Hematoma epidural espinal en un joven con hemofilia: reporte de caso / Spinal epidural hematoma in a young man with hemophilia: case report

El hematoma epidural espinal es una complicación poco frecuente de la hemofilia. En la literatura han sido descritos algunos casos principalmente en la población pediátrica. El cuadro clínico del hematoma epidural espinal es bien conocido; sin embargo, la etiología de este plantea un reto médico. El tratamiento consiste en la descompresión quirúrgica, aunque últimamente se han planteado algunos casos de resolución espontánea cuando el cuadro neurológico es leve o tiene tendencia a la mejoría. El manejo de la hemofilia por lo general consiste en el reemplazo del factor deficiente de la coagulación. Reportamos el caso de un paciente masculino de 17 años de edad manejado en nuestro servicio de neurocirugía.

Dolor radicular como forma de presentación de un hematoma epidural espinal espontáneo / Radicular pain presenting as a spontaneous spinal epidural hematoma

Fundamento: Las hemorragias espontáneas dentro del estuche espinal en las edades pediátricas son poco frecuentes. La sangre puede extenderse por el espacio epidural, subdural o intramedular y producir compresión de las estructuras neurales. El espacio epidural es la zona más vulnerable a sufrir el sangrado y dentro de éste su porción posterior. Objetivo: Presentar un caso poco frecuente de Hematoma epidural espinal cervical espontáneo que debutó con signos radiculares. Caso Clínico: Paciente masculino de 14 años de edad con antecedentes de salud que es remitido a la consulta con una historia iniciada siete días, antes, caracterizada por: dolor cervical bajo, de moderada intensidad de inicio brusco y que se irradiaba a los dermatomas cervicales 4 a 6 (C4-C6). Al examen físico se pudo constatar dolor al percutir las espinosas de C4 a C6, hiporreflexia bicipital y reducción de la fuerza en la pinza digital derecha. Se realizó una Resonancia Magnética Nuclear Cervical (RMN), pudiéndose diagnosticar un Hematoma epidural espinal espontaneo (HEE) que se extendía anteriormente desde C3 a C7. Se decidió el tratamiento médico y el paciente fue egresado a los doce días libre de manifestaciones clínicas. Conclusiones: La evolución clínica del paciente, el tamaño, la localización del hematoma y tiempo de evolución de la enfermedad son elementos a tener en cuenta a la hora de seleccionar la modalidad de tratamiento, el cual permitirá la reversibilidad de los síntomas y signos neurológicos así como el desarrollo de complicaciones tardías.

Spontaneous spinal epidural haematoma

Spinal epidural haematomas [SHE] is a potentially reversible cause of spinal cord and nerve root compression, may be acute or chronic; usually its occurrence may be associated with coagulation dysfunction from medications and disease states. Patients usually present with sudden onset of neurological dysfunction. The prompt diagnosis and treatment of this relatively rare condition, when attained rapidly requires surgical decompression and can result in satisfactory neurological recovery. In the period from 2001 - 2007, 7 patients were diagnosed as spontaneous SEH and managed by urgent spinal cord decompression, age from 12-44 years. Urgent magnetic resonance imaging [MRI] was done for all patients followed by urgent decompression according to the affected levels. Spontaneous spinal epidural haematomas are a rare spinal problem and need immediate diagnosis. Imaging study, mainly MRI according to the sensory level is the key for diagnosis and immediate surgical intervention is the cornerstone to get a good result

Hematoma extradural espinhal espontâneo: relato de caso / Spontaneous spinal epidural hematoma: case report

O hematoma extradural espinhal espontâneo é considerado raro. Tem sido associado com hipertensão arterial e coagulopatias. O exame de escolha para diagnóstico é a ressonância nuclear magnética.O tratamento de escolha é drenagem cirúrgica do hematoma. O prognóstico está relacionado com a etiologia, intervalo entre icto e diagnóstico e o grau de déficits neurológicos. Os autores relatam um caso de hematoma extradural espinhal espontâneo, localizado na região torácica, com quadro de choque medular, sendo submetido a tratamento cirúrgico, que evoluiu para óbito.

The spontaneous spinal extradural hematoma is rare. It has been associated with arterial hypertension and coagulopaties. Magnetic resonance is the first choice for neuroimaging diagnosis. The surgical drainage of the hematoma is the best treatment. Prognosis is related to etiology, interval between ictus and diagnosis and degree of neurological deficits. The authors report a case of spontaneous spinal extradural hematoma, located in thoracic region, with medullar shock syndrome, that was submitted tosurgical treatment but died for non neurological complications.

Paraplegia after thoracotomy for division and suture Patent Ductus Arteriosus (PDA).

A Thai women, aged 22 years old, came to hospital with Patent Ductus Arteriosis (PDA). Left thoracotomy, with division and suturing PDA, was performed. The second day after operation, she developed paraplegia below umbilical level. The CT-scan detected an extradural hematoma in the spinal cavity from T3-T6. To remove the blood clot, the T spine laminectomy was performed. 6 months after the laminectomy, the patient was able to perform her regular exercise.

Pure Epidural Cavernous Hemangioma of the Cervical Spine that Presented with an Acute Sensory Deficit Caused by Hemorrhage

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.

Pure Epidural Cavernous Hemangioma of the Cervical Spine that Presented with an Acute Sensory Deficit Caused by Hemorrhage

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.