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Kwasnicki A, Calandriello A, Nikas D. Spontaneous spinal epidural hematoma in an infant presenting with Horner syndrome. Childs Nerv Syst 2022; 38:827-830. [PMID: 34228175 DOI: 10.1007/s00381-021-05252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic entity, especially in infants, that develops in the absence of underlying coagulopathy, bleeding diathesis, infection, vascular malformation, trauma, iatrogenic, or other identifiable cause. In contrast to adults, diagnosis is frequently delayed or missed in infants due to non-specific symptoms and limited clinical examination. CASE ILLUSTRATION An 11-month-old female demonstrated symptoms of irritability, intermittent diarrhea, lethargy, decreased oral intake, and difficulties crawling before presenting to the emergency room. At time of presentation, she was noted to have minimal spontaneous movement of the lower extremities and anisocoria with ptosis of the right eye. Given her clinical presentation, a magnetic resonance image (MRI) of the spine was obtained which revealed an epidural hematoma with compression extending from C7-T3. She underwent C7-T3 laminoplasty and hematoma evacuation. Following surgical intervention, she demonstrated significant improvements in her lower extremity strength and resolution of Horner syndrome. CONCLUSION SSEH in infants is a rare neurologic condition, with diagnosis often delayed due to nonspecific symptomatology. Prompt diagnosis and intervention are essential in the treatment of SSEH to prevent permanent neurologic dysfunction. Physicians should have a high index of suspicion for SSEH in these instances, and investigation with spinal MRI imaging is recommended.
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Affiliation(s)
- Amanda Kwasnicki
- Department of Neurological Surgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA.
| | - Amy Calandriello
- Department of Pediatric Neurological Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Dimitrios Nikas
- Department of Neurological Surgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA.,Department of Pediatric Neurological Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA
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Vashisht S, Dagar A, Kumar V, Dhatt SS. Post-traumatic thoracolumbar spinal epidural haematoma in a child: a rare clinical entity. BMJ Case Rep 2019; 12:12/12/e232055. [PMID: 31801780 DOI: 10.1136/bcr-2019-232055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Post-traumatic spinal epidural haematoma (SEH) is a rare clinical entity in children. We are reporting the case of an 8-year-old child who presented with thoracolumbar SEH with neurological deficit. MRI confirmed SEH without bony disruption. Emergency evacuation of haematoma was done. There was an improvement in neurological status after removal of haematoma. Diagnosis of this rare condition is tricky in children owing to variable presenting symptoms, especially in an early stage with subtle neurological changes. There should be high clinical suspicion in children with atypical symptoms, and MRI should be done to confirm the diagnosis. Patients with acute neurological deficit should undergo urgent operative decompression. Conservative treatment has a limited role. Patients may be considered for non-operative management if they have medical contraindications, coagulation dysfunction or a small SEH without neurological deficit. These patients require serial MRI monitoring.
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Affiliation(s)
- Saurabh Vashisht
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Dagar
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Kumar
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarvdeep Singh Dhatt
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Sudden Onset of Severe Cervical Pain in an Adolescent Girl: Case Report and Review of Literature. Pediatr Emerg Care 2019; 35:e248-e251. [PMID: 29489609 DOI: 10.1097/pec.0000000000001437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A previously healthy 13-year-old girl presented with a 9-day history of acute onset severe neck pain associated with limited range of movement. Medical evaluation at day 2 was suggestive of muscle contracture, and she was discharged home with diazepam, antiinflammatory agents, and rest; however, she returned because of progressive clinical worsening with left arm distal paresthesia and paralysis since day 3. There was no history of trauma or other systemic complaints, and her familial medical history was unremarkable.Physical examination revealed left cervical and paravertebral tenderness on palpation with severe limitation of cervical and trunk movements; neurologic examination revealed left forearm and hand weakness and paralysis (grade II/V) with thenarhypothenar atrophy. Laboratory studies including coagulation profile were normal. Magnetic resonance imaging revealed an epidural hematoma from C4-T1 without underlying cause apparent on magnetic resonance angiography. On day 12, she underwent C3-7 laminotomy with laminoplasty and complete drainage of the hematoma. After 5 months of follow-up, she displays no neurological deficits. The spontaneous spinal epidural hematoma is a rare neurosurgical emergency in children. It usually presents acutely with neurologic deficits, but the initial presentation may be atypical or insidious, delaying diagnosis and intervention. Definitive diagnosis is made by magnetic resonance imaging and implies a high index of suspicion. Surgical drainage of the hematoma is the mainstay of treatment with favorable prognosis even in cases with a delayed diagnosis.
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4
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Traumatic spinal epidural hematoma in a 1-year-old boy. Arch Pediatr 2016; 23:731-4. [DOI: 10.1016/j.arcped.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/20/2015] [Accepted: 04/06/2016] [Indexed: 01/30/2023]
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Sivakumaran R, King A, Bodi I, Chandler CL, Walsh DC. Spontaneous epidural spinal haematoma in children caused by vascular malformations. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 25:614-8. [PMID: 25301573 DOI: 10.1007/s00586-014-3616-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 10/05/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The occurrence of spinal epidural haematoma of 'spontaneous' origin in adults is a well-documented entity, though it is rare in children. In the literature to date, there are few cases of this kind of spontaneous haematoma proven to be due to an underlying vascular abnormality. METHOD Retrospective review of two cases of children under 15 years of age with spontaneous epidural spinal haematoma. RESULTS Underlying arteriovenous malformations were identified in both cases. Intra-operative photographs and histological sections of these anomalies are presented. CONCLUSION These are the first two such cases described with clinico-pathological correlation.
