Traumatic spinal epidural hematoma without bone disruption

Abstract

Abbreviations SEH: Spinal epidural hematoma . TSEH: Traumatic spinal epidural hematoma . MRI: Magnetic resonance imaging Traumatic spinal epidural hematoma (TSEH) is an uncommon disorder usually associated with spinal fracture or dislocation [3]. TSEH without bone disruption is rare and has been reported in only 18 children [1][2][3][4][5][6][7]. Although the precise reasons for the rarity of TSEH without bone disruption remain unclear, the kind of minor trauma that can actually cause TSEH may be underestimated or overlooked [6,7]. We describe a further patient with TSEH without bone disruption caused by minor back trauma.A previously healthy 4-year-old boy jumped from a table (height of 1 m) and was hit in the back by a chair on the evening before admission. At that time he was well and did not have severe back pain. The next morning he complained of severe pain in his back and legs and was admitted to another hospital. Cervical and thoracic spine X-ray films were normal. Twelve hours later, he was transferred to our hospital after developing paraplegia of the lower extremities and urinary retention necessitating insertion of a Foley catheter. On admission the patient was conscious but could not stand or sit. Neurological examination revealed a complete sensory loss below the fourth thoracic level with flaccid paraplegia of the lower extremities. Bilateral tendon reflexes of the knee and ankle were absent whilst bilateral Babinski reflexes were present. The cranial nerves were normal. There was a loss of bowel and bladder control. Laboratory studies revealed normal results of complete blood cell count, serum electrolytes, serum liver enzymes, partial thromboplastin time, prothrombin time, and bleeding time. Magnetic resonance imaging (MRI) of the thoracic spine demonstrated a posterior spinal epidural hematoma (SEH) that extended from T2 to T4 with cord compression (Fig.

Chronic Traumatic Spinal Epidural Hematoma in a Child

“…5,15,16 However, TSEH in children occurs because of minor traumas such as being struck by objects, falling down, or excessive motion of the spine, although the rate of TSEH in children is very low. [1][2][3][4][5][6][7][8][9][10][11][12] Particularly, in very young-aged patients, TSEH usually occurs without any bony fracture because of the greater elasticity of the spinal column. 1,5,7,8,11,12 In addition, the most widely accepted origin of hematoma is considered to be the venous plexus in the epidural space, and this venous plexus is vulnerable to rupture with any abrupt changes in venous pressure after even minor trauma.…”

“…1 Only 17 cases of traumatic SEH (TSEH) in children have been reported in the medical literature. [1][2][3][4][5][6][7][8][9][10][11][12] Those cases were found at the early stages (within 2 wks); however, there have been no reported cases of chronic TSEH. We present here the first case of chronic TSEH in a 3-yr-old boy who had a cervical epidural hematoma and who was admitted 4 wks after the predisposing trauma.…”

Evaluation and Management of Thoracolumbar Spine Trauma in Pediatric Patients

“…This describes a phenomenon in which the spine bony and ligamentous architecture can withstand more force and displacement than the spinal cord, resulting in injury to the cord in the absence of evidence of any osseous or ligamentous injury on XR or CT. Therefore, spinal MRI should be obtained in patients presenting with abnormal neurologic examination in a trauma setting, especially if there is no obvious abnormality detected on XR or CT. Other soft-tissue injuries such as traumatic disc herniations, apophyseal injuries, compressive epidural hematomas, as well as congenital spinal defects can be detected on MRI 23,33,34 . Therefore, spinal MRI should be performed in patients presenting with abnormal neurologic examination, especially if there is no obvious abnormality detected on XR or CT. MRI should also be obtained in patients in with head injuries, altered mental status, inability to cooperate with examination, and injury to more than 1 column of the spine.…”

Post-traumatic thoracolumbar spinal epidural haematoma in a child: a rare clinical entity

“…Spinal epidural haematoma (SEH) is a rare clinical entity that can present with acute neurological deficit. First reported by Jackson in 1869, SEH infrequently occurred following spine fractures and dislocations but rarely found in children 1–3. Cervical spine involvement is seen in cases reported among children 4.…”