Cervical Hematomyelia: A Rare Entity in a Neonate with Cesarean Section and Surgical Recovery

Abstract

Spinal cord injury with or without trauma has been reported in the perinatal period. The prognosis depends primarily on diagnosis of the level, extent and nature of the lesion, established by correlations between clinical, imaging and electrophysiological data. A 25-day-old boy with normal birth weight delivered at term by cesarean section was transferred to Inönü University Turgut Özal Medical Center because of respiratory distress and brachial diplegia. A suspicious medullary lesion on cervical computerized tomography was confirmed as an intramedullary lesion extending from C3 to D1 on magnetic resonance imaging (MRI). Emergent surgery consisting of exposure of the lesion site and interlaminar direct puncture of the lesion under fluoroscopy revealed that the pathology was an intramedullary hematoma. The partial evacuation of the lesion with direct puncture, the patient’s neurological improvement and close follow-up of the patient with ultrasonography, electrophysiology and MRI are discussed in the light of recent literature.

Part 1

“…Any neuromuscular condition that reduces muscle tone increases the risk of SCI because these conditions allow increased stretch of the vertebral column during delivery. 5,9,11,27 Exposure to narcotics or general anesthesia at the time of the delivery may also result in decreased muscle tone and increased risk of injury. 2,26 …”

“…6,37 Because the vertebrae of a newborn contain a large proportion of cartilage, simple radiographs are usually not helpful in diagnosing SCI. 8,9 Ultrasound may be a useful noninvasive bedside study to evaluate the spine. 5,6,9,31 The appearance of the normal spinal cord and the craniovertebral junc- tion is well described.…”

“…2,3 The incidence is estimated to be 1 in 80,000 live births 4 ; SCIs have been documented on neonatal postmortem studies in 10% to 14.9% of cases that included evaluation of the spinal cord. 2,[5][6][7][8][9][10] Obstetrical manipulations at or around birth, such as traction or rotation, escalate the risk of SCI. 6,11 Advances in diagnostic imaging that improve the accurate estimation of fetal size and presentation and the use of cesarean birth to avoid difficult deliveries has reduced the incidence of SCI related to obstetrical maneuvers.…”

“…6,11 Advances in diagnostic imaging that improve the accurate estimation of fetal size and presentation and the use of cesarean birth to avoid difficult deliveries has reduced the incidence of SCI related to obstetrical maneuvers. 9,11,12 Although the diagnosis is primarily considered following a difficult or instrumented delivery, some caregivers may be unaware that SCI can occur in utero, at birth, and in the nursery setting after birth. 13,14 Spinal cord injuries are not always related to trauma and intrapartum events.…”

Hematomielia in Acute Leukemia Patients. Two Clinical Cases

“…Скопившаяся кровь приводит к разрушению центральных структур спинного мозга, передней и задней спаек, передних, зад-них и боковых рогов, сдавлению проводящих путей [11]. Кровь может диффузно пропиты-вать вещество спинного мозга или скопиться в виде интраспинальной гематомы.…”