Ligamentum flavum hematoma

Sweasey, Thomas A.; Coester, Hans C.; Rawal, Harish; Blaivas, Mila; McGillicuddy, John E.

doi:10.3171/jns.1992.76.3.0534

Cited by 62 publications

(48 citation statements)

References 14 publications

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“…Sweasey reported two cases of ligamentum¯avum hematoma, which compressed the nerve root. 16 Hematoma was not found in our cases. Moiel reported a case of a nodule of the ligamentum¯avum as a cause of nerve root compression.…”

Section: Discussioncontrasting

confidence: 59%

Myxomatous degeneration of the ligamentum flavum of the lumbar spine

Yoshii¹,

Ikeda²,

Murakami³

2001

Spinal Cord

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Study design: Report of two cases of acute lumbar nerve root compression caused by myxomatous degeneration of the ligamentum¯avum. Objective: To report a rare cause of acute lumbar nerve root compression. Setting: Orthopaedic department, Osaka, Japan. Summary of background data: Two patients, both 50-year-old men presenting with signs and symptoms suggestive of acute lumbar nerve root compression were found to have a ligamentum¯avum mass. The masses were removed and the patients regained normal function postoperatively. Methods: To reveal the nature of the mass, histopathological studies were made. Continuous sections were prepared from the removed mass lesions. The sections were stained with hematoxylin and eosin, van Gieson's stain, azan stain, periodic acid Schi reaction, Alcian blue stain and von Kossa's stain. Results: Histological examination revealed myxomatous degeneration of the ligamentum avum. No elastic ®bers were found at the degeneration site. Di use mucopolysaccharide deposition was found at the degeneration site, however, no cyst was found. Collagen ®bers were not increased. Hypertrophy or ossi®cation of the ligamentum¯avum was not recognized in the sections. At a follow-up examination over 2 years later, the patients were free of symptoms and the ®ndings of a neurological examination were normal. Conclusion: Two cases of myxomatous degeneration of the ligamentum¯avum of the lumbar spine were reported, which have seldom been described as the cause of acute lumbar nerve root compression. Spinal Cord (2001) 39, 488 ± 491

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Section: Discussioncontrasting

confidence: 59%

Myxomatous degeneration of the ligamentum flavum of the lumbar spine

Yoshii¹,

Ikeda²,

Murakami³

2001

Spinal Cord

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“…Os segmentos mais acometidos são os lombares e torácicos 2. e Sweasey et al relataram que os menos acometidos são os lombares 6 . No caso relatado a única medicação usada pela paciente, por sete dias antes dos sintomas, foi o beta bloqueador succinato de metoprolol, que pode ter sido a causa da grave hipoagregação plaquetária que pode ter levado à hemorragia.…”

Section: Discussionunclassified

“…Sweasey et al relataram dois casos de outros pacientes com hipertensão arterial, tratados com beta bloqueador, que desenvolveram hematoma intrarraquidiano extradural espontâneo 6 .…”

Section: Discussionunclassified

Hematoma extradural intrarraquidiano espontâneo: relato de caso

Tanuri

Guerreiro

Nakano

et al. 1999

Arq. Neuro-Psiquiatr.

