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Body composition in normal weight, overweight and obese children:

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50 Years Ago in THEJOURNAL OFPEDIATRICS

A Report of 16 Tumors of the Spinal Cord in Children; The Importance of SpinalRigidity as an Early Sign of DiseaseRichardson FL. J Pediatr 1960;57:42-54.

F ifty years ago in The Journal, Richardson described 16 children with tumors involving the spinal cord. The diag-noses were difficult, he chronicled. Indeed, for these 1950s children, poliomyelitis was the more typical etiology ofspinal symptomatology, and a pediatricians tools were limited to lumbar puncture and myelography. Richardson

lamented the delay to diagnosis, a median of 7 months.Do we fare better today making this diagnosis? No! One report of 25 children with primary spinal cord tumors

found an average of 7.8 months to diagnosis.1 Have we heeded Richardsons lessons? Perhaps not.Richardson identified the presence of painful spinal rigidity in most cases. Specifically, these children often resist

flexion at the vertebral column because of pain, preferring instead to flex at their hips or knees. We cannot forget theearly manifestations he points out, such as irritability, sudden screaming at night, anorexia, weight loss, constipation,

fear of moving about, head tilt, waddling gait, and anhidrosis below the level of the tumor. We could also add theclinical pearl of scoliosis with a left thoracic curvature, a rare finding, but highly indicative of a tumor or occult syrinx.

With time, more obvious neurologic findings ensue: paraparesis, absent or increased reflexes, paresthesias, or enuresis.We still tend to forget the presentation of these tumors. Spinal ependymoma, astrocytoma (glioma), meningioma,neurofibroma, lipomas, dermoid cyst, or other aggressive cancers are found only after misdiagnosis and delay.Richardson remains on target: Routine investigations, such as x-rays of the vertebral column, are regarded too

frequently as satisfactory evidence of the absence of disease..It is not justifiable to delay myelography for weeksor months, during which time the patient may be in considerable pain, until serious deterioration gives additionalclinical or neurological signs. We could simply substitute magnetic resonance imaging for myelography.Make haste, and dont waste. Painful spinal rigidity and other aforementioned findings merit a sooner rather than later

trip to the magnetic resonance imaging suite.

Paul Graham Fisher, MDDepartments of Neurology, Pediatrics, Neurosurgery, and Human Biology

Stanford University

Palo Alto, California10.1016/j.jpeds.2010.01.021

Reference

1. Crawford JR, Zaninovic A, Santi M, Rushing EJ, Olsen CH, Keating RF, et al. Primary spinal cord tumors of childhood: effects of clinical

presentation, radiographic features, and pathology on survival. J Neurooncol 2009;95:259-69.

July 2010 ORIGINAL ARTICLES

Infant Overweight Is Associated with Delayed Motor Development 25