Tailor Jignesh, Dunn Ian F, Smith Edward
Department of Neurosurgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
Childs Nerv Syst. 2006 Dec;22(12):1643-5. doi: 10.1007/s00381-006-0220-6. Epub 2006 Sep 15.
Spontaneous spinal epidural hematoma (SSEH) is rare in the pediatric population. This case report reviews the indications and strategies for nonoperative management in selected patients.
An eight-year-old boy presented with back pain. There was no antecedent trauma, but the patient was anticoagulated for a mechanical heart valve. MRI revealed an epidural mass from T12 to L2 consistent with SSEH. The absence of focal neurologic deficits, combined with the high stroke risk with anticoagulation reversal, prompted a nonoperative approach. Clinical symptoms resolved over several weeks while maintaining therapeutic anticoagulation. Follow-up MRI demonstrated resolution of the hematoma.
SSEH can present in the setting of poorly controlled therapeutic anticoagulation in the pediatric population. This case supports the premise that patients who present with SSEH without focal neurologic deficit can be successfully managed while maintaining therapeutic levels of anticoagulation. Close follow-up with frequent neurologic examinations, imaging and monitoring of the prothrombin time is mandatory.
自发性脊髓硬膜外血肿（SSEH）在儿科人群中较为罕见。本病例报告回顾了特定患者非手术治疗的指征和策略。
一名8岁男孩出现背痛。无前驱创伤史，但该患者因机械心脏瓣膜而接受抗凝治疗。MRI显示T12至L2水平有一个硬膜外肿块，符合SSEH表现。由于缺乏局灶性神经功能缺损，且抗凝逆转会带来较高的卒中风险，因此采取了非手术治疗方法。在维持治疗性抗凝的同时，临床症状在数周内得到缓解。随访MRI显示血肿已消退。
SSEH可出现在儿科人群中治疗性抗凝控制不佳的情况下。本病例支持这样一个前提，即对于出现SSEH但无局灶性神经功能缺损的患者，在维持治疗性抗凝水平的同时可成功进行治疗。必须进行密切随访，频繁进行神经学检查、影像学检查以及监测凝血酶原时间。
