Delayed Diagnosis of Cervical Epidural Hematoma in a 3-Year-Old Boy: A Case Report
Yan Zhou1, Gina Guglielmi2, Sumeet Garg3,4
1University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado.
Insights
A pediatric case of cervical epidural hematoma, a rare condition, highlights the importance of timely diagnosis and surgical intervention for young patients following trauma. Prompt management leads to full recovery.
Area of Science:
- Pediatric Neurosurgery
- Spinal Imaging
- Trauma Management
Background:
- Pediatric spinal epidural hematoma (SEH) is an uncommon condition.
- Symptoms can be nonspecific, delaying diagnosis.
- Early recognition and intervention are critical for favorable outcomes.
Observation:
- A 3-year-old boy presented with torticollis after a fall.
- Initial cervical radiographs and neurological examination were normal, leading to a diagnosis of cervical strain.
- Symptoms progressed over two weeks, prompting referral to a pediatric spine surgeon.
Findings:
- Magnetic resonance imaging (MRI) identified a cervical epidural hematoma.
- Surgical evacuation of the hematoma was performed.
- The patient experienced a full recovery and remained symptom-free at 2-year follow-up.
Implications:
- This case underscores the need for high clinical suspicion for SEH in pediatric patients with persistent or progressive neck symptoms after trauma, even with initially normal imaging.
- Comprehensive evaluation including advanced imaging like MRI is crucial for accurate diagnosis.
- Timely surgical decompression can lead to excellent neurological recovery in pediatric SEH.
Case:
A 3-year-old boy presented to the emergency department with torticollis after a fall. With normal cervical radiographs and neurologic exam, he was diagnosed with cervical strain and discharged. After 2-week progressive symptoms, he was referred to a pediatric spine surgeon. Magnetic resonance imaging (MRI) revealed a cervical epidural hematoma, which was then surgically evacuated. He recovered fully and remains symptom-free 2 years later.
Conclusion:
Pediatric spinal epidural hematoma is a rare condition with potentially serious outcomes yet often nonspecific symptoms. Timely management based on a comprehensive evaluation of symptoms and imaging findings is crucial in improving patient outcomes.
