Emergent medical and surgical management of mediastinal infantile hemangioma with symptomatic spinal cord compression: case report and literature review

Childs Nerv Syst. 2010 Dec;26(12):1799-805. doi: 10.1007/s00381-010-1153-7. Epub 2010 Apr 20.

Abstract

Purpose: We report an extremely rare case of a patient with a large, cervical, and upper thoracic cutaneous hemangioma associated with a separate, underlying mediastinal hemangioma extending to the epidural space causing significant spinal cord compression.

Case report: A 6-week-old female presented with decreased movement of her right arm and bilateral lower extremity hyperreflexia. Her arm weakness progressed to paralysis over the course of 24 h. She underwent emergent surgical decompression and medical therapy with propranolol and systemic corticosteroids.

Conclusion: While several recent reports have described dramatic responses of hemangiomas to propranolol, this is the first case in which it was used as part of a multimodal approach to symptomatic spinal cord compression. The infant improved immediately after surgery. She is neurologically intact and has radiographic regression of the hemangiomas on follow-up examination 6 months later.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Child, Preschool
  • Decompression, Surgical / adverse effects*
  • Female
  • Hemangioma, Capillary / drug therapy*
  • Hemangioma, Capillary / pathology
  • Hemangioma, Capillary / surgery*
  • Heparin / therapeutic use
  • Humans
  • Mediastinal Neoplasms / drug therapy*
  • Mediastinal Neoplasms / pathology
  • Mediastinal Neoplasms / surgery*
  • Postoperative Complications / drug therapy
  • Postoperative Complications / etiology
  • Prednisolone / therapeutic use
  • Propranolol / therapeutic use
  • Spinal Cord Compression / etiology
  • Spinal Cord Compression / surgery*
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / etiology

Substances

  • Adrenergic beta-Antagonists
  • Anti-Inflammatory Agents
  • Anticoagulants
  • Heparin
  • Prednisolone
  • Propranolol