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Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury without Radiographic Abnormality Caused by a Trivial Trauma? Case Report and Review of the Literature.
World Neurosurg. 2016 Jun; 90:38-44.WN

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.

Authors+Show Affiliations

Department of Neurosurgery, IRCCS San Martino-IST University Hospital, Genoa, Italy. Electronic address: pietro.fiaschi@alice.it.Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy.Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

26899465

Citation

Fiaschi, Pietro, et al. "Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury Without Radiographic Abnormality Caused By a Trivial Trauma? Case Report and Review of the Literature." World Neurosurgery, vol. 90, 2016, pp. 38-44.
Fiaschi P, Severino M, Ravegnani GM, et al. Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury without Radiographic Abnormality Caused by a Trivial Trauma? Case Report and Review of the Literature. World Neurosurg. 2016;90:38-44.
Fiaschi, P., Severino, M., Ravegnani, G. M., Piatelli, G., Consales, A., Accogli, A., Capra, V., Cama, A., & Pavanello, M. (2016). Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury without Radiographic Abnormality Caused by a Trivial Trauma? Case Report and Review of the Literature. World Neurosurgery, 90, 38-44. https://doi.org/10.1016/j.wneu.2016.01.094
Fiaschi P, et al. Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury Without Radiographic Abnormality Caused By a Trivial Trauma? Case Report and Review of the Literature. World Neurosurg. 2016;90:38-44. PubMed PMID: 26899465.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Idiopathic Cervical Hematomyelia in an Infant: 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, Y1 - 2016/02/16/ PY - 2015/11/06/received PY - 2016/01/22/revised PY - 2016/01/23/accepted PY - 2016/2/23/entrez PY - 2016/2/24/pubmed PY - 2017/8/31/medline KW - CT KW - Children KW - Idiopathic hematomyelia KW - MRI KW - SCIWORA KW - Spontaneous intramedullary hemorrhage KW - Trivial trauma SP - 38 EP - 44 JF - World neurosurgery JO - World Neurosurg VL - 90 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. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/26899465/Idiopathic_Cervical_Hematomyelia_in_an_Infant:_Spinal_Cord_Injury_without_Radiographic_Abnormality_Caused_by_a_Trivial_Trauma_Case_Report_and_Review_of_the_Literature_ DB - PRIME DP - Unbound Medicine ER -