title: Epidural hematoma of a cauda equina in a child with hemophilia A.
abstract: OBJECTIVE
  The presenting signs, treatment, and outcome of an epidural hematoma of the cauda equina in a child with severe hemophilia are reported for the first time.
  
  
  METHODS
  A 20-month-old boy with severe hemophilia A (factor VIII <0.01 U/ml) presented with a 12-day history of refusal to stand and constipation of 5-7 days duration. He had normal deep tendon reflexes with normal sensation and withdrawal to pinprick of his lower extremities bilaterally. He stood on his right leg, but had inversion of his left foot and refused to bear weight on his left leg. MRI revealed an epidural hematoma of the cauda equina and a distended bladder. Factor VIII replacement therapy and lumbosacral laminectomy with evacuation of the hematoma resulted in recovery of a normal gait, but bladder dysfunction persisted for 11 months. Clean intermittent catheterization (CIC) was required until bladder function returned.
  
  
  RESULTS
  Complete neurologic recovery occurred 11 months after presentation
  
  
  CONCLUSIONS
  This case demonstrates the following points: (a) an epidural hematoma of the cauda equina in a child with severe hemophilia can present with neurologic findings that are as subtle as those seen in normal children; (b) CIC can be performed safely over an extended period without factor VIII replacement; and (c) complete recovery is possible, despite prolonged bladder dysfunction and a 12-day interval between the onset of symptoms and treatment.
authors.affiliation: Division of Pediatric Hematology/Oncology, Department of Pediatrics, Cooper Hospital/University Medical Center, Camden, New Jersey 08103, USA.
authors.forename: S F
authors.initials: SF
authors.lastname: Travis
authors.forename: B H
authors.initials: BH
authors.lastname: Greenbaum
authors.forename: M
authors.initials: M
authors.lastname: Mintz
authors.forename: R M
authors.initials: RM
authors.lastname: White
authors.forename: S
authors.initials: S
authors.lastname: Stein
authors.forename: R E
authors.initials: RE
authors.lastname: Steckler
authors.forename: K M
authors.initials: KM
authors.lastname: Hirsch
authors.forename: M H
authors.initials: MH
authors.lastname: Donaldson
mesh_terms: D002420:Cauda Equina; D005169:Factor VIII / Q000627:therapeutic use; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007223:Infant; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000150:complications / Q000628:therapy
chemical_list: D005169:Factor VIII