Spinal epidural hematoma in hemophilic children: controversies in management

Introduction and objective Spinal epidural hematoma (SEH) is an uncommon complication in hemophilic children. It can produce rapidly progressive neurological deficits. We aim to discuss the different management options for these patients. Case report A 13-year-old boy with a history of hemophilia A...

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Bibliographic Details
Published in:	Child's nervous system Vol. 25; no. 8; pp. 987 - 991
Main Authors:	Rois, Pilar Varela, López, Manuel Rodríguez, de Vergara, Beatriz Cabanas López, de la Lama Zaragoza, Adolfo, García, Jesús González, Uxo, Jorge Mañas
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01-08-2009 Springer-Verlag
Subjects:	Adolescent Back Pain - etiology Back Pain - therapy Case for Discussion Coagulants - therapeutic use Diagnosis, Differential Factor VIII - therapeutic use Hematoma, Epidural, Spinal - complications Hematoma, Epidural, Spinal - surgery Hematoma, Epidural, Spinal - therapy Hemophilia A - complications Hemophilia A - drug therapy Humans Laminectomy Magnetic Resonance Imaging Male Medicine Medicine & Public Health Neurosciences Neurosurgery Practice Guidelines as Topic Spine - pathology Treatment Outcome Factor VIII deficiency Magnetic resonance imaging Spinal epidural hematoma Hemophilia Spinal hemorrhage
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Summary:	Introduction and objective Spinal epidural hematoma (SEH) is an uncommon complication in hemophilic children. It can produce rapidly progressive neurological deficits. We aim to discuss the different management options for these patients. Case report A 13-year-old boy with a history of hemophilia A was admitted with acute onset of localized spine pain and weakness. No trauma was reported on review of the history. Recombinant factor VIII aggressive replacement therapy was started. Spinal magnetic resonance imaging revealed an extradural mass lesion extending from D5 to D6 level. Emergency hemilaminectomies of D5 and D6 and evacuation of the clot were done. The patient made excellent recovery following surgery. Conclusion Early diagnosis and immediate aggressive replacement therapy are mandatory in the management of SEH. Prompt surgical decompression to avoid any permanent neurological deficit is a safe and effective treatment option for an SEH in selected hemophilic children.
Bibliography:	http://dx.doi.org/10.1007/s00381-009-0861-3 ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0256-7040 1433-0350
DOI:	10.1007/s00381-009-0861-3