Spontaneous spinal epidural hematoma in a toddler—a case report

Objects Spontaneous spinal epidural hematoma (SSEDH) is rare in children below the age of 2 years. It can produce rapidly progressive neurological deficits.Methods The authors report a case of SSEDH in a 15-month-old boy diagnosed by MRI. Suspension laminotomy and evacuation of the clot were done 48 h after the onset of symptoms. The patient made excellent neurological recovery. Computed tomography (CT) and MRI scanning carried out 6 months after surgery revealed good fusion of the laminotomy. A brief review of relevant literature is presented.Conclusion Although rare SSEDH requires immediate surgical decompression to avoid any permanent neurological deficit. Reconstructive surgical procedures like laminotomy are preferred in children where the incidence of spinal deformity is high following laminectomy.     

Spontaneous spinal epidural hematoma with uncommon clinical presentation: a case report

Spinal epidural haematoma (SEH)--posttraumatic or spontaneous (SSEH) is a rare entity, usually associated with severe neurological deficit. Urgent surgical decompression of the spinal cord is mandatory procedure. A case of SSEH with unusual transient clinical symptomatology and subsequent spontaneous resolution during conservative management is reported.     

Anterior spinal epidural hematoma: a case report

PURPOSE: to present a case of post traumatic anterior spinal epidural hematoma. CASE REPORT: a 55-year-old man presented with abrupt onset of paraparesia following a motor vehicle accident. Magnetic resonance imaging showed an anterior lumbar epidural hematoma. Surgical evacuation of the hematoma resulted in complete recovery.     

Spontaneous spinal epidural hematoma

Spontaneous spinal epidural hematoma (SSEH) is a rare emergent condition. It may result in paraplegia, quadriplegia and even death. Prompt diagnosis and emergent decompressive surgical management have been recommended to prevent mortality and morbidity. Although several factors have been associated with prognosis, controversy remains, partly due to its rarity. Thus, the history, clinical presentation, physical examination findings, radiological images, and surgical and pathological records of 30 patients with SSEH (21 male, nine female [sex ratio of 2.3:1], average age of 35 years) treated between January 2002 and September 2010 have been reviewed. The association of age, sex, hypertension, vascular malformation, vertebral level, position and extension of the hematoma, progression interval, operative interval, spinal cord edema, and preoperative neurological condition with the prognosis is discussed. The outcome was better for patients with incomplete neurological deficit (p = 0.001), lesions extending <4 vertebral segments (p = 0.026), and lesions in the thoracolumbar and lumbar region. A shorter progression interval often led to a less favorable prognosis (p = 0.017). Patients with spinal cord edema experienced a worse preoperative neurological deficit (p = 0.005) and a worse outcome (p = 0.000). Patients with a progression interval ?12 hours presented with a worse preoperative neurological deficit (p = 0.026). Early surgical intervention to evacuate the hematoma remains the main treatment for most symptomatic patients. Conservative treatment may be used only for those in a good preoperative neurological condition. Prognosis is associated with the preoperative neurological condition, progression internal, spinal cord edema, and extension and vertebral level of the SSEH. Patients with SSEH in the cervical or cervicothoracic region with a complete preoperative motor deficit have a higher mortality rate.     

Spontaneous epidural hematoma in a patient undergoing hemodialysis: a case report]

A 54-year-old male with chronic renal failure due to diabetic nephropathy suffered dysphagia and left facial spasm without head trauma during a hemodialysis session. CT scan revealed a right acute epidural hematoma. MRI and cerebral angiography did not reveal any abnormalities in the intracranial vasculature. The occurrence of intracranial spontaneous epidural hematoma in a haemodialysis patient has not been reported. During hemodialysis, the intracranial pressure transiently increases and rapidly recovers. It is assumed that the decreasing intracranial pressure caused epidural hematoma.     

Spontaneous spinal epidural hematoma during pregnancy

BACKGROUND: Spontaneous spinal epidural hematoma is a rare phenomenon that has no distinct etiology. Spontaneous spinal epidural hematoma (SSEH) during pregnancy is extremely rare. We present what we believe to be the fifth reported case of spontaneous spinal epidural hematoma associated with pregnancy in the English literature. METHODS: A 31-year-old female presented with acute onset of paraplegia at 32 weeks of pregnancy. The patient had a T2 sensory level and complete paralysis of all lower extremity motor groups. Magnetic resonance imaging of the thoracic spine showed an acute epidural hematoma posterior to the thoracic spinal cord between the second and fourth thoracic vertebrae. RESULTS: The patient was taken to the operating room were her child was delivered by caesarean section. She then underwent a posterior laminectomy and evacuation of a spinal epidural hematoma. Follow-up selective spinal angiography was negative for any vascular malformation. The patient gradually recovered lower extremity function and was independently ambulating at six month follow-up. Voluntary bowel and bladder function returned within four months but twice daily intermittent catheterization remained necessary for excessive post-void residual urine. CONCLUSIONS: Spontaneous spinal epidural hematoma in pregnancy is a rare phenomenon. It is postulated that elevated venous pressure associated with pregnancy may be a contributing factor. In the reported cases of SSEH in pregnancy most patients presented with acute symptoms, thoracic location and profound neurological deficits but, with prompt surgical treatment, generally had good long term recovery.     

Acute thoracic epidural hematoma following spinal manipulative therapy: case report and review of the literature

Spinal epidural hematoma is a rare complication of chiropractic manipulation. This study reports a case of thoracic spinal epidural hematoma following spinal manipulative therapy in the absence of predisposing factors. The effectiveness and safety of chiropractic treatment in chronic spinal pain and a literature review are also presented.     

