Acute Cervical and Thoracic Ventral Side Spontaneous Spinal Epidural Hematoma Causing High Paraplegia: A Case Report

Abstract

IntroductionSpontaneous spinal epidural hematoma (SSEH) is a rare condition that can potentially cause paraplegia. SSEH has an increasing incidence rate and its cause remains unclear. Magnetic resonance imaging (MRI) results shows that SSEH presents a spinal epidural space-occupying lesion; therefore, emergency surgical treatment is required in some cases. MRI results of most SSEH cases showed that hematoma occurs in the dorsal or lateral side. By contrast, hematoma in the ventral side is very rarely shown.Case PresentationA 42-year-old healthy woman developed a sudden onset of severe neck pain with mild limb weakness, gradual breathing difficulty, and high paraplegia. MRI results revealed that an SSEH was compressing her spinal cord in the ventral epidural space from C2 to T3. Upon admission, she received emergency decompressive laminectomy in a posterior approach from C3 to T1, and the epidural hematoma was evacuated through full incision of the dorsal side dural, release of cerebrospinal fluid, and intermittent incision of the ventral side dural. The symptoms of limb paralysis and breathing distress gradually improved after recover rehabilitation, and the patient was discharged with life self-care after 2 months.ConclusionsPerforming early decompressive laminectomy and evacuation of hematoma on severe SSEH patients improves neurological outcomes. For patients with ventral side SSEH, the cerebrospinal fluid should be released after the incision on the dorsal side dural, and the ventral side dural should be gradually as well as intermittently clipped to evacuate the hematoma. The patient would also receive a good prognosis after the total release of the spinal cord compression.

Spontaneous spinal epidural hematoma following IV heparin and catheter-directed thrombolysis for deep vein thrombosis

“… 4 SSEH occurs owing to blood accumulating in the epidural space compressing the spinal cord and nerve roots leading to neurological deficits. 5 SSEH mainly occurs in the cervicothoracic (C5-T2) and thoracolumbar (T10-L2) levels. 6 SSEH is characterized by its acute onset compression of neural tissue, either by direct injury or ischemia, 7 and hence immediate surgical intervention is required in the presence of neurological dysfunction.…”

Spontaneous Epidural Hematoma of the Cervical Spine Following Thrombolysis in a Patient with STEMI—Two Medical Specialties Facing a Rare Dilemma

“…2,5,10 It may also be presented with breathing distress and paraplegia. 11 Furthermore, it has been stated that even the initial symptoms of Guillain-Barre syndrome can be similar to a case of SSEH located at the cervicothoracic junction. 12 The occurrence of SSEH has been associated with several conditions, such as hemodialysis, thrombolysis, or antiplatelet-anticoagulant therapy including aspirin, dabigatran, and rivaroxaban.…”

“…Surgery and, more specifically, urgent decompressive laminectomy and evacuation of hematoma is indicated in several cases; however, it can occasionally be deferred if the patient demonstrates significant and rapid improvement. 11,17 In general terms, the gold standard treatment choice still remains controversial.…”

Diagnosis and Spontaneous Resolution of an Epidural Hematoma in a Patient Presenting after Cervical Epidural Steroid Injection

“…Cervical epidural hematomas (CEH) are frequently rapidly progressing and lead to acute worsening of neurological deficits. Increased time to treatment is associated with worsened neurological prognosis (20)(21)(22)(23). CEH initially presents with sharp neck pain radiating to the shoulder and arm.…”