Primary spinal epidural extraosseous Ewing's sarcoma mimicking a spinal abscess

Ewing's sarcoma is one of the most common malignant tumors of the skeletal system in children and young adults. It most frequently stems from the long bones of the extremities. However, though uncommon, extraosseous localization can be seen. Epidural extraosseous presentations are extremely rare. In this case, the authors report on the long-term follow-up of a patient with this well-demonstrated, but uncommon localization, and the initial unique presentation of the patient, which clinically and radiologically mimicked a cervical abscess.     

Chronic spinal epidural hematoma in hemophilia A in a child

A case of chronic spinal epidural hematoma in a thirteen-year-old male, subsequently found to have hemophilia A is reported. Following myelography, surgery was undertaken with clotting factor replacement with relief of cord compression. The patient made an uneventful recovery.     

Traumatic acute giant epidural hematoma in a hydrocephalic shunted child

Extradural hematoma (EDH) is considered to be a rare complication of head trauma in children, and represents a serious and urgent pathology from which complete recovery can be expected if specialized treatment is instituted in time. In this article, the authors report the potential danger to a hydrocephalic shunted child who was apparently asymptomatic at the time of hospital admission with a mild head injury and developed an EDH of venous origin. This child had a rapid (time interval from injury to decerebrate posture of about 2 h), atypical (remained asymptomatic most of the time until abruptly deterioration) and fatal course, stressing the importance of early diagnosis and rapid therapy in order to avoid the death of the patient. The authors discuss the role of the ventriculoperitoneal shunting system in the lack of clinical symptoms associated with the presence of a giant EDH and a rapid and fatal course, and stress the importance of computed tomographic (CT) scanning in these patients, even if they are asymptomatic. If a skull fracture is suspected, a CT scan must be performed without delay.     

新生儿硬膜外血肿伴颅骨骨折及头颅血肿治疗方法初探

目的 探讨新生儿硬膜外血肿伴颅骨骨折及头颅血肿时通过头颅血肿穿刺抽血对硬膜下血肿的治疗效果。方法 对2012—2013年我科收治的4例新生儿硬膜外血肿伴颅骨骨折及头颅血肿患儿的临床表现、影像学特点进行总结;患儿均行床旁抽取头颅血肿内的血液治疗颅内硬膜外血肿。对比患儿手术前后的影像学改变,并对患儿进行随访。结果 4例硬膜外血肿患儿均有头颅血肿和颅骨骨折。2例临床无神经系统异常表现,其中1例生后头颅血肿进行性增大;1例患儿有神经兴奋症状;1例患儿生后21 h出现惊厥,生后6天仍有肌张力减低。4例患儿影像学均发现在头颅血肿对应颅内部位有硬膜外血肿并对周围脑皮质有不同程度压迫,在头颅血肿和硬膜外血肿之间的颅骨存在骨折。4例患儿分别于生后3~9天行头颅血肿穿刺,抽出血量3~24 ml不等,手术后硬膜外血肿均明显减小,其中1例抽过两次头颅血肿。2例患儿已随访1年,2例患儿随访3个月;其中3例患儿神经发育同同龄儿,1例因肌张力减低进行康复治疗,已明显好转。结论 对于伴颅骨骨折及头颅血肿的硬膜外血肿,可行头颅血肿穿刺,通过骨折缝隙将颅内硬膜外血肿的血液引流至颅外头颅血肿处,减小硬膜外血肿,达到减轻对脑实质的压迫及减少神经系统后遗症的目的。     

Bilateral epidural hematoma in a pyknodysostotic child

Pyknodysostosis is a rarely encountered disease. It is characterized by abnormal facial development, fragility of the bones with relatively mild trauma, cranial abnormalities including widely opened sutures and fontanels frontal bossing, wrinkled skin, finger and nail abnormalities. In the literature, pyknodysostosis was reported only as case reports. Here, we describe a pyknodysostotic child with a bilateral parietal epidural hematoma, caused by a relatively mild head trauma. He was operated on, and the hematoma was evacuated through two different parietal craniotomies. We reported this case, since pyknodysostosis is a rare disease, and our case is the first one who had a surgical intervention as well as being the first with an epidural hematoma in pyknodysostosis.     

