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
