Recurrent cervicothoracic spontaneous epidural hematoma in a toddler

Background: Recurrent cases of spontaneous spinal epidural hematoma are rare, and there are no reports of spontaneous resolution and recurrence in toddlers.

Case presentation: We present a case of a toddler with a cervical spontaneous spinal epidural hematoma, characterized by three episodes of sudden-onset transient torticollis with subsequent natural recovery. The patient was referred to our hospital after the second episode, during which symptoms were already improving. Conservative management without surgery was chosen, leading to spontaneous resolution. During the third episode, the symptoms were mild, and observation was again selected, resulting in natural improvement. Post-resolution magnetic resonance imaging revealed an extradural cyst, suggesting that the hemorrhage had occurred within the cyst.

Conclusion: Recurrent cases of cervical spontaneous epidural hematomas often resolve with conservative treatment, particularly in cases with mild myelopathy. Our case suggests a possible association between a spinal cystic structure and hemorrhage within the spinal canal. Conservative management may be appropriate in cases of spontaneous epidural hematomas with mild or improving symptoms to avoid the risk of postoperative kyphosis.