Spontaneous spinal epidural hematoma in two toddlers: diagnostic pitfalls

Abstract

We report two boys with a spontaneous spinal epidural hematoma (SSEH). The first child presented at the age of 2 years with back pain and general weakness after a respiratory tract infection. After a first surgical intervention he developed a recurrence of bleeding, necessitating re-intervention. He developed medullary ischemia. Important neurologic deficits with paresis of the lower extremities and bladder dysfunction persisted. The other child presented at the age of 1,5 years with irritability and crying, attributed to a mesenteric lymphadenitis. He underwent a laminectomy with drainage of the hematoma. The postoperative course was uneventful. In both cases, no identifiable cause was found for the bleeding. SSEH is a rare condition, but represents a medical emergency. In most pediatric cases, presentation is atypical with back or neck pain and general irritability as sole initial symptom. Neurologic focal signs can arise hours or days after the onset of the bleeding. Knowledge of SSEH presenting signs and symptoms is important for timely diagnosis and treatment. Although it is mostly a solitary event, we stress the importance of close clinical, and if necessary radiological, follow up.

Spontaneous Spinal Epidural Hematoma in a 12-Year-Old Child

“…SSEH is an infrequent pathology in children, with only 29 cases having been reported. The majority of cases were in the cervical spine (17 out of 29; 58.6%) [3][4][5]. Clinically, the presentation of epidural hematoma in the pediatric age group varies significantly.…”

“…A review of 29 pediatric cases reported by Pecha and Smeets showed complete resolution of neurological deficits in 15 out of 29 (51.7%) patients, partial resolution in 13 (44.8%) patients, and death in one (3.4%) patient [ 3 , 5 ]. In the present report, the child showed partial recovery after five days from laminectomy and evacuation of hematoma and full recovery was reached after three months.…”

“…The incidence has been estimated at one per million per year in the general population [2]. Only 29 cases have been reported in the pediatric population and the majority of the reported cases spontaneously occurred [3][4][5]. These reports showed the importance of early detection and emergency hematoma evacuation to achieve practical outcomes [3,6,7].…”