Anaesthetic Challenge in an Infant with Achondroplasia who Developed Tetraparesis after Whiplash Injury: A case report

Abstract Background: This report presents the case of an infant with dwarfism due to achondroplasia who experienced acute tetraparesis after a cervical whiplash injury. We describe the considerations in the anaesthetic management of this patient, including the potential risks associated with this rare disease. Case presentation: A 1-year-old boy with achondroplasia presented with acute tetraparesis after a whiplash injury. The initial craniocervical computed tomography showed a small posterior fossa, narrow foramen magnum, and ventriculomegaly without any fractures or dislocations.However, magnetic resonance imaging revealed foramen magnum stenosis, signal changesrepresenting myelopathy in the spinal cord extending from the craniocervical junction to the C2 level, oedema of the medulla oblongata, and traction injury of the posterior atlantoaxial ligament. Initial conservative therapy resulted in partial remission of tetraparesis. The patient underwent microsurgical decompression of the craniocervical junction under general anaesthesia, which was performed by a paediatric anaesthesiologist. For airway management, the spontaneously breathing patient underwent fibreoptic-guided nasal intubation under deep inhalation anaesthesia. Ultrasound navigation facilitated venous access. Surgery was performed with the patient in the prone position with careful monitoring. The patient showed complete remission of neurological symptoms at 3 months postoperatively. Conclusions: Herein, we discuss the specifics of anaesthesia and its role in the optimal management of an infant with dwarfism due to achondroplasia and an injured upper cervical myelon and lower brain stem. The role of paediatric anaesthesiologists in the management of this rare condition has been highlighted.