Insidious onset of spontaneous spinal epidural hematoma in immune thrombocytopenic purpura: a case-based review,Child's Nervous System

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Insidious onset of spontaneous spinal epidural hematoma in immune thrombocytopenic purpura: a case-based review
Child's Nervous System ( IF 1.3 ) Pub Date : 2023-05-01 , DOI: 10.1007/s00381-023-05963-8
YeonSoo Kim ₁ , George W Koutsouras ₁ , George Bourdages ₁ , Timothy Beutler ₁

Affiliation

Introduction

Spontaneous spinal epidural hematoma (SSEH) can result from various etiologies with a variable degree of neurological deficits. Here, we describe a rare case of SEH secondary to immune thrombocytopenic purpura (ITP) in a child and review the literature of SSEH caused by ITP.

Case report

A 9-year-old female who presented with rapid neurological decline, including bowel and bladder incontinence and paraparesis. A SSEH was observed extending from C2 to T6, causing a mass effect on the spinal cord. Her platelet count was only 7000/µL. Multidisciplinary care was established with neurosurgery, pediatric hematology, and pediatric surgery. The patient was managed emergently with splenectomy and surgical evacuation, with multilevel laminectomy and laminoplasty for evacuation of the hematoma. After a short course of rehabilitation, the patient regained all neurological function.

Conclusion

We report the first case of cervicothoracic SSEH secondary to ITP in a child managed with emergent splenectomy and surgical evacuation with multilevel lamoplasty. We also described the methods of timely diagnosis, urgent management, and overall prognosis of patients with this condition.

中文翻译：

免疫性血小板减少性紫癜自发性脊髓硬膜外血肿的隐袭发作：基于病例的回顾

介绍

自发性脊髓硬膜外血肿 (SSEH) 可由多种病因引起，并伴有不同程度的神经功能缺损。在此，我们描述一例罕见的继发于免疫性血小板减少性紫癜（ITP）的儿童 SEH 病例，并回顾了 ITP 引起的 SSEH 的文献。

案例报告

一名 9 岁女性，出现神经功能快速衰退，包括肠和膀胱失禁以及截瘫。观察到 SSEH 从 C2 延伸到 T6，对脊髓造成占位效应。她的血小板计数仅为 7000/μL。建立了神经外科、小儿血液学和小儿外科的多学科护理。对该患者进行了紧急处理，包括脾切除术和手术清除术，以及多节段椎板切除术和椎板成形术以清除血肿。经过短暂的康复治疗，患者恢复了所有神经功能。