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RESUMO -Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro súbito de síndrome de compressão medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nível de sensibilidade em C 4 . Foi diagnosticado, por ressonância magnética, hematoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente através de laminectomia. A paciente encontrase em acompanhamento fisioterápico e evolui com melhora da motricidade e sensibilidade. PALAVRAS-CHAVE: hematoma intrarraquidiano extradural espontâneo, beta bloqueador, compressão medular. Spontaneous extradural spinal hematoma: case reportABSTRACT -We report a case of a 55-year-old woman, that has a mild hypertension, in use of a betablocker drugs, who had a sudden spinal cord compression syndrome with intense cervical pain, tetraplegia and sensitivity level in C4. Extradural spinal hematoma of the cervical spine was diagnosed by magnetic resonance. The patient underwent a laminectomy and aspiration of the hematoma. The patient is on physiotherapy and presents progressive motor and sensivity improvement. O hematoma intrarraquidiano extradural espontâneo é patologia rara, que se apresenta clinicamente como uma síndrome de compressão medular, representando uma urgência em neurocirurgia 1,2 . O prognóstico neurológico está diretamente relacionado à precocidade diagnóstica e terapêutica 2 . Discutimos aspectos relacionados a etiologia, fisiopatologia e tratamento dessa patologia a propósito do caso que registramos. RELATO DO CASOPaciente do sexo feminino, 55 anos, branca, com hipertensão arterial leve, em uso de beta-bloqueador há uma semana, sem uso de outros medicamentos. Apresentou quadro de dor súbita, intensa e lancinante na região cervical. Após 6 horas do início da dor, apresentou paresia do membro superior direito e membro inferior esquerdo e, posteriormente, de todos os membros, procurando então o serviço de emergência.Ao exame físico geral, encontrava-se com FC 68 bpm, FR 20 ipm e PA 190/120 mm/Hg. Ao exame neurológico apresentava-se consciente, com tetraparesia flácida, assimétrica, com força grau 0 nos membros inferiores, grau II nos membro superior direito e grau I no membro superior esquerdo. No exame de sensibilidade notava-se nível sensitivo em dermátomo correspondente a C 4 . Foi solicitada: ressonância magnética da coluna cervical por suspeitar-se de compressão medular nesse nível. Esta evidenciou material hiperintenso tanto em T 1 quanto em T 2 , no interior do canal vertebral cervical, ocupando a porção póstero-lateral esquerda e desviando a medula para a direita da linha média, estendendo-se de C 2 a C 5 , compatível com hematoma epidural cervical (Figs 1 e 2).

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“…SEH can be classified into idiopathic, spontaneous, and secondary. The most important causes of secondary SEHs are: coagulopathies, anticoagulants [2,15,18,37], vascular malformations [5,24], neoplasms, trauma with or without fractures [21], medical procedures such as epidural catheterization or lumbar spinal surgery [34,36]. Co-risk factors have also been described: minor trauma, chiropractic manipulation [33], Paget's disease, ankylosing spondylitis, rheumatoid arthritis, and cervical spondylitis [13,19,39].…”

Section: Casementioning

confidence: 99%

“…Chronic SEH may also be caused by bleeding of smaller vessels inside the ligamentum flavum which could explain the almost exclusive dorsal or dorso-lateral location of this type of hematoma [36]; the yellow ligament is largely composed of elastic tissue containing numerous small blood vessels which can be torn during forced hyperflexion. The arterial bleeding source, however, has been considered the main origin of the rarer acute forms of SEHs in the lumbar spinal tract.…”

Section: Casementioning

confidence: 99%

Spontaneous and idiopathic chronic spinal epidural hematoma: two case reports and review of the literature

Sarubbo¹,

Garofano

Maida

et al. 2009

Eur Spine J

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Spinal epidural hematoma (SEH) represents the most frequent entity of acute or chronic spinal bleeding. Based upon pathogenesis, SEH can be classified as idiopathic, spontaneous, and secondary. The idiopathic forms are considered not to be attributed to any specific risk factors. Spontaneous SEH, accounting for 0.3-0.9% of all spinal epidural space occupying lesions, instead is associated with risk factors (such as substantial soft trauma or coagulation abnormalities). The chronic form, as our literature review revealed, is the rarest and its most frequent location is the lumbar spine. The pathophysiology of spontaneous and idiopathic SEH is still under debate: There are only a few reports in literature of chronically evolving SEH with progressively increasing pain and neurological impairment. Magnetic resonance imaging may be inconclusive for differential diagnosis. Here, we present two cases of lumbar chronic SEH with slow, progressive, and persistent lumbar radicular impairment. The first patient reported a minor trauma with slight back contusion and thus was classified as spontaneous SEH. In the second case not even a minor trauma was involved, so we considered it to be idiopathic SEH. In both cases preoperative blood and coagulation tests were normal and we did not find any other or cofactors in the patients' clinical histories. MR imaging showed uncertain spinal canal obstructing lesions at L3 and L4 level in both cases. Surgical treatment allowed a correct diagnosis and resulted in full clinical and neuroradiological recovery after 1 year follow-up. Our aim is to discuss pathogenesis, clinical and radiological features, differential diagnosis and treatment options, on the background of relevant literature review.

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Ligamentum flavum hematoma

Cited by 62 publications

References 14 publications

Myxomatous degeneration of the ligamentum flavum of the lumbar spine

Myxomatous degeneration of the ligamentum flavum of the lumbar spine

Hematoma extradural intrarraquidiano espontâneo: relato de caso

Spontaneous and idiopathic chronic spinal epidural hematoma: two case reports and review of the literature

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