dis Child119:513-520, 1970) entitled "Congenital Sensory Neurology" might be interpreted differently. On the basis of the evidence presented, our diagnosis would be "severe injury to the cervical spinal cord secondary to difficult breech delivery."

The baby was born by "a difficult breech extraction with forceps." Also, "he had hematomas on his buttocks and scrotum." The clinical findings noted thereafter are typical of patients who have suffered from avulsion of the cervical cord due to hyperextension of the neck during a difficult breech delivery. These findings include (1) respiratory distress due to intercostal paralysis (note the collapsed chest and abdominal breathing in the color photograph), (2) bilateral spasticity due to bilateral pyramidal tract damage (this would account for the opisthotonos, periodic episodes of arm flexion and leg jerking, the patulous anus, and the

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