2020 Volume 11 Issue 4 Pages 769-773
Patients of hemophilia are normally diagnosed after unusual subcutaneous bleeding at infants. After acquired self-walk and getting active to run, some patients are diagnosed after intracranial hemorrhage since they still tend to fall. In orthopaedic clinic situation, it is reported that osteoarthritis after repeated joint hemorrhage is a major problem for hemophilia patients. However, there are very few reports that patients develop epidural hematoma before diagnosis of hemophilia.
Here, we report one extremely rare case of 3-month-old infant of hemophilia who was diagnosed after epidural hematoma. The parents found that the patient did not move his legs very well and looked displeased. After they visit a pediatric clinic, they went to a hospital to take MRI which revealed epidural mass at thoracic level. The mass looked like an epidural hematoma or abscess. The blood examination suggested no infection regarding WBC and CRP. But the only outlier was APTT that indicates some abnormality in blood coagulation. The patient did not show any recovery so that we decided to perform surgery. Surgery was one-side open wedge laminoplasty from Th8 to L2. The mass was hematoma. Right after surgery, the muscle strength recovered. After surgery, he was diagnosed as hemophilia A. At the moment, he does not have any growth problem including gait-disturbance and scoliosis. He acquired self-walk at 11-month-old. At one year after surgery, MRI shows no mass in spinal canal and that the dura spreads widely enough in spinal canal.
While there are reports that lumbar puncture to hemophilia patients should be avoided because of the risk of epidural hematoma, the treatment of epidural hematoma of hemophilia patients is not enough established because clinical cases are rare. Some authors report that their patients recovered after conservative treatment and some report good recovery after surgery. If patients any recovery before surgery, it may be good by conservative treatment. However, without any recovery surgery should be considered. Recently treatment of hemophilia has developed so well that patients could take only one shot of clotting factor monthly. And the blood coagulation is now able to be controlled strictly, the risk of bleeding can be controlled well, too. Surgery can be one optional treatment for epidural hematoma of hemophilia patients.
