title: Idiopathic Cervical Hematomyelia in an Infant: Spinal Cord Injury without Radiographic Abnormality Caused by a Trivial Trauma? Case Report and Review of the Literature.
abstract: BACKGROUND
  Spontaneous or idiopathic intramedullary bleeding is a very rare event in pediatric patients. This diagnosis requires an extended clinical, laboratory, and radiologic work-up to rule out all potential causes of hematomyelia. However, children may present with hematomyelia or spinal cord injury without radiographic abnormality even after a minor trauma.
  
  
  METHODS
  A 15-month-old girl presented with a 24-hour history of progressive neurologic deficits. A trivial trauma had occurred a few days before the clinical onset. Head computed tomography scan and craniospinal magnetic resonance imaging revealed an isolated hemorrhagic central medullary lesion extending from the obex to C3 level. No underlying causes of intramedullary bleeding were identified. In the absence of obvious vascular abnormalities, the patient underwent an urgent occipitocervical decompression with hematoma evacuation. Postoperatively, the patient's motor symptoms rapidly resolved, and she was discharged with cervical collar immobilization.
  
  
  CONCLUSIONS
  We discuss the differential diagnosis of intramedullary bleeding in children, focusing on the diagnostic protocol and therapeutic options in this age group.
authors.affiliation: Department of Neurosurgery, IRCCS San Martino-IST University Hospital, Genoa, Italy. Electronic address: pietro.fiaschi@alice.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Fiaschi
authors.affiliation: Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Mariasavina
authors.initials: M
authors.lastname: Severino
authors.affiliation: Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Giuseppe Marcello
authors.initials: GM
authors.lastname: Ravegnani
authors.affiliation: Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Piatelli
authors.affiliation: Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Consales
authors.affiliation: Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Accogli
authors.affiliation: Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Capra
authors.affiliation: Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Cama
authors.affiliation: Neurosurgery Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pavanello
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004322:Drainage; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D061145:Microvascular Decompression Surgery; D013119:Spinal Cord Injuries / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D020758:Spinal Cord Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*
keywords: CT; Children; Idiopathic hematomyelia; MRI; SCIWORA; Spontaneous intramedullary hemorrhage; Trivial trauma