Chronic Cervicothoracic Extradural Hematoma Presenting With Progressive Neck Flexion Deformity in an Adolescent: A Rare Case Report

Background: Spinal epidural hematomas (SEHs) are rare but potentially a fatal cause of spinal cord compression. This report describes a case of chronic cervicothoracic SEH presenting with progressive neck flexion deformity. Case presentation: We present a 16-year-old girl with a 5-month history of progressive neck pain, flexion deformity, and features of myeloradiculopathy. Neurologic examination revealed hyperreflexia (3+), bilateral extensor plantar responses, diminished right grip strength, right-sided limb weakness (4/5 power) and spastic gait. Magnetic resonance imaging (MRI) showed a C6-D1 epidural collection with T1 hypointensity and T2 hyperintensity causing spinal cord compression. She underwent C5–D1 laminectomy with complete hematoma evacuation. Following complete evacuation of the hematoma and excision of this sac-like epidural layer, a second true dural mater was visualized. Histopathology confirmed chronic hematoma with sac like epidural layer with neovascularization and fibrous membrane formation. Postoperatively, the patient achieved complete neurological recovery (5/5 power and normal bilateral grip strength) with no recurrence at six months follow up. Conclusion: Chronic cervicothoracic SEH should be considered in adolescents presenting with progressive neck pain, deformity, and myeloradiculopathy, even without trauma. Identification of a hematoma membrane resembling dual dura suggests chronic SEH features and is important for achieving complete evacuation. Prompt MRI evaluation, and timely surgical decompression can achieve complete neurological recovery.