Torticollis and right arm weakness due to atraumatic spinal epidural hematoma in a 5-year-old girl child

Esam E. Barnawi; Altaf Ahmad Bhat; Abdullatif Almalki; Nada Daud Bin Daud; Mohammad Abdullah Almazeedi; Abdulelah Ahmad Ali Al Amri

doi:10.18203/2349-3291.ijcp20241371

Authors

Esam E. Barnawi Department of Pediatric Emergency, King Fahad Medical City, Riyadh, Saudi Arabia
Altaf Ahmad Bhat Department of Pediatric Emergency, King Fahad Medical City, Riyadh, Saudi Arabia
Abdullatif Almalki Department of Pediatric Emergency, King Fahad Medical City, Riyadh, Saudi Arabia
Nada Daud Bin Daud Department of Pediatric Emergency, King Fahad Medical City, Riyadh, Saudi Arabia
Mohammad Abdullah Almazeedi Department of Pediatric Emergency, King Fahad Medical City, Riyadh, Saudi Arabia
Abdulelah Ahmad Ali Al Amri Department of Pediatric Emergency, King Fahad Medical City, Riyadh, Saudi Arabia

DOI:

https://doi.org/10.18203/2349-3291.ijcp20241371

Keywords:

Torticollis, Right arm weakness, Spontaneous spinal epidural hematoma pediatric, Neurological emergency

Abstract

Spontaneous spinal epidural hematoma (SEH) is a rare presentation as cause of neurological weakness in children and is neurological emergency. The most commonly affected site in children is cardiothoracic region. Early management is associated with better functional outcomes. We report a 5-year-old girl who presented with long standing neck pain now presenting to emergency with torticollis and right arm weakness around shoulder joint. Magnetic resonance imaging of C-spine revealed posterior epidural hematoma that extend from C3/C4 level down to C6/C7 level, it is causing moderate spinal canal stenosis and mass-effect on the spinal cord, with mild intramedullary abnormal T2 signal intensity indicating myelomalacia. There were no predisposing factors in our patient. Epidural hematoma was drained surgically and post-surgery patient started showing neurological recovery on follow. Cases of spontaneous SEH have been reported in infants as well and the clinical features in children are often nonspecific leading to a delay in diagnosis. This case report aims to raise awareness about this neurological emergency, in which early intervention is crucial.

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References

Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003;26(1):1-49.

Groen RJM. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir. 2004;146(2):103-10.

Domenicucci M, Cristina M, Giorgio S, Demo ED, Alessandro R, Maria FA, et al. Spinal epidural hematomas: personal experience and literature review of more than 1000 cases. J Neurosurg Spine. 2017;27(2):198-208.

Chang CW, Lin LH, Liao HT, Hung KL, Hwan JS. Spontaneous Spinal Epidural Hematoma in a 5-year-old Girl: Case Reports. Acta Paediatr Taiwan. 2002;43(6):345-7.

Patel H, Boaz JC, Phillips JP, Garg BP. Spontaneous Spinal Epidural Hematoma in Children. Pediatr Neurol. 1998;19(4):302-7.

Patel H, Garg BP. Increasing Irritability with Sudden Onset of Flaccid Weakness. Semin Pediatr Neurol. 1996;3(3):192-7.

Jumani DB, Littlewood R, Iyer A, Fellows G, Healy A, Abernethy L, et al. Spontaneous spinal epidural haematoma mimicking meningitis in a 2-yearold child-a case report and literature review. Childs Nerv Syst. 2013;29(10):1795-8.

Van Heesewijk JPM, Casparie JWBM. Acute spontaneous spinal epidural haematoma in a child: case report. Eur Radiol. 2000;10(12):1874-6.

Caldarelli M, Di Rocco C, La Marca F. Spontaneous Spinal Epidural Hematoma in Toddlers: Description of Two Cases and Review of the Literature. Surg Neurol. 1994;41(4):325-9.

Patel H, Boaz JC, Phillips JP, Garg BP. Spontaneous spinal epidural hematoma in children. Pediatr Neurol. 1998;19(4):302-30.

Groen RJ, Van Alphen HA. Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery. 1996;39(3):494-508.

Caldarelli M, Di Rocco C, La Marca F. Spontaneous spinal epidural hematoma in toddlers: description of two cases and review of the literature. Surg Neurol. 1994;41(4):325-9.