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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 196-200
DOI: 10.1055/s-0043-1768249
Case Report

Spontaneous Cervicothoracic Extradural Hematoma with Rare Presentation in Pediatric Patient with Stroke-Like Features in Association with COVID-19, Presenting as Management Dillemma

Vikas Chandra Jha 
1   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
,
Shahnawaz Alam 
1   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
,
Neeraj Jha
1   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
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Abstract

Presentation of cervico-thoracic extradural hematoma in pediatric age is rare with stroke-like features. Its association with COVID-19 in the active stage of the disease had not been reported and its management presents a management dilemma as COVID-19 with stroke-like features.

A 14-year-old boy was referred to our institute with complaints of sudden-onset upper and middle back pain, associated with loss of sensation below the middle of the back, sudden progressive weakness of both lower limbs (power 0/5) and upper limbs (power grade-2/5), and incontinence of urine, following bouts of vomiting 12 days back. There was no history of trauma, bleeding diathesis, etc. Blood investigation was suggestive of leukocytosis, and RT-PCR test for COVID-19 was positive with raised D-dimer, serum ferritin, and C-reactive protein. MRI spine was suggestive of cervicothoracic extradural hematoma extending from C5-D3 level and compressing the spinal cord. The patient refused surgical decompression and was managed conservatively, following which he improved with power grade in limbs to 4/5.

Surgical decompression is the treatment of choice but the patient can sometimes improve on medical management. Association of COVID-19 with spontaneous cervicothoracic extradural hematoma had not been reported earlier in the active stage, but its role in inducing vasculopathy and increased chances of bleeding at the uncommon site had been reported in the literature, and it may precipitate such cervical epidural hematoma.

Keywords

spontaneous cervical epidural hematoma - pediatric patient - stroke - COVID-19

Consent

The patient's relatives' consent was taken at the time of admission to use his data for teaching and research purposes.


Authors' Contributions

Conceptualization, clinical work, data collection, data analysis, manuscript drafting and revision were done by VCJ. Data collection and analysis were done by VCJ, NJ, and MSA. Data analysis and manuscript supervision were done by VCJ, MSA, and NJ. All the authors have read and approved the final version of manuscript. This manuscript has neither been presented as whole or part in any conference or scientific meeting. This article is neither published nor under consideration for publication anywhere else.




Publication History

Article published online:
31 March 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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