Spontaneous ventral spinal epidural hematoma in an infant: an unusual presentation

Abstract

Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recognized by the appearance of acute asymmetric focal motor and sensory involvement. In infants, the initial presenting symptoms are very non-specific and irritability is often the only initial manifestation. Appearance of other neurological signs may be delayed up to hours or even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies, the diagnosis is usually delayed until the full picture of severe cord compression is developed. The diagnosis is finally made by performing magnetic resonance imaging. We report a 5-month-old infant with spinal epidural hematoma who presented with symmetrical upper limb weakness and diaphragmatic involvement to highlight the importance of recognizing the atypical manifestations for early diagnosis and intervention.

Keywords: Magnetic Resonance Imaging; Neurological Deficit; Spinal Epidural Hematoma; Spinal Hematoma; Spontaneous Epidural Hematoma.

Fig1(A, B)

MRI of the spine showing an epidural hematoma extending from C4 to C7 leading to displacement and compression of the spinal cord with expansion of segments proximal and distal to the site as well as a hematoma in pre and paravertebral spaces on axial view. A Sagittal T2-weighted image (TR 550 ms, TE 24 ms); B Axial T2-weighted image