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Traumatic cervical epidural hematoma in an infant
Vithal Rangarajan1, Sandip B Mavani1, Trimurti D Nadkarni1
1Department of Neurosurgery, King Edward Memorial Hospital, Seth G.S. Medical College, Mumbai, Maharashtra, India.
Insights
A rare pediatric case of spinal epidural hematoma following minor trauma resulted in spastic paraplegia. Surgical evacuation led to rapid neurological recovery, highlighting the importance of timely intervention for pediatric spinal cord injuries.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Injury Research
- Trauma Management
Background:
- Spinal epidural hematomas (SEH) are rare in pediatric populations.
- Traumatic SEH in infants is exceptionally uncommon, with limited case reports.
- Early diagnosis and intervention are crucial for neurological outcomes.
Observation:
- An 8-month-old infant presented with progressive lower limb weakness after a fall.
- Cervical spine magnetic resonance (MR) imaging revealed an epidural hematoma (C4-D1) causing cord compression.
- The infant exhibited spastic paraplegia without identifiable bleeding disorders.
Findings:
- Surgical cervical laminoplasty (C6-C7) and hematoma evacuation were performed.
- Immediate cervical cord pulsation was observed post-evacuation.
- Dramatic improvement in paraplegia occurred within 48 hours post-surgery.
Implications:
- This case represents the youngest reported patient with traumatic pediatric SEH.
- Prompt surgical decompression is vital for reversing neurological deficits in pediatric traumatic SEH.
- Highlights the need for high clinical suspicion for SEH in infants with neurological decline after trauma.
Abstract:
An 8-month-old male infant had presented with a history of a fall from the crib a fortnight ago. He had developed progressive weakness of both lower limbs. On examination, the infant had spastic paraplegia. Magnetic resonance (MR) imaging of the cervical spine showed an epidural hematoma extending from the fourth cervical (C4) to the first dorsal (D1) vertebral level with cord compression. The patient had no bleeding disorder on investigation. He underwent cervical laminoplasty at C6 and C7 levels. The epidural hematoma was evacuated. The cervical cord started pulsating immediately. Postoperatively, the patient's paraplegia improved dramatically in 48 hours. According to the author's literature search, only seven cases of post-traumatic epidural hematoma have been reported in pediatric patients, and our patient is the youngest. The present case report discusses the etiopathology, presentation, and management of this rare case.
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