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Syringomyelia following surgery for a spontaneous spinal subdural hematoma in a 13-year-old girl with congenital von Willebrand disease: case report and literature review

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Abstract

Background and importance

Spontaneous spinal subdural hematomas are rare. Their occurrence in a child with congenital von Willebrand disease and the complication of their surgery by a large secondary syringomyelia have never been previously reported.

Case presentation

A 13-year-old girl with congenital von Willebrand disease presented to our emergency department in January 2011 for sudden onset of severe back pain centered in her thoracic spine rapidly aggravated by signs of acute myelopathy without any precipitating factor. MRI scan revealed a thoracic subdural collection anterior to the spinal cord at the T7–T9 level, hyperintense on T1- and T2-weighted sequences consistent with an acute spinal subdural hemorrhage. Evacuation of the subdural hematoma was realized immediately after hemostasis parameter correction, and post-operative course was uneventful with full functional recovery. One year later, the patient presented once again but with progressive and more severe myelopathy caused by a large syringomyelia extending from the T5 level to the conus medullaris. A syringopleural shunting was performed and the patient was unrolled under an intensive care and rehabilitation program. Her condition remarkably improved and she became able to walk independently within 2 weeks post-operatively.

Conclusions

von Willebrand disease should be included as a possible factor of spontaneous spinal subdural hemorrhage. Surgery is advised in emergency and can be associated with remarkable recovery especially in children. Delayed syringomyelia can complicate the post-operative course and can be successfully addressed by syringopleural shunting. Long-term clinical and radiological follow-up is advocated.

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

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Acknowledgments

Disclosure

“The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.”

Consent

Although written informed consent is not needed in this paper as illustrations do not permit the recognition of the patient, we have obtained such consent for the publication of this clinical picture and the accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of the journal.

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Authors and Affiliations

  1. Neurosurgery Department, Fattouma Bourguiba University Hospital–University of Medicine of Monastir, Monastir, Tunisia

    A Ben Nsir

  2. Neurosurgery Department, Tunisian National Institute of Neurology–Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, 1007, Tunis, Tunisia

    A Boubaker & H Jemel

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  1. A Ben Nsir
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  2. A Boubaker
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Correspondence to A Ben Nsir.

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Ben Nsir, A., Boubaker, A. & Jemel, H. Syringomyelia following surgery for a spontaneous spinal subdural hematoma in a 13-year-old girl with congenital von Willebrand disease: case report and literature review. Childs Nerv Syst 32, 727–731 (2016). https://doi.org/10.1007/s00381-015-2875-3

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  • DOI: https://doi.org/10.1007/s00381-015-2875-3

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