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Affiliation(s)
- Ramanan Sivakumaran
- Department of Neurosurgery, King's College Hospital, London, UK. .,Academic Neurosurgery Unit, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Andrew King
- Department of Neuropathology, King's College Hospital, London, UK
| | - Istvan Bodi
- Department of Neuropathology, King's College Hospital, London, UK
| | | | - Daniel C Walsh
- Department of Neurosurgery, King's College Hospital, London, UK.,Institute of Psychiatry, King's College University, London, UK
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Garg K, Satyarthee GD, Singla R, Sharma BS. Extensive long-segment cervicothoracic traumatic spinal epidural hematoma with avulsion of C7, C8, and T1 nerve roots. J Neurosci Rural Pract 2014; 5:414-6. [PMID: 25288853 PMCID: PMC4173248 DOI: 10.4103/0976-3147.140007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Traumatic spinal epidural hematoma (TSEH) is of rare clinical occurrence. We report a case of a young man with posttraumatic long-segment spinal epidural hematoma. Evacuation of the hematoma led to complete neurologic recovery in our patient. Our case highlights the importance of early diagnosis and prompt surgical intervention for the evacuation of hematoma in preservation or maximum recovery of neurologic function. Imaging findings, management options, and the relevant literature are reviewed.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutta Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Singla
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Yiş U, Kalemci O, Polat I, Karaoğlu P, Oztura I, Güleryüz H, Kurul SH. Chronic spinal epidural hematoma. J Pediatr 2014; 164:215-215.e1. [PMID: 24119875 DOI: 10.1016/j.jpeds.2013.08.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 08/21/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Uluç Yiş
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Orhan Kalemci
- Department of Neurosurgery, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Ipek Polat
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Pakize Karaoğlu
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Ibrahim Oztura
- Department of Neurology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Handan Güleryüz
- Department of Pediatric Radiology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Semra Hız Kurul
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University, School of Medicine, İzmir, Turkey
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Jumani DB, Littlewood R, Iyer A, Fellows G, Healey A, Abernethy L, Spinty S, Sarginson R, Pettorini B. Spontaneous spinal epidural haematoma mimicking meningitis in a 2-year-old child--a case report and literature review. Childs Nerv Syst 2013; 29:1795-8. [PMID: 23708933 DOI: 10.1007/s00381-013-2130-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/24/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We report the case of a 2-year-old boy with suspected meningitis who presented with acute onset neck pain and stiffness associated with right-sided weakness and ataxia. MANAGEMENT Despite intravenous antibiotics and antiviral treatment, his condition deteriorated. Magnetic resonance imaging demonstrated spontaneous cervical epidural haematoma (C4-C7) extending down to thoracic (T7) level with associated compression of the spinal cord. He was treated successfully by neurosurgical decompression and made a complete recovery. DISCUSSION Spinal epidural haematoma is a neurosurgical emergency characterised by extravasation of blood in the spinal epidural space. The clinical presentation particularly in young children can masquerade other conditions such as meningitis. In this article, we discuss our case and review the literature on spontaneous spinal epidural hematoma with an aim to improve awareness of this condition which if not recognised and treated early can lead to significant lifelong morbidity.
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Affiliation(s)
- D B Jumani
- Jackson Rees Department of Anaesthesia, Alder Hey Children's Hospital NHS Trust, Eaton Road, West Derby, Liverpool, L12 2AP, UK,
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Abstract
Two cases of acute spinal cord injury resulting from spontaneous spinal epidural hematoma are reported, both of which had a cavernous vascular malformation origin. Both spontaneous spinal epidural hematoma and intramedullary cavernous malformation are rare in children. In the pediatric emergency setting, spontaneous epidural hematoma should be considered as part of the differential diagnosis for acute extremity weakness and paresthesia. Immediate magnetic resonance imaging of the brain and spine as well as prompt neurosurgical consult is recommended for the best chance of improved outcome.
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Two children with traumatic thoracic spinal epidural hematoma. J Clin Neurosci 2009; 16:1356-8. [DOI: 10.1016/j.jocn.2009.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 01/07/2009] [Accepted: 01/08/2009] [Indexed: 01/30/2023]
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Lim JJ, Yoon SH, Cho KH, Kim SH. Spontaneous spinal epidural hematoma in an infant : a case report and review of the literature. J Korean Neurosurg Soc 2008; 44:84-7. [PMID: 19096698 DOI: 10.3340/jkns.2008.44.2.84] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 07/24/2008] [Indexed: 01/30/2023] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is rare in children, especially in infants, in whom only 12 cases have been reported. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed. We report herein a case of SSEH in a 20-month-old girl who initially presented with neck pain, and developed lower extremity motor weakness and symptoms of neurogenic bladder 2 weeks prior to admission. The magnetic resonance imaging showed an epidural mass lesion extending from C7 to T4, and the spinal cord was severely compressed by the mass. After emergency decompressive surgery the neurologic function was improved immediately. Two months after surgery, the neurological status was normal with achievement of spontaneous voiding. We suggest that surgical intervention can provide excellent prognosis in case of SSEH in infants, even if surgery delayed.
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Affiliation(s)
- Jae Joon Lim
- Department of Neurosurgery, Ajou University, School of Medicine, Suwon, Korea
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