Introduction: Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The incidence of SSEH is 0.1 patients per 100,000 per year. It has been reported to occur in all age groups, and very rarely in children. While the lesion is located in the thoracolumbar lesion in older patients, the cervicothoracic site is more common in children. We report the case of a child who presented with acute onset of progressive weakness of his upper and lower limbs without any trauma history, to the point of being unable to stand or walk.
Case Report: A 14-year-old, previously healthy boy was admitted to our hospital with a chief complants of progressive weakness of his upper and lower limbs (upper - Medical Research Council (MRC) grade 3/5, lower- MRC grade 0/5) without trauma history. The pediatrician suspected Guillain-Barre syndrome early. MRI of the brain was normal. And MRI of the whole spine revealed posterior epidural hematoma from C5-6 to T5 level and abnormal T2 high signal at the anterior spinal cord at C6-7 levels (Fig.1). After transferred to the department of Neurosurgery, he underwent C7 to T3 laminectomy with hematoma removal. During surgery, vein engorgement was observed near the hematoma. After 2 weeks, he was referred to the rehabilitation unit. At that time, MRC grade 0/5 in the right leg, 2/5 in the left leg and 3/5 in the both arm. On sensory examination, there was diminished sensation to light touch and pinpricks below C7 on the both. His ASIA impairment scale (AIS) was C and neurologic level was C7. The walking index spinal cord injury (WISCI) level was 0/20. The spinal cord independence measure (SCIM) was 10/100. Clean intermittent catheterization was performed for incomplete voiding. After the urodynamic study, he was diagnosed as a neurogenic bladder with characteristic detrusor hyperreflexia. Somatosensory evoked potentials (SEP) study showed delayed latency in right posterior tibial nerve. And motor evoked potentials (MEP) of the both lower extremities is not evoked (Table 1). The patient was performed all rehabilitation modalities. After two months, it revealed improvement in left leg MRC Grade 3-4 and in right leg MRC Grade 1-2 (Table 2). And upper extremity muscle strength improved to MRC Grade 4. Sensory examination showed decreased sensation to light touch and pinpricks below T4 on the both side. His AIS improved to D and neurologic level was C7. He could walk with the aid of walker. WISCI improved to 13/20 and SCIM improved to 51/100.
Conclusion: The SSEH is extremely rare in children. In children with non-traumatic motor weakness, this condition should be considered a differential diagnosis through spine/brain MRI. Although his disease was initially suspected of Guillain-Barre syndrome, he was diagnosed with SSEH in a spine MRI. After emergency surgery and early rehabilitation, his symptoms recovered quickly. So, we report this case to emphasize that rapid diagnosis and treatment are helpful for recovery.
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