• Pietro Fiaschi, Mariasavina Severino, Giuseppe Marcello Ravegnani, Gianluca Piatelli, Alessandro Consales, Andrea Accogli, Valeria Capra, Armando Cama, and Marco Pavanello.
• Department of Neurosurgery, IRCCS San Martino-IST University Hospital, Genoa, Italy. Electronic address: pietro.fiaschi@alice.it.
• World Neurosurg. 2016 Jun 1; 90: 38-44.

BackgroundSpontaneous or idiopathic intramedullary bleeding is a very rare event in pediatric patients. This diagnosis requires an extended clinical, laboratory, and radiologic work-up to rule out all potential causes of hematomyelia. However, children may present with hematomyelia or spinal cord injury without radiographic abnormality even after a minor trauma.Case DescriptionA 15-month-old girl presented with a 24-hour history of progressive neurologic deficits. A trivial trauma had occurred a few days before the clinical onset. Head computed tomography scan and craniospinal magnetic resonance imaging revealed an isolated hemorrhagic central medullary lesion extending from the obex to C3 level. No underlying causes of intramedullary bleeding were identified. In the absence of obvious vascular abnormalities, the patient underwent an urgent occipitocervical decompression with hematoma evacuation. Postoperatively, the patient's motor symptoms rapidly resolved, and she was discharged with cervical collar immobilization.ConclusionsWe discuss the differential diagnosis of intramedullary bleeding in children, focusing on the diagnostic protocol and therapeutic options in this age group.Copyright © 2016 Elsevier Inc. All rights reserved.

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