Mukai Manabu, Miyagi Masayuki, Koyama Tomohisa, Imura Takayuki, Nakahara Kuniaki, Nakazawa Toshiyuki, Inoue Gen, Saito Wataru, Shirasawa Eiki, Uchida Kentaro, Takaso Masashi
Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Sagamihara, Japan.
Spine Surg Relat Res. 2018 Apr 7;2(4):335-339. doi: 10.22603/ssrr.2017-0085. eCollection 2018 Oct 26.
Spontaneous spinal epidural hematomas (SSEHs) are rare in childhood, especially in infants.
We present the case of a 17-month-old-boy with trisomy 21 and a large SSEH. He was hospitalized for acute onset paraplegia after 6 days of irritability. Nine days after symptom onset, magnetic resonance imaging (MRI) of the spine revealed an extensive epidural hematoma between C7 and T5 causing severe spinal cord compression. After a coagulation disorder was ruled out (12 days after onset), he underwent emergency hemilaminectomy with evacuation of the hematoma. His neurologic impairment gradually improved, and 4 months after surgery he was back to his neurologic baseline. At 18 months after surgery, he was walking independently, although he had some developmental disabilities due to trisomy 21.
Only 20 cases of SSEH in infancy have been previously reported, and this is the first report of SSEH in an infant with developmental disabilities. Because of the non-specific symptoms and difficulty obtaining MRIs in infants, particularly in those with developmental disabilities, the diagnosis and treatment of SSEH may be delayed. However, early diagnosis with MRI and early evacuation of SSEH in patients with severe neurological impairments is important for good outcomes. Attention must be paid to postoperative spinal deformity in infants.
自发性脊髓硬膜外血肿（SSEH）在儿童期较为罕见，尤其是在婴儿中。
我们报告一例患有21三体综合征且伴有巨大SSEH的17个月大男孩。他在烦躁不安6天后因急性发作性截瘫入院。症状出现9天后，脊柱磁共振成像（MRI）显示C7至T5之间有广泛的硬膜外血肿，导致严重脊髓受压。在排除凝血障碍（发病12天后）后，他接受了急诊半椎板切除术并清除血肿。他的神经功能障碍逐渐改善，术后4个月恢复到神经功能基线水平。术后18个月，他能够独立行走，尽管由于21三体综合征存在一些发育障碍。
此前仅报道过20例婴儿期SSEH病例，这是首例关于患有发育障碍婴儿的SSEH报告。由于婴儿症状不具特异性且难以进行MRI检查，尤其是患有发育障碍的婴儿，SSEH的诊断和治疗可能会延迟。然而，对于严重神经功能障碍患者，通过MRI早期诊断并早期清除SSEH对于获得良好预后很重要。必须关注婴儿术后的脊柱畸形。
