Spontaneous Spinal Epidural Hematoma in a Known Case of Hemophilia a Managed Conservatively

Abstract

Spontaneous spinal extradural hematomas are rarely attributed to hemophilia. When it occurs, magnetic resonance imaging (MRI) best establishes the diagnosis that should prompt immediate medical or surgical management. Here, we present a case with large spinal epidural hematomas (EDH) which was managed conservatively with good neurological outcome. A 12-year-old male who is a known case of hemophilia A was admitted with a complaint of neck pain, was neurologically intact on examination with no motor or sensory deficits. MRI cervical spine revealed a large spinal EDH in the cervical region compressing the cord posteriorly. The patient was managed conservatively with tranexamic acid and factor VIII replacement and observed over few days. He recovered well with interval resolution of hematoma. this case depicts the role of conservative management of spontaneous EDH in patients with Hemophilia A utilizing factor replacement therapy, steroids, and tranexamic acid and emphasizes that surgery is not always required even in such radiologically large appearing lesions.

Spontaneous spinal epidural hematoma in a pediatric hemophiliac

“…In a review of the literature, 28 of 38 pediatric patients with SSEH were successfully managed conservatively, while only 10 cases warranted surgery [Table 1]. [1][2][3]5,7,[9][10][11][12][13][14][15][16][17][18][24][25][26][27][28][29]32,33,[35][36][37][38][39][40] Notably, there was just one death (i.e., expiration due to a postoperative complication) and just one other patient who requiring additional surgery to address a recurrent spinal epidural hematoma [Table 2]. Jones and Knighton [17] 1956 1 12 y M A Yes C6-T2 Yes No Persistence of paraplegia 2.…”