A 4 month old boy was admitted to our hospital because of irritability and incomplete left limb paralysis. He was born at term at another hospital by spontaneous vaginal delivery to a 26 year old primipara Filipino woman. He had a productive cough, rhinorrhea and was irritable for 1 week before admission. The left hemisphere incomplete paralysis began at that time. He had no trauma and no skin lesions, such as petechiae or purpura. The neurological examination revealed mild muscle weakness and decreased deep tendon reflexes on his left side. Spinal magnetic resonance imaging (MRI) revealed an extradural haemorrhage extending from C4 to S1 (figs 1 and 2). A detailed interview revealed a history of bleeding on the maternal side, and he was diagnosed with haemophilia A.1,2 His clinical condition improved promptly and fully following treatment with clotting factor. At the age of 2 years, he is developing normally; no neurological abnormalities have been detected and there has been no spinal recurrence.
Figure 1 MRI of the spine showing coexisting old and new haemorrhages.
Figure 2 Enhanced MRI of the spine showing an extradural haemorrhage extending from C4 to S1.
Unless the neurological deficiency progresses rapidly, as in this case, non‐surgical, conservative management is safe for a spinal extradural haematoma in patients with haemophilia, rather than attempting high‐risk surgical management with inappropriate coagulation status.3,4
Footnotes
Competing interests: None declared.
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