Spontaneous spinal epidural haematomas in children

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Spinal Cord Imaging

Background:

• Spontaneous spinal epidural hematomas (SSEH) are rare in children.
• Understanding their presentation and outcomes is vital for timely diagnosis and treatment.

Purpose of the Study:

• To characterize the typical presentation, risk factors, location, size, treatment, and outcomes of SSEH in pediatric patients.
• To identify factors influencing neurological recovery and survival in affected children.

Main Methods:

• A systematic review of English literature from 1960 to 2018, focusing on patients aged 18 years and younger.
• Extraction and collation of individual patient data, including clinical presentation, diagnostic findings, and treatment outcomes.

Main Results:

• 36 pediatric patients from 31 publications were reviewed; 83% lacked known risk factors.
• 97% presented with neurological dysfunction and 61% with back pain; 28% had initial misdiagnoses.
• Cervico-thoracic region was most common (average 6.3 vertebral levels); 72% underwent surgery, with 83% showing neurological improvement.

Conclusions:

• SSEH in children typically manifest with neurological deficits and back pain, affecting all age groups.
• Despite potential initial diagnostic challenges, spinal imaging confirms SSEH, predominantly in the cervico-thoracic region.
• Treatment strategies vary based on bleeding disorders and neurological status, with most patients experiencing recovery.