Spontaneous Spinal Epidural Hematoma Coexisting Guillan-Barré Syndrome in a Child: A Case Report

Spontaneous spinal epidural hematoma in children: a case report and literature review

BACKGROUND

Spontaneous spinal epidural hematoma (SSEH) is a hematoma within the spinal epidural space without the underlying causes of trauma or iatrogenic and is considered a very rare neurosurgical emergency disease in children that can cause spinal cord compression and neurological dysfunction. This article provides useful information and guidance to the clinician about SSEH in children regarding its specific characteristics, clinical presentation, and management strategy to achieve a better outcome.

CASE DESCRIPTION

A 14-year-old boy presented with an acute onset of neck pain radiating to the right shoulder and progressive right hemiparesis. The cervical spine magnetic resonance imaging (MRI) revealed a right posterolateral hyperacute spinal epidural hematoma at C4-C7. The patient underwent an emergent open-door laminoplasty (C5-C6) with partial laminectomy (C4 and C7) and complete evacuation of the hematoma. The patient had a complete recovery after surgery with no neurological deficits. A literature search in the PubMed electronic database was performed to identify published English articles between January 2000 to December 2023 focusing on SSEH in children. We have found 81 articles with a total of 95 cases of SSEH in children, providing comparison data on sex, age, clinical presentation, etiology, location of the hematoma, treatment modalities, and outcomes.

CONCLUSIONS

SSEH in children is a very rare neurosurgical emergency disease. Prompt and proper examination is essential to establish the diagnosis and early surgical decompression. Adequate surgical decompression may reduce intradural pressure and increase the blood perfusion to the spinal cord, thus, this will eventually reduce ischemia and prevent secondary spinal injury. As a result, complete recovery can be expected.

Spontaneous Cervical Epidural Hematoma Presenting with Respiratory Failure: A Case Report and Literature Review

CASE

A 62-year-old woman who had an unremarkable medical history presented with sudden headache and neck pain. After the presentation, complete quadriplegia and respiratory arrest developed, and the patient was urgently intubated. Magnetic resonance imaging revealed an extensive epidural hematoma (EH), and emergency hematoma evacuation was performed. At the 1-year follow-up visit, the patient had no motor deficits.

CONCLUSION

We reported a case of spontaneous cervical EH presenting with respiratory failure that was successfully treated with surgical management. Literature review has shown that the surgical outcome is very poor; nevertheless, prompt surgical decompression of the spinal cord can minimize neurological sequelae.

Spontaneous spinal epidural hematoma mimicking Guillain-Barre Syndrome

BACKGROUND

The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS.

CASE REPORT

A previously healthy 6-year-old girl presented with a 2-day history of progressive pain in the lower extremities and an inability to walk. On initial evaluation, she was completely paraparetic in the lower extremities. Deep tendon reflexes were absent in the lower extremities, and Babinski reflexes were positive on both sides. She exhibited reduced response to light touch and pinprick with a sensory level below T10, and experienced difficulty during urination. However, the strength, sensation and flexion of upper extremities were normal. Because her presentation and examinations were consistent with GBS, we initiated intravenous immunoglobulin therapy. The next day, she also developed pain and muscle weakness of the right upper extremity. Three days after admission, respiratory depression progressed rapidly. Spinal MRI showed a mass extending from the level of C7-T3, with spinal cord compression. The patient underwent an emergency laminectomy with evacuation of hematoma, and was diagnosed with SSEH. Sixty days after admission, she was transferred to the rehabilitation hospital with severe neurologic sequelae of paralysis in both legs.

CONCLUSION

SSEH might have severe consequences, including neurologic deficits and risk of death. This case report serves to raise the awareness of SSEH that mimics the initial presentation of GBS.

Posttraumatic Guillain-Barré Syndrome Immediately Following a Traffic Accident

Guillain-Barré syndrome (GBS) is an inflammatory demyelinating polyneuropathy characterized by areflexic paralysis. Most cases of GBS are preceded by an infection, however, posttraumatic GBS has also recently been reported. We report a case of posttraumatic GBS immediately following a traffic accident. We think this case is of clinical significance for practitioners because of the rare cause of a sudden flaccid paralysis following trauma.