<b><i>Introduction:</i></b> Intraspinal epidermoid cysts are congenital or acquired in origin; whereas intraspinal neurenteric cysts (NECs) are of congenital origin. Their individual association with spinal dysraphism and vertebral segmentation anomalies is very well known. <b><i>Case presentation:</i></b> We hereby report a case of concurrent intradural extramedullary epidermoid and NEC at adjacent vertebral levels in a spinal dysraphism child, not reported in English Literature till now. <b><i>Conclusion:</i></b> Multiple spinal lesions related to any/all of the 3 germ layers can coexist at same or adjacent vertebral levels in the same patient and surgical planning shown to be done accordingly.
166minor injuries in the past was present, but there was no externally visible bleeding this time. There was no history suggesting a familial bleeding disorder. Clinically, child was active and alert without any neurological deficit. Head circumference was 62 cm, with fluctuant nontender circumferential scalp swelling [ Figure 1a] with areas of crust formation (due to pressure necrosis) without any discharge. Question mark scar of the previous craniotomy on the left side of the head was present. There were no features of raised intracranial pressure, meningitis, or scalp infection. Computed tomography (CT) head [ Figure 2] showed a left parieto-occipital extradural hematoma and massive circumferential extracalvarial hypodense scalp collection [ Figure 2a] which was increasing on repeat scan [ Figure 2b]. There was no brain parenchymal hematoma or skull fracture. Hemogram, peripheral smear, liver and renal function tests, and abdominal ultrasound were normal. Blood group was O positive. Both prothrombin time (PT) and activated partial thromboplastin time (aPTT) were deranged, but thrombin time was normal. Serum fibrinogen level was low -156 mg/dL (normal 200-400 mg/dL). Factors V and VIII assays were normal. D-dimer assay was normal. Patient was managed by fresh frozen plasma (FFP) transfusion till correction of PT and aPTT followed by needle aspiration of scalp collection -1300 ml of altered liquefied blood was aspirated (in three stages) and circumferential pressure head bandage was applied. Head circumference reduced to 48 cm [ Figure 1b]. He is asymptomatic at 6 months follow-up and is advised to take precautions to avoid all sorts of injuries like contact sports.
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