Spinal epidural hematoma without significant trauma in children: two case reports and review of the literature

Abstract

Background: Spinal epidural hematoma without significant trauma is a rare condition with potentially severe outcome. This case report and systematic review of the literature illustrates the clinical presentation, risk factors, evaluation, treatment and outcomes of spinal epidural hematoma without significant trauma in children. Case presentation: We report one case of a 7-year-old girl who developed a neck pain after minor cervical sprain. MRI showed a right posterior epidural hematoma extending from C2/3 to T1. The hematoma was surgically evacuated, and the histopathology showed an arteriovenous malformation. Postoperative MRI showed complete evacuation of the hematoma and no residual vascular malformation. We report a second ASE with idiopathic spinal epidural hematoma of a 4½-year-old boy presenting with neck pain. MRI showed a right-sided latero-posterior subacute spinal epidural hematoma at C3-C5. Owing to the absence of any neurological deficit, the patient was treated conservatively. MRI at 3 months showed complete resolution of the hematoma. Conclusions: Spinal epidural hematoma without significant trauma in children is a rare condition. It may present with unspecific symptoms. Screening for bleeding diathesis is warranted and neuroradiologic follow-up is essential to rule out vascular malformation. Whereas most children have a favorable outcome, some do not recover, and neurological follow-up is required.

Spontaneous spinal epidural hematoma in a pediatric hemophiliac

“…[21] Further, Carlhan-Ledermann et al presented a case of SSEH successfully treated conservatively, but also noted that some patients' hemorrhages/severe neurological deficits warranted acute surgical intervention. [8]…”

“…[ 19 , 31 , 34 ] Conservative treatment (i.e., infusion of recombinant coagulation factors, corticosteroids) may suffice where there are no major neurological deficits, while surgery is warranted for those with significant paresis. [ 4 , 6 , 8 ] Here, a 1-year-old hemophiliac male with a significant C5-T10 SSEH that contributed to a severe quadriparetic deficit warranted emergent surgical decompression.…”

A Rare Case of Traumatic Cervical Spinal Epidural Hematoma in a Toddler: A Two-Year Follow-Up

“…Spinal epidural hematoma (SEH) in pediatrics is a rare condition that can be either spontaneous or traumatic [1][2][3][4]. SEH represents less than 1% of space-occupying lesions of the spinal canal [2].…”

Delayed Diagnosis of Cervical Epidural Hematoma in a 3-Year-Old Boy

“…Conservative treatment may be justified in cases with mild compression, minimal neurological deficits, or evidence of spontaneous resolution 6,18 . In cases of nonoperatively managed hematoma that causes mass effect, repeated MRI within 12 to 24 hours and inpatient clinical monitoring are recommended, whereas in asymptomatic patients with hematoma that does not cause mass effect, outpatient follow-up is often appropriate.…”