title: Torticollis as a sign of cervico-thoracic epidural haematoma in an infant with severe haemophilia A.
abstract: We describe the case of a spinal epidural haematoma in an infant with severe haemophilia A. Initial signs and symptoms were non-specific resulting in delay of the diagnosis and more definitive therapy. The patient eventually developed torticollis, acute flaccid paralysis of the upper extremities, and respiratory distress, prompting radiological examination of the spinal cord. The patient was treated with recombinant FactorVIII and laminectomy. Neurological recovery was complete 3 months following the event. We hypothesize that infants with haemophilia may be at higher risk for this rare complication because of their increasing mobility, frequent falls while cruising furniture, and lack of prophylactic factor replacement. Non-specific signs such as irritability without a focus should alert the clinician to this diagnostic possibility. Torticollis should prompt rapid radiological evaluation of the cervical spine with magnetic resonance imaging to avoid delay in diagnosis.
authors.affiliation: Division of Pediatric Hematology, Oncology and BMT, British Columbia Children's Hospital, Vancouver, BC, Canada. gcuvelier@cw.bc.ca
authors.forename: G D E
authors.initials: GD
authors.lastname: Cuvelier
authors.forename: J H
authors.initials: JH
authors.lastname: Davis
authors.forename: E C
authors.initials: EC
authors.lastname: Purves
authors.forename: J K
authors.initials: JK
authors.lastname: Wu
mesh_terms: D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D006467:Hemophilia A / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male; D014103:Torticollis / Q000209:etiology