Evidence of cord compression or epidural, subdural, or intramedullary bleeding may be present on MRI. Atrophy may occur with old lesions (Figure 127.1). Although mental status should be normal in patients with cervical spinal cord injury, it seldom is. Most patients are lethargic (at least during the first hour after delivery) due to concomitant head trauma at the time of the spinal cord injury. When traumatic spinal cord injury is suspected in a neonate, the head should be immobilized.
Traumatic spinal cord injuries should be treated with 3 mg/kg of methylprednisolone and an infusion of 5.4 mg/kg per hour for the next 23 hours. Surgical intervention should be carried out in the presence of extramedullary lesions or bone displacement. Supportive therapy includes mechanical respiratory support, maintenance of body temperature, and prevention of urinary tract infections. Physical and occupational therapy should be started when the patient is stable.

Figure 127.1.— T1-weighted sagittal image demonstrates narrowing of the cervico-medullary junction.