椎管内硬脊膜外海绵状血管瘤1例及文献复习

海绵状血管瘤是中枢神经系统少见的一种血管畸形，多见于大脑半球，脊髓少见，硬脊膜外更为罕见。作报导1例64岁的男性硬脊膜外海绵状血管瘤患，以进行性双下肢麻木无力为主要症状。结合相关献，对该肿瘤的临床表现、诊断、病理及治疗进行了回顾。     

Recurrent spontaneous spinal epidural hematoma in a child: first case report

Spontaneous spinal epidural hematomas are a rare cause of spinal cord compression. These are typically isolated events. Recurrent spontaneous spinal epidural hematomas have been reported only in two instances in adults. There have been no reports of recurrent spontaneous spinal epidural hematomas involving a child. This report details the case of a 10-year-old female with a recurrent spontaneous spinal epidural hematomas who presented with two episodes of transient lower extremity paralysis, 2 months apart, followed by a third episode a year later which resulted in permanent paralysis.     

Spontaneous resolution of an acute epidural hematoma with normal intracranial pressure: case report and literature review

Traumatic epidural hematomas are critical emergencies in neurosurgery, and patients symptomatic from acute epidural hematomas are typically treated with rapid surgical decompression. However, some patients, if asymptomatic, may be treated with close clinical observation and serial imaging. Although rare, rapid spontaneous resolution of epidural hematomas in the pediatric population has even been reported, with only seven cases in the literature. Numerous theories have been proposed to explain the pathophysiology behind these cases, including egress of epidural collections through cranial discontinuities (fractures/open sutures), blood that originates in the subgaleal space, and bleeding from the cranial diploic cavity after a skull fracture that preferentially expands into the subgaleal space. We report the case of a rapidly resolving epidural hematoma in a 13-year-old boy. This case allows for more detailed inferences to be made concerning the nature of the epidural hematoma’s resolution, as it is the first reported case in which an intracranial pressure monitor has been utilized. We also review the literature and discuss the nature of rapid spontaneous epidural hematoma resolution.     

Acute interdural hematoma mimicking epidural hematoma: a case report

Intracranial hematoma rarely presents between two dural layers of pachimeninges. Here, we present a case of an interdural hematoma with similar appearance to an epidural hematoma. A 51-year-old man presented with a left temporal contusion following a motor vehicle accident. After craniotomy and contusion removal, the post-operative CT scan showed a parietal intracranial hematoma located posterior and superior to the bone flap. The CT scan appearance of the new hematoma was similar to the CT scan appearance of an epidural hematoma. Upon operation, we determined that the hematoma was located between two layers of dura mater, i.e., an interdural hematoma. We removed the hematoma and sutured the two layers of dura to each other at multiple sites. Interdural hematoma is a rare entity. Its appearance in a CT scan can be mistaken for an extradural hematoma.     

Spontaneous spinal epidural hematoma mimicking Guillain-Barre Syndrome

Background

The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS. Case Report: A previously healthy 6-year-old girl presented with a 2-day history of progressive pain in the lower extremities and an inability to walk. On initial evaluation, she was completely paraparetic in the lower extremities. Deep tendon reflexes were absent in the lower extremities, and Babinski reflexes were positive on both sides. She exhibited reduced response to light touch and pinprick with a sensory level below T10, and experienced difficulty during urination. However, the strength, sensation and flexion of upper extremities were normal. Because her presentation and examinations were consistent with GBS, we initiated intravenous immunoglobulin therapy. The next day, she also developed pain and muscle weakness of the right upper extremity. Three days after admission, respiratory depression progressed rapidly. Spinal MRI showed a mass extending from the level of C7-T3, with spinal cord compression. The patient underwent an emergency laminectomy with evacuation of hematoma, and was diagnosed with SSEH. Sixty days after admission, she was transferred to the rehabilitation hospital with severe neurologic sequelae of paralysis in both legs. Conclusion: SSEH might have severe consequences, including neurologic deficits and risk of death. This case report serves to raise the awareness of SSEH that mimics the initial presentation of GBS.     

Spontaneous spinal epidural hematoma: Pre-operative diagnosis by MRI

A case of “spontaneous” spinal epidural hematoma diagnosed by MRI confirms the accuracy of the procedure in establishing the nature of the lesion, in delineating its topography and its effects on the spinal cord. MRI, when available, should be regarded as a primary method of investigation.     

Spontaneous cranial extradural hematoma: case report and review of literature

Extradural hematoma (EDH) is usually a post‐traumatic sequel but a few cases of spontaneous EDH have been reported. Here we report a woman who presented with spontaneous acute EDH but was later found to have dural metastasis from lung carcinoma. Causal factors have been present in all reported cases, as well as in this case. We propose the term non‐traumatic EDH.     

Primary spinal epidural rhabdomyosarcoma: a case report and review of the literature

Background

Primary intraspinal sarcomas are very rare in children. Rhabdomyosarcoma (RMS) is a highly aggressive and rapidly growing sarcoma with skeletal origin that occasionally appears in the spinal epidural space.

Method

We report a 13-year-old girl who presented with back pain, progressive paraparesis, and urinary retention. She had muscular weakness in her lower extremities and absent deep tendon reflex. An epidural dumbbell-shape mass at T11–T12 level was observed on MRI. The patient underwent T12 hemilaminectomy, partial T11 hemilaminectomy, and right facetectomy. A large, firm, dark-red vascular epidural tumor was found compressing the cord. The tumor which extended to intracanal and foraminal parts was removed completely.

Discussion

Histopathological examination revealed undifferentiated small round and oval tumoral cells. Immunohistochemical staining was positive for vimentin, desmin, and myogenin. The final diagnosis was alveolar RMS. She received radiotherapy and chemotherapy by vincristine, actinomycin-D, doxorubicin, and ifosfamide. The patient was in good condition with no tumor recurrence or metastasis at the 1-year follow-up.