Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury without Radiographic Abnormality Caused by a Trivial Trauma? Case Report and Review of the Literature

Research output: Contribution to journalArticle

Abstract

Background Spontaneous or idiopathic intramedullary bleeding is a very rare event in pediatric patients. This diagnosis requires an extended clinical, laboratory, and radiologic work-up to rule out all potential causes of hematomyelia. However, children may present with hematomyelia or spinal cord injury without radiographic abnormality even after a minor trauma. Case Description A 15-month-old girl presented with a 24-hour history of progressive neurologic deficits. A trivial trauma had occurred a few days before the clinical onset. Head computed tomography scan and craniospinal magnetic resonance imaging revealed an isolated hemorrhagic central medullary lesion extending from the obex to C3 level. No underlying causes of intramedullary bleeding were identified. In the absence of obvious vascular abnormalities, the patient underwent an urgent occipitocervical decompression with hematoma evacuation. Postoperatively, the patient's motor symptoms rapidly resolved, and she was discharged with cervical collar immobilization. Conclusions We discuss the differential diagnosis of intramedullary bleeding in children, focusing on the diagnostic protocol and therapeutic options in this age group.

Original languageEnglish
Pages (from-to)38-44
Number of pages7
JournalWorld Neurosurgery
Volume90
DOIs
Publication statusPublished - Jun 1 2016

Fingerprint

Spinal Cord Vascular Diseases
Spinal Cord Injuries
Hemorrhage
Wounds and Injuries
Neurologic Manifestations
Decompression
Immobilization
Hematoma
Blood Vessels
Differential Diagnosis
Age Groups
Head
Tomography
Magnetic Resonance Imaging
Pediatrics
Therapeutics

Keywords

  • Children
  • CT
  • Idiopathic hematomyelia
  • MRI
  • SCIWORA
  • Spontaneous intramedullary hemorrhage
  • Trivial trauma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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title = "Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury without Radiographic Abnormality Caused by a Trivial Trauma? Case Report and Review of the Literature",
abstract = "Background Spontaneous or idiopathic intramedullary bleeding is a very rare event in pediatric patients. This diagnosis requires an extended clinical, laboratory, and radiologic work-up to rule out all potential causes of hematomyelia. However, children may present with hematomyelia or spinal cord injury without radiographic abnormality even after a minor trauma. Case Description A 15-month-old girl presented with a 24-hour history of progressive neurologic deficits. A trivial trauma had occurred a few days before the clinical onset. Head computed tomography scan and craniospinal magnetic resonance imaging revealed an isolated hemorrhagic central medullary lesion extending from the obex to C3 level. No underlying causes of intramedullary bleeding were identified. In the absence of obvious vascular abnormalities, the patient underwent an urgent occipitocervical decompression with hematoma evacuation. Postoperatively, the patient's motor symptoms rapidly resolved, and she was discharged with cervical collar immobilization. Conclusions We discuss the differential diagnosis of intramedullary bleeding in children, focusing on the diagnostic protocol and therapeutic options in this age group.",
keywords = "Children, CT, Idiopathic hematomyelia, MRI, SCIWORA, Spontaneous intramedullary hemorrhage, Trivial trauma",
author = "Pietro Fiaschi and Mariasavina Severino and Ravegnani, {Giuseppe Marcello} and Gianluca Piatelli and Alessandro Consales and Andrea Accogli and Valeria Capra and Armando Cama and Marco Pavanello",
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T1 - Idiopathic Cervical Hematomyelia in an Infant

T2 - Spinal Cord Injury without Radiographic Abnormality Caused by a Trivial Trauma? Case Report and Review of the Literature

AU - Fiaschi, Pietro

AU - Severino, Mariasavina

AU - Ravegnani, Giuseppe Marcello

AU - Piatelli, Gianluca

AU - Consales, Alessandro

AU - Accogli, Andrea

AU - Capra, Valeria

AU - Cama, Armando

AU - Pavanello, Marco

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background Spontaneous or idiopathic intramedullary bleeding is a very rare event in pediatric patients. This diagnosis requires an extended clinical, laboratory, and radiologic work-up to rule out all potential causes of hematomyelia. However, children may present with hematomyelia or spinal cord injury without radiographic abnormality even after a minor trauma. Case Description A 15-month-old girl presented with a 24-hour history of progressive neurologic deficits. A trivial trauma had occurred a few days before the clinical onset. Head computed tomography scan and craniospinal magnetic resonance imaging revealed an isolated hemorrhagic central medullary lesion extending from the obex to C3 level. No underlying causes of intramedullary bleeding were identified. In the absence of obvious vascular abnormalities, the patient underwent an urgent occipitocervical decompression with hematoma evacuation. Postoperatively, the patient's motor symptoms rapidly resolved, and she was discharged with cervical collar immobilization. Conclusions We discuss the differential diagnosis of intramedullary bleeding in children, focusing on the diagnostic protocol and therapeutic options in this age group.

AB - Background Spontaneous or idiopathic intramedullary bleeding is a very rare event in pediatric patients. This diagnosis requires an extended clinical, laboratory, and radiologic work-up to rule out all potential causes of hematomyelia. However, children may present with hematomyelia or spinal cord injury without radiographic abnormality even after a minor trauma. Case Description A 15-month-old girl presented with a 24-hour history of progressive neurologic deficits. A trivial trauma had occurred a few days before the clinical onset. Head computed tomography scan and craniospinal magnetic resonance imaging revealed an isolated hemorrhagic central medullary lesion extending from the obex to C3 level. No underlying causes of intramedullary bleeding were identified. In the absence of obvious vascular abnormalities, the patient underwent an urgent occipitocervical decompression with hematoma evacuation. Postoperatively, the patient's motor symptoms rapidly resolved, and she was discharged with cervical collar immobilization. Conclusions We discuss the differential diagnosis of intramedullary bleeding in children, focusing on the diagnostic protocol and therapeutic options in this age group.

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KW - Idiopathic hematomyelia

KW - MRI

KW - SCIWORA

KW - Spontaneous intramedullary hemorrhage

KW - Trivial trauma

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