Nontraumatic acute and subacute enhancing spinal epidural hematoma mimicking a tumor in a child

Abstract

We describe a 10-year-old boy who presented with acute onset of neck pain and neurologic symptoms caused by a spinal epidural hematoma. An enhancing mass, which mimicked a tumor, was seen on MR imaging of the cervical spine. The uptake of gadolinium in the mass and the associated mass effect suggested a tumor etiology. Such spinal epidural hematomas are extremely rare in the pediatric population. Additionally, it is even more uncommon for spinal epidural hematomas to resemble tumors. It is important to consider this entity when an enhancing epidural mass is found on MRI in the setting of an acute presentation.

Cervical epidural hematoma in a child

“…The cause of the hematomas in the non-traumatic cases was probably related to tumors, arteriovenous malformations, epidural hemangiomas, coagulopathies, infections, and bleeding diatheses. [5][6][7] The location of the hematoma in the vast majority of cases was cervical (as in the present case), but thoracic [2] and lumbar [7] epidural hematomas have also been reported. The clinical presentation of epidural hematomas in pediatric patients varies significantly; abnormal crying might be the only symptom in infants, which makes an appropriate diagnosis even more challenging.…”

“…Spinal epidural hematomas are very rare in children. [2,4,5] The annual incidence of spontaneous epidural spinal hematoma has been reported to be 0.1 in 100,000 population, whereas, in the pediatric population this incidence is significantly lower. Only 40 cases have been reported in literature, out of which 34 were nontraumatic and the rest were traumatic (as in our case).…”

“…The clinical presentation of epidural hematomas in pediatric patients varies significantly; abnormal crying might be the only symptom in infants, which makes an appropriate diagnosis even more challenging. Neck pain and tenderness, torticollis, [5] focal motor or sensory deficits (depending on the location of the hematoma), irritability, and the Brown-Sequard syndrome [8] are some of the most commonly reported presenting symptoms. The progression of symptomatology and clinical signs is usually very rapid as was seen in our case, although slower progression over a few days is also possible.…”

“…[3] In all these case reports, the prime importance was early diagnosis and urgent evacuation of the hematoma for a good functional outcome. [2,4,5] In this pretext, we report the case of a six -year-old boy who was admitted and managed surgically at our institution.…”

Spontaneous Spinal Epidural Hematoma in a 12-Year-Old Child

“…Only 29 cases have been reported in the pediatric population and the majority of the reported cases spontaneously occurred [3][4][5]. These reports showed the importance of early detection and emergency hematoma evacuation to achieve practical outcomes [3,6,7]. SSEH symptoms include an acute onset of severe neck pain which might be associated with mid back pain followed by symptoms of rapidly evolving nerve root or spinal cord compression.…”