Cervical intramedullary hematoma in pediatrics
Keywords:
pediatric spinal hematoma, post-traumatic spinal hematoma, intramedullary hematoma, expansive laminoplasty, intraoperative neurophysiological monitoring.Abstract
OBJECTIVE: The goal of this article is to describe clinical, radiologic and anatomopathological features of a spinal cervical hematoma in a pediatric patient.
CLINICAL CASE: A 13 years old female patient what arrived to the emergency department of the Octavio de la Concepción de la Pedraja Universitary Pediatric Hospital in Holguin accompanied by her family. They reported that, 72 hours after a cranial trauma, this patient presented decreased muscle strength in both upper limbs, predominantly distal, and paresthetic sensations. Physical examination revealed a bilateral decrease in the distal predominance of muscle strength in both upper limbs, associated with muscular hyporeflexia. She was admitted to the Neuropediatric Service. A magnetic resonance imaging of the cervical spine was performed, which reported a cystic medullary lesion from the first to the sixth cervical vertebra. Surgical treatment was decided, using double window laminoplasty from C3 to C6, supported with intraoperative neurophysiological monitoring. Subtotal excision of the lesion was performed. Her postoperative evolution was favorable.
CONCLUSIONS: Intramedullary spinal hematomas can present subacute, and sometimes simulate other diseases of the spinal cord. Imagenologically, they usually present as a cystic area surrounded by a capsule that is enhanced by contrast administration. The pathological anatomy is the accurate diagnosis. In this patient, surgical treatment of the lesion was performed satisfactorily despite the time elapsed between the trauma and the surgical treatment performed.
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