Spontaneous spinal epidural hematomas in children: can we prevent a negative prognosis?--reflections on 2 cases
Gian Paolo Ramelli1, Duccio Boscherini, Pierre Kehrli
1Department of Pediatrics, Ospedale San Giovanni, Bellinzona, Hopitaux Universitaires, Switzerland. gianpaolo.ramelli@eoc.ch
Insights
Spontaneous spinal epidural hematomas are rare in children, with this study detailing the first infant case. Early diagnosis and treatment are crucial for better outcomes in this pediatric condition.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Medical Case Reports
Background:
- Spontaneous spinal epidural hematomas (SSEH) are uncommon neurological emergencies.
- SSEH typically present with acute back pain and rapid neurological decline.
- Diagnosis and optimal treatment timing for SSEH remain subjects of ongoing debate.
Observation:
- This report details two rare pediatric cases of SSEH.
- Includes the first documented case of SSEH in an infant (7-month-old girl) presenting with acute paraplegia.
- A second case involves a 13.5-year-old boy with acute paraplegia due to SSEH.
Findings:
- The infant case resulted in no recovery despite timely spinal decompression.
- The adolescent case showed only partial neurological recovery following urgent decompression.
- These cases highlight the severe potential outcomes of SSEH in pediatric populations.
Implications:
- Emphasizes the critical need for heightened awareness of SSEH in infants and children.
- Suggests that even prompt surgical intervention may not guarantee full recovery.
- Underscores the importance of further research into the etiology and management of pediatric SSEH.
Abstract:
Spontaneous spinal epidural hematomas in children are very rare and, until now, have not been described in infants. Spontaneous spinal epidural hematomas is characterized by a sudden onset of acute back pain followed by acute neurological deterioration within a few hours, but in younger children the initial symptoms are often nonspecific, leading to a delay in diagnosis and treatment. Although some cases have been reported, controversy persists as to its origin, diagnosis, and timing of treatment. We present 2 new cases of this rare condition: a 7-month-old girl who suffered from acute paraplegia and, unfortunately, did not recover after adequate spinal decompression. To our knowledge, this is the first reported case of spontaneous spinal epidural hematomas in an infant. We also report a similar observation in a 13.5-year-old boy who also suffered from acute paraplegia and had only a partial recovery after urgent decompression.
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