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Conservative treatment of spontaneous spinal epidural hematoma associated with oral anticoagulant therapy in a child.
Childs Nerv Syst. 2006 Dec; 22(12):1643-5.CN

Abstract

OBJECTIVE

Spontaneous spinal epidural hematoma (SSEH) is rare in the pediatric population. This case report reviews the indications and strategies for nonoperative management in selected patients.

METHODS

An eight-year-old boy presented with back pain. There was no antecedent trauma, but the patient was anticoagulated for a mechanical heart valve. MRI revealed an epidural mass from T12 to L2 consistent with SSEH. The absence of focal neurologic deficits, combined with the high stroke risk with anticoagulation reversal, prompted a nonoperative approach. Clinical symptoms resolved over several weeks while maintaining therapeutic anticoagulation. Follow-up MRI demonstrated resolution of the hematoma.

CONCLUSION

SSEH can present in the setting of poorly controlled therapeutic anticoagulation in the pediatric population. This case supports the premise that patients who present with SSEH without focal neurologic deficit can be successfully managed while maintaining therapeutic levels of anticoagulation. Close follow-up with frequent neurologic examinations, imaging and monitoring of the prothrombin time is mandatory.

Authors+Show Affiliations

Department of Neurosurgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

16977486

Citation

Tailor, Jignesh, et al. "Conservative Treatment of Spontaneous Spinal Epidural Hematoma Associated With Oral Anticoagulant Therapy in a Child." Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, vol. 22, no. 12, 2006, pp. 1643-5.
Tailor J, Dunn IF, Smith E. Conservative treatment of spontaneous spinal epidural hematoma associated with oral anticoagulant therapy in a child. Childs Nerv Syst. 2006;22(12):1643-5.
Tailor, J., Dunn, I. F., & Smith, E. (2006). Conservative treatment of spontaneous spinal epidural hematoma associated with oral anticoagulant therapy in a child. Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery, 22(12), 1643-5.
Tailor J, Dunn IF, Smith E. Conservative Treatment of Spontaneous Spinal Epidural Hematoma Associated With Oral Anticoagulant Therapy in a Child. Childs Nerv Syst. 2006;22(12):1643-5. PubMed PMID: 16977486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conservative treatment of spontaneous spinal epidural hematoma associated with oral anticoagulant therapy in a child. AU - Tailor,Jignesh, AU - Dunn,Ian F, AU - Smith,Edward, Y1 - 2006/09/15/ PY - 2006/04/20/received PY - 2006/9/16/pubmed PY - 2007/3/28/medline PY - 2006/9/16/entrez SP - 1643 EP - 5 JF - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery JO - Childs Nerv Syst VL - 22 IS - 12 N2 - OBJECTIVE: Spontaneous spinal epidural hematoma (SSEH) is rare in the pediatric population. This case report reviews the indications and strategies for nonoperative management in selected patients. METHODS: An eight-year-old boy presented with back pain. There was no antecedent trauma, but the patient was anticoagulated for a mechanical heart valve. MRI revealed an epidural mass from T12 to L2 consistent with SSEH. The absence of focal neurologic deficits, combined with the high stroke risk with anticoagulation reversal, prompted a nonoperative approach. Clinical symptoms resolved over several weeks while maintaining therapeutic anticoagulation. Follow-up MRI demonstrated resolution of the hematoma. CONCLUSION: SSEH can present in the setting of poorly controlled therapeutic anticoagulation in the pediatric population. This case supports the premise that patients who present with SSEH without focal neurologic deficit can be successfully managed while maintaining therapeutic levels of anticoagulation. Close follow-up with frequent neurologic examinations, imaging and monitoring of the prothrombin time is mandatory. SN - 0256-7040 UR - https://www.unboundmedicine.com/medline/citation/16977486/Conservative_treatment_of_spontaneous_spinal_epidural_hematoma_associated_with_oral_anticoagulant_therapy_in_a_child_ L2 - https://doi.org/10.1007/s00381-006-0220-6 DB - PRIME DP - Unbound Medicine ER -