Spontaneous Spinal Epidural Hematoma in an Infant : A Case Report and Review of the Literature

Lim, Jae Joon; Yoon, Soo Han; Cho, Ki Hong; Kim, Sang Hyun

doi:10.3340/jkns.2008.44.2.84

Cited by 20 publications

(22 citation statements)

References 28 publications

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“…Recent reviews support treatment of selected cases with mild or stable neurological deficit conservatively with factor VIII concentrate infusions begun as early during the course as possible. 3,[8][9][10] Neurological recovery is gradual and complete recovery eventually occurs over weeks based on severity. Surgical evacuation of the hematoma by decompression laminectomy has its complications but maybe considered in case of delay at diagnosis or if conservative management fails or the condition worsens rapidly.…”

Section: Discussionmentioning

confidence: 99%

First manifestation of severe haemophilia: acute flaccid paralysis due to spinal cord contusion with subdural hemorrhage

Narain

Ahmed

et al. 2018

Int J Contemp Pediatr

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Hemophilia A and hemophilia B are the most common and serious congenital coagulation factor deficiencies. Intracranial hemorrhages occur in 3-10%. Spinal epidural hematomas are rare. Even with severe hemophilia, only 90% have evidence of increased bleeding by 1 year of age. Only 2% of neonates with hemophilia sustain intracranial hemorrhages. Here we describe a case of a 5-month old boy with positive family history of hemophilia A on his maternal side who was admitted to the hospital because of retention of urine and decreased movement in both lower limbs following history of fall from height (approximately 2 feet high), two days prior to admission. Physical examination showed no skin lesion or hematoma. Neurological examination showed the infant in frog like posture with flaccid paralysis of both lower limbs without loss of sensation. There was associated bladder involvement with a Phantom hernia on the right side of his abdomen. MRI Spine revealed cord contusion in D4-D9 segment with spinal subdural hemorrhage. Coagulation profile was abnormal with a prolonged Activated plasma thromboplastin time. Factor VIII assay revealed a level of 1%. Treatment was conservative, and the infant was given factor VIII replacement. There was remarkable improvement within weeks. Thus, spinal hematomas being rare should still be considered and ruled out for prompt management of cases of suspected hemophilia. This case highlights the importance of a thorough family history which led to the ultimate diagnosis of severe Hemophilia A by coagulation profile and neuroimaging and further confirmed by factor VIII assay.

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Section: Discussionmentioning

confidence: 99%

First manifestation of severe haemophilia: acute flaccid paralysis due to spinal cord contusion with subdural hemorrhage

Narain

Ahmed

et al. 2018

Int J Contemp Pediatr

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“…The diagnosis of SSEH requires extensive laboratory testing for coagulation disorders, as well as CTA imaging. SSEH is rare in infants; only 20 cases have been reported in the literature (Table 1) 2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . To our knowledge, this is the first report of SSEH in an infant with developmental disabilities.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Spinal Epidural Hematoma in an Infant with Developmental Disabilities

Mukai

Miyagi

Koyama

et al. 2018

Spine Surg Relat Res

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Introduction: Spontaneous spinal epidural hematomas (SSEHs) are rare in childhood, especially in infants. Case Report: We present the case of a 17-month-old-boy with trisomy 21 and a large SSEH. He was hospitalized for acute onset paraplegia after 6 days of irritability. Nine days after symptom onset, magnetic resonance imaging (MRI) of the spine revealed an extensive epidural hematoma between C7 and T5 causing severe spinal cord compression. After a coagulation disorder was ruled out (12 days after onset), he underwent emergency hemilaminectomy with evacuation of the hematoma. His neurologic impairment gradually improved, and 4 months after surgery he was back to his neurologic baseline. At 18 months after surgery, he was walking independently, although he had some developmental disabilities due to trisomy 21. Conclusions: Only 20 cases of SSEH in infancy have been previously reported, and this is the first report of SSEH in an infant with developmental disabilities. Because of the non-specific symptoms and difficulty obtaining MRIs in infants, particularly in those with developmental disabilities, the diagnosis and treatment of SSEH may be delayed. However, early diagnosis with MRI and early evacuation of SSEH in patients with severe neurological impairments is important for good outcomes. Attention must be paid to postoperative spinal deformity in infants.

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“…Statistically, idiopathic cases account for approximate 40% of all cases [13] [14]. The most common site of a spontaneous spinal epidural hematoma is the cervicothoracic region or thoracolumbar region [7] [15]. Up to now, there have been disputes about the origin of these hematomas.…”

Section: Discussionmentioning

confidence: 99%

“…The spontaneous development of such hematomas is most frequent after the fourth or fifth decade [5] [6]. However, it has been reported to occur in all age groups, but it is a very rare clinical entity in children [7]- [9]. Certain precipitating factors, including anticoagulant therapy for prosthetic cardiac valves, therapeutic thrombolysis for acute myocardiac infarction, hemophilia B, factor XI (a) (b) Figure 1.…”

Section: Discussionmentioning

confidence: 99%

“…It typically shows biconvex hematomas in the epidural space with well-defined border stapering superiorly and inferiorly. Subacute hematomas show characteristic high signal intensity on T1-weighted images, low signal intensity on theT2 weighted images [7] [23]. A Computed Tomography (CT) scan should be obtained if MRI is unavailable or contraindicated [23] [24].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Spinal Epidural Hematoma Causing Paraplegia: A Case Report

Coulibaly¹,

Habibou²,

Régis³

et al. 2015

WJNS

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A spontaneous spinal epidural hematoma without any identified etiology is a very rare entity. We report here a 44 years old woman admitted within our department for 04 days of severe back pain complicated rapidly of bilateral lower-limbs weakness and urinary retention. Neurological examination found a complete paraplegia (0/5 stergh), with incomplete sensory deficit below the T-10 level, bowel and bladder dysfunction, decreased deep and superficial reflex. MRI with different sequences showed a large epidural mass lesion with slightly high signal intensity on T1-weighted images and heterogeneous low signal intensity on T2-weighted images from T11 to L1 suggesting an epidural hematoma. She underwent an urgent total laminectomy from T11 to L1 following by a complete removal of a large dark and compact epidural hematoma compressing the spinal cord. Operatively, there's no sign suggesting an AVM. Postoperative course was uneventful and she was discharged ten days after surgery with complete recovery.

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Spontaneous Spinal Epidural Hematoma in an Infant : A Case Report and Review of the Literature

Cited by 20 publications

References 28 publications

First manifestation of severe haemophilia: acute flaccid paralysis due to spinal cord contusion with subdural hemorrhage

First manifestation of severe haemophilia: acute flaccid paralysis due to spinal cord contusion with subdural hemorrhage

Spontaneous Spinal Epidural Hematoma in an Infant with Developmental Disabilities

Spontaneous Spinal Epidural Hematoma Causing Paraplegia: A Case Report

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