Breech delivery, rupture of Batson's plexus, T8 epidural hematoma, and paraplegia
| Autor: | L Lilien, Randy Ray Richardson, C Billingham |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Cord Anastomosis Veins 03 medical and health sciences 0302 clinical medicine Epidural hematoma Pregnancy 030225 pediatrics Edema Birth Injuries medicine Humans Breech Presentation Spinal cord injury Paraplegia Plexus 030219 obstetrics & reproductive medicine Lumbar Vertebrae Rupture Spontaneous business.industry Infant Newborn medicine.disease Hematoma Epidural Spinal Surgery body regions Conus medullaris surgical procedures operative medicine.anatomical_structure Pediatrics Perinatology and Child Health Hematoma Subdural Spinal Female medicine.symptom business Magnetic Resonance Angiography |
| Zdroj: | Journal of neonatal-perinatal medicine. 12(3) |
| ISSN: | 1878-4429 |
| Popis: | A male newborn born by an atraumatic vaginal frank breech delivery was noted to have normal limb movement at birth. However, at 24 hours the neonate developed paraplegia with no evidence of spinal cord injury on radiographic films. Ultrasound and MRI demonstrated an epidural hematoma at the level of T8 and distal cord edema which extended to the conus medullaris. Delayed onset paraplegia following an atraumatic vaginal breech delivery is unlikely to have been caused by acute traction or torsion at birth. Traction and torsion injuries would present acutely. This infant developed a T8 epidural hematoma which has not been reported in a newborn. The pathophysiology of a spontaneous spinal epidural hematoma (SSEH) in adults is frequently related to increased abdominal/thoracic pressure which results in increased pressure in the highly anastomotic network of thin walled and valve-less vertebral venous plexus (Batson's plexus). Such increase in abdominal/thoracic pressure could occur during a frank breech delivery and result in a slow onset epidural hematoma. This report highlights the importance of considering slow onset epidural hematoma in the differential diagnosis of neonates who develop slow onset paraplegia. If diagnosed quickly, an epidural hematoma represents a potentially treatable etiology by rapid surgical decompression. |
| Databáze: | OpenAIRE |
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