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Spontaneous spinal epidural hematoma in children
H Patel1, J C Boaz, J P Phillips
1Department of Neurology, Indiana University School of Medicine, Indianapolis, USA.
Pediatric Neurology
|November 27, 1998
Summary
Spinal epidural hematoma in children is rare, often presenting with nonspecific symptoms. Early recognition of neck pain and irritability is crucial for timely diagnosis and improved outcomes.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Radiology
Background:
- Spontaneous spinal epidural hematoma (SSEH) is an uncommon condition in pediatric patients.
- While typically dorsal, ventral SSEH is exceptionally rare, with limited case reports.
- Etiology is often unknown, and trauma is not a prerequisite.
Observation:
- The cervicothoracic region is the most frequent site for pediatric SSEH.
- Onset is often subacute, and unlike adults, there is no observed male predominance.
- Initial symptoms can be nonspecific, leading to diagnostic delays, particularly in younger children.
Findings:
- A review of 27 pediatric cases (including 3 new ones) showed varied outcomes: 15 complete recoveries, 11 with residual deficits, and 1 fatality.
- Irritability, neck pain, and restricted cervical spine movement in afebrile children can be early indicators.
- These early signs may precede neurological deficits by hours to days.
Implications:
- Clinicians should consider SSEH in children presenting with suggestive symptoms, even without a history of trauma.
- Prompt diagnosis via urgent spinal magnetic resonance imaging (MRI) is essential.
- Early intervention can significantly minimize morbidity and improve patient recovery.