Spinal epidural hematoma in hemophilic children: controversies in management.
OBJECTIVE
Spinal epidural hematoma (SEH) is an uncommon complication in hemophilic children. It can produce rapidly progressive neurological deficits. We aim to discuss the different management options for these patients.


METHODS
A 13-year-old boy with a history of hemophilia A was admitted with acute onset of localized spine pain and weakness. No trauma was reported on review of the history. Recombinant factor VIII aggressive replacement therapy was started. Spinal magnetic resonance imaging revealed an extradural mass lesion extending from D5 to D6 level. Emergency hemilaminectomies of D5 and D6 and evacuation of the clot were done. The patient made excellent recovery following surgery.


CONCLUSIONS
Early diagnosis and immediate aggressive replacement therapy are mandatory in the management of SEH. Prompt surgical decompression to avoid any permanent neurological deficit is a safe and effective treatment option for an SEH in selected hemophilic children.
Department of Neurosurgery, Xeral-Cies Hospital, Pizarro Street, Vigo 36204, Pontevedra, Spain. pilirois@hotmail.com
Pilar Varela
PV
Rois
Manuel Rodríguez
MR
López
Beatriz Cabanas López
BC
de Vergara
Adolfo
A
de la Lama Zaragoza
Jesús González
JG
García
Jorge Mañas
JM
Uxo
D000293:Adolescent; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D003029:Coagulants / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005169:Factor VIII / Q000627:therapeutic use; D046748:Hematoma, Epidural, Spinal / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D017410:Practice Guidelines as Topic; D013131:Spine / Q000473:pathology; D016896:Treatment Outcome
D003029:Coagulants; C078147:F8 protein, human; D005169:Factor VIII