A previously healthy 8-year-old female presented with right flank and lumbar spine tenderness but no focal neurologic deficit after sustaining a motor vehicle accident at 60 miles per hour.  Patient was found to have a bowel perforation and underwent uncomplicated laparoscopic jejunojejunostomy. On postoperative day 4, patient was noted to have bilateral lower extremity paresis and pain. Exam was significant for decreased tone and absent Achilles reflexes. MRI showed an “owl eye” sign, symmetric T2 signal hyperintensity and enhancement involving the anterior horn of the T9-10 cord segments extending to the conus medullaris and anterior roots. MRI was otherwise unrevealing and did not demonstrate evidence of intervertebral disc rupture or vertebral fracture.  Preoperative computed tomography (CT) of the abdomen showed no evidence of aortoiliac vascular abnormality or variant. The patient remained stable and was discharged to inpatient rehab.  

Pediatric spinal cord ischemia is an underrecognized condition which can cause myelopathy. This case demonstrated an atypical location of ischemia involving the anterior conus medullaris. These findings were likely due to a confluence of anatomical vascular variation and traumatic or iatrogenic disruption of the adjacent mesenteric vessels.