title: Conservative treatment of spontaneous spinal epidural hematoma associated with oral anticoagulant therapy in a child.
abstract: OBJECTIVE
  Spontaneous spinal epidural hematoma (SSEH) is rare in the pediatric population. This case report reviews the indications and strategies for nonoperative management in selected patients.
  
  
  METHODS
  An eight-year-old boy presented with back pain. There was no antecedent trauma, but the patient was anticoagulated for a mechanical heart valve. MRI revealed an epidural mass from T12 to L2 consistent with SSEH. The absence of focal neurologic deficits, combined with the high stroke risk with anticoagulation reversal, prompted a nonoperative approach. Clinical symptoms resolved over several weeks while maintaining therapeutic anticoagulation. Follow-up MRI demonstrated resolution of the hematoma.
  
  
  CONCLUSIONS
  SSEH can present in the setting of poorly controlled therapeutic anticoagulation in the pediatric population. This case supports the premise that patients who present with SSEH without focal neurologic deficit can be successfully managed while maintaining therapeutic levels of anticoagulation. Close follow-up with frequent neurologic examinations, imaging and monitoring of the prothrombin time is mandatory.
authors.affiliation: Department of Neurosurgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Tailor
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.forename: Edward
authors.initials: E
authors.lastname: Smith
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D006350:Heart Valve Prosthesis; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin