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Diaphragmatic flutter after spinal cord trauma in a child

Diaphragmatic flutter (DF) is an infrequent movement disorder characterized by bursts of rhythmic contractions of the diaphragm and other muscles innervated by cervical roots. Clinically it looks like an involuntary irregular rhythmic movement of the abdominal wall, very often associated with abdominal wall pain and dyspnea.1 Many terms have been proposed: diaphragmatic myoclonus (convulsions, tremor, spasms, cramps, rumbles, pulsations), moving umbilicus, and belly dancer.2 EMG recordings demonstrated a frequency of the contraction between 0.5 and 15 Hz, more often around 4 to 6 Hz. For a correct diagnosis, an EMG of the diaphragm and the scalene muscles should show repetitive contractions.3,4 Its mechanism is not fully understood. Different kinds of neurologic lesions, both central and peripheral, were related to DF.5 Several drugs (carbamazepine, phenytoin, chlorpromazine, benzodiazepines) can be useful.2,3

A 12-year-old girl fell. Extreme flexion of her neck was immediately followed by tetraparesis, paraesthesias, and numbness. Emergency spinal radiographs and MRI showed no abnormalities. Neurologic deficits disappeared in the 10 hours following the accident. Four days later, she started having bursts of abdominal jerks, …