Unilateral proptosis and extradural hematoma in a child with scurvy

We report a 3-year-old boy with unilateral proptosis, painful swelling of the right thigh and aphasia. He had radiographic evidence of scurvy in the limbs and bilateral frontal extradural hematomas with a mass lesion in the left orbit on MRI. He was treated with vitamin C and on follow-up 8 weeks later had recovered with no evidence of the orbital mass on clinical or radiological study. Scurvy manifesting as proptosis and extradural hematoma is rare.     

Non-operative treated spontaneous spinal epidural hematoma in a 12-year-old boy

Spontaneous spinal epidural hematoma (SSEH) has been reported as a rare condition especially in childhood. Because its symptoms are atypical, it is not easy to diagnose the onset of SSEH. However, with wider use of magnetic resonance imaging (MRI), several SSEH cases, especially not requiring surgical intervention, have been reported. We report on a 12-year-old boy who presented with a 5-day history of progressive pain in his back and extremities and numbness of his lower legs. An MRI of the spine demonstrated a dorsal epidural hematoma extending from C4 to T4, and the axial scan of the MRI revealed a posterior hematoma. Neurological deficit was estimated as not severe and not progressive, therefore surgery was postponed, and the patient was discharged without surgical intervention. Seven months later, MRI and myelography were performed, and we confirmed that the spinal epidural hematoma was absorbed. There have been some cases showing spontaneous regression of SSEH, and in younger than 18 years old, most of those cases that were treated with hematopathy such as hemophilia and spontaneous regression after SSEH correlated to larger size of hematoma. Because of bleeding tendencies in these cases the spinal cord was not pressed by the hematoma; this contributed conclusively to the prognosis. On the contrary, the 12-year-old boy, not having bleeding tendency, had the larger lesion of SSEH and recovered spontaneously without surgical intervention. Evaluation of MRI findings and neurological deficits in SSEH cases is important for deciding the indication of surgical intervention.     

Lead encephalopathy mimicking a cerebellar tumor

Encephalopathy is a rare but severe complication of lead poisoning, mainly due to cerebral edema. Usually diffuse, symptoms and signs are sometimes focal, suggesting a false diagnosis of tumor, particularly cerebellar tumor. We report such a case diagnosed by MR imaging in which early treatment for edema avoided neurosurgical exploration. Only six cases have been published since Biemond and Van Creveld's first report in 1939. Several data—clinical and experimental—providing specific involvement of cerebellum in lead poisoning are emphasized.     

A Persistent epidural mass in a child with B‐lineage ALL

Epidural spinal cord compression as the initial presentation of acute lymphoblastic leukemia (ALL) is a rare and serious complication. Extramedullary disease is rarely reported in patients with ALL. The most common sites are bone, followed by soft tissue, skin and lymph nodes. We describe a child with common B—lineage ALL who presented with a mass in the spinal epidural space. She was initially treated with intrathecal chemotherapy and intravenous dexamethasone with total resolution of her clinical symptoms but a persistent epidural mass. An open biopsy of the residual epidural mass was performed 7 months after diagnosis. The histological examination did not reveal any tumor infiltration, only fibrosis. We conclude that a persistent epidural mass in patients with ALL may not indicate resistant disease and may require over a year for resolution, even when response to therapy is adequate. Pediatr Blood Cancer. 2010;55:727–729. © 2010 Wiley‐Liss, Inc.     

Traumatic spinal epidural hematoma-unusual cause of torticollis in a child

Traumatic spinal epidural hematoma is rare in children. The presentation could be nonspecific, leading to a delay in diagnosis. We present an infant who sustained an epidural hematoma after a "trivial" injury. The delay in diagnosis led to minor neurological deficit at 6-week follow-up. Irritability and torticollis after a neck trauma in an afebrile child should alert to the possibility of spinal cord compression. Early imaging and early decompression will minimize morbidity.