Spinal epidural hematoma in an infant patient: a differential diagnostic of spinal cord compression syndrome

Felipe Gutierrez Pineda,Daniela Perez Cadavid,Mauro Marcelo Suarez Marin

doi:10.46900/apn.v4i1(january-april).99

Felipe Gutierrez Pineda, Daniela Perez Cadavid + Show 1 more

Open Access

https://doi.org/10.46900/apn.v4i1(january-april).99

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Abstract

A spontaneous spinal epidural hematoma is a collection of blood in the epidural space of the spine occurring in the absence of trauma or other pathological blood conditions, this epidural blood clot has the risk to compress the spinal cord and impact negatively on the neurological outcome of the patients. With a low incidence on pediatrics this condition has not been studied deep, with difficulties on the clinical approach in infants and children due to the limitation in the pediatric neurological exam with the risk to be misdiagnosed. We describe a rare case of spinal cord compression on a young 14 month old patient with a spontaneous cervicothoracic epidural hematoma that presented with a ascending paralysis. Magnetic resonance imaging of the spine demonstrated an extensive epidural hematoma between C4 to T5 with spinal cord compression. An emergency laminectomy was performed with evacuation of the epidural blood clot with a total improve of the neurologic symptoms and without any residual hematoma following 3 months of the surgery. The spontaneous spinal epidural heamtoma is rare cause of spinal cord compression on infants and children with high risk of neurological impact without prompt diagnosis with MRI and emergent surgical evacuation.

Highlights

Spontaneous spinal epidural hematoma is a rare cause of spinal cord compression during childhood
A control spinal and cerebral angiogram and a control Magnetic resonance imaging (MRI) performed 3 months postoperatively showed a complete evacuation of the epidural hematoma, without any vascular malformation or spinal tumor (Figure 2), the patient was capable to walk without any neurological impairment and was discharged
Initial symptoms of spontaneous spinal epidural hematoma (SSEH) are non-specifics on infants, the majority of the cases presents with irritability and neck pain, with the neurological deficits been minimal and often no recognized until its declining [5]

Summary

INTRODUCTION

Spontaneous spinal epidural hematoma is a rare cause of spinal cord compression during childhood. Some authors define this pathology as any blood collection in the epidural spinal space of non-traumatic origin, while others define it as any hematoma that occurs in the absence of any identifiable cause like arteriovenous malformation, bleeding diathesis and minor trauma [1] The diagnosis of this rare disease is challenging on infants because of the unspecific symptoms at presentation and the limited neurological examination in this population [2]. A control spinal and cerebral angiogram and a control MRI performed 3 months postoperatively showed a complete evacuation of the epidural hematoma, without any vascular malformation or spinal tumor (Figure 2), the patient was capable to walk without any neurological impairment and was discharged

DISCUSSION

CONCLUSIONS

Findings

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