Azumagawa Kohji, Yamamoto Shinji, Tanaka Keiko, Sakanaka Hideki, Teraura Hidetoshi, Takahashi Keiji, Tamai Hiroshi
Department of Pediatrics, Seikeikai Hospital, Sakai; Japan.
Pediatr Emerg Care. 2012 Feb;28(2):167-9. doi: 10.1097/PEC.0b013e318244785d.
Spontaneous spinal epidural hematoma (SSEH) has been reported as a rare condition especially in childhood. Because its symptoms are atypical, it is not easy to diagnose the onset of SSEH. However, with wider use of magnetic resonance imaging (MRI), several SSEH cases, especially not requiring surgical intervention, have been reported. We report on a 12-year-old boy who presented with a 5-day history of progressive pain in his back and extremities and numbness of his lower legs. An MRI of the spine demonstrated a dorsal epidural hematoma extending from C4 to T4, and the axial scan of the MRI revealed a posterior hematoma. Neurological deficit was estimated as not severe and not progressive, therefore surgery was postponed, and the patient was discharged without surgical intervention. Seven months later, MRI and myelography were performed, and we confirmed that the spinal epidural hematoma was absorbed. There have been some cases showing spontaneous regression of SSEH, and in younger than 18 years old, most of those cases that were treated with hematopathy such as hemophilia and spontaneous regression after SSEH correlated to larger size of hematoma. Because of bleeding tendencies in these cases the spinal cord was not pressed by the hematoma; this contributed conclusively to the prognosis. On the contrary, the 12-year-old boy, not having bleeding tendency, had the larger lesion of SSEH and recovered spontaneously without surgical intervention. Evaluation of MRI findings and neurological deficits in SSEH cases is important for deciding the indication of surgical intervention.
自发性脊髓硬膜外血肿（SSEH）已被报道为一种罕见病症，尤其是在儿童时期。由于其症状不典型，SSEH的发病不易诊断。然而，随着磁共振成像（MRI）的更广泛应用，已有数例SSEH病例被报道，尤其是那些不需要手术干预的病例。我们报告了一名12岁男孩，他有5天背部和四肢进行性疼痛以及小腿麻木的病史。脊柱MRI显示硬膜外血肿从C4延伸至T4，MRI的轴位扫描显示为后部血肿。神经功能缺损估计不严重且无进展，因此推迟手术，患者未经手术干预出院。七个月后，进行了MRI和脊髓造影，我们确认脊髓硬膜外血肿已被吸收。已有一些SSEH病例显示自发消退，在18岁以下的患者中，大多数患有血友病等血液疾病的病例以及SSEH后自发消退与血肿较大有关。由于这些病例存在出血倾向，血肿未压迫脊髓；这对预后有决定性作用。相反，这名12岁男孩没有出血倾向，患有较大的SSEH病变且未经手术干预而自发康复。评估SSEH病例的MRI表现和神经功能缺损对于决定手术干预的指征很重要。
