Rangwala Shivani D, Birk Daniel M, Tobin Matthew K, Hahn Yoon S, Nikas Demetrios C
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill., USA.
Pediatr Neurosurg. 2017;52(1):51-54. doi: 10.1159/000448737. Epub 2016 Sep 20.
Nonaccidental head injury, as seen in domestic child abuse cases, is often associated with spinal injury, and spinal subdural hematoma is the most frequent diagnosis. While spinal epidural hematomas are a rare occurrence, the incidence of spontaneous epidural hematomas occurring in nonaccidental head injury patients is even lower. Epidural hematomas often result in acute focal neurological deficits necessitating emergent neurosurgical intervention. In patients without focal neurological deficits, conservative management may allow for spontaneous resolution of the epidural hematoma. The authors present the case of a 2-year-old boy with a large spinal epidural hematoma resulting after an event of nonaccidental injury, specifically, domestic child abuse. This patient exhibited no focal neurological deficits and was managed conservatively without surgical clot evacuation. On a follow-up visit, repeat imaging studies demonstrated a stable resolution of spinal epidural hematoma, providing further support for the safety of conservative management in these patients.
非意外性头部损伤，如在家庭虐待儿童案件中所见，常与脊柱损伤相关，而脊髓硬膜下血肿是最常见的诊断结果。虽然脊髓硬膜外血肿很少见，但在非意外性头部损伤患者中发生自发性硬膜外血肿的发生率更低。硬膜外血肿常导致急性局灶性神经功能缺损，需要紧急神经外科干预。对于没有局灶性神经功能缺损的患者，保守治疗可能使硬膜外血肿自行消退。作者报告了一例2岁男孩的病例，该男孩在非意外性损伤（具体为家庭虐待儿童）事件后出现了巨大的脊髓硬膜外血肿。该患者没有局灶性神经功能缺损，采用保守治疗，未进行手术清除血块。在随访中，重复影像学检查显示脊髓硬膜外血肿稳定消退，为这些患者保守治疗的安全性提供了进一步支持。
