Acute clival and spinal subdural hematoma with spontaneous resolution: clinical and radiographic correlation in support of a proposed pathophysiological mechanism - Case report

被引:37
作者
Ahn, ES
Smith, ER
机构
[1] Harvard Univ, Childrens Hosp, Sch Med, Dept Neurosurg, Boston, MA 02115 USA
[2] Univ Maryland, Sch Med, Dept Neurosurg, Baltimore, MD 21201 USA
关键词
pediatric trauma; spinal subdural hematoma; clival subdural hematoma; pediatric neurosurgery;
D O I
10.3171/ped.2005.103.2.0175
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Infratentorial and spinal subdural hematomas (SDHs) from traumatic injury in the pediatric population occur with such rarity that they can present the clinician with a challenge in diagnosis and management. When such hematomas are correctly identified, clinicians must decide whether to evacuate the lesion or manage it expectantly. The authors discuss the case of a 4-year-old child who presented with a clival and spinal SDH after a fall from a fourth-story window. The clinical and radiographic findings support a possible mechanism of evolution of these lesions. There is little evidence to guide management of clival and spinal SDHs. This case supports the evaluation for a spinal SDH when a clival hematoma is diagnosed. In the setting of a good neurological examination, expectant management can be an appropriate method of treatment. Additionally, this case lends insight into the pathophysiology of spinal SDHs. Unlike its intracranial counterpart, the spinal subdural space lacks bridging veins. The mechanism of formation of spinal SDHs after trauma has been heretofore relatively unclear. The images in this case support the hypothesis that redistribution of the clival SDH to dependent areas in the spinal subdural space is a significant mechanism in the evolution of these lesions.
引用
收藏
页码:175 / 179
页数:5
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