Pure cervical radiculopathy due to spontaneous spinal epidural haematoma (SSEH): report of a case solved conservatively

Abstract

Introduction: Spontaneous spinal epidural haematoma (SSEH) is widely recognised throughout the literature as a cause of myelopathy, radicular compression being very rarely reported. Surgical management is almost always recommended, especially in the cases of spinal cord compression. Conservative treatment is reported as a curiosity and only in the case of spontaneous improvement. This report presents the particular case of a 64-year-old patient undergoing anticoagulant therapy that had a cervical radiculopathy due to a SSEH confirmed by MRI. The patient improved spontaneously and symptoms were solved with unconventional conservative treatment and without stopping the anticoagulant therapy. Conclusions: Spontaneous epidural haematoma must be kept in mind when patients undergoing anticoagulant therapy have a sudden onset of cervicobrachialgia. Even though most spinal surgeons advocate surgical treatment, a conservative approach may lead to a complete recovery and may be considered as a good option in the case of radicular involvement. Discontinuation of the anticoagulant therapy may not always be needed, especially when the clinical syndrome improves spontaneously.

Spontaneous spinal epidural hematoma in a patient on acenocoumarol for valvular atrial fibrillation: A rare case report

“…Surgery is more effective when done within 12–36 hours from the symptoms onset and recovery is faster [ 3 , 20 ]. As reported in many studies, in patients with mild symptoms and rapid clinical improvement, conservative treatment can be adopted with good outcomes [ 9 , 21 ]. In these studies, 30% of patients had residual neurological deficits.…”

Chronic pure radiculopathy in patient with organizing epidural hematoma around C8 nerve root

“…Pure radicular involvement is distinctly rare, especially in cervical spine [6,7]. Groen [9] reported that 9% of a series of 64 SCEH cases treated conservatively presented an isolated radicular compromise; only one of his cases was located on the cervicothoracic spine.…”

“…Recently Villas reported one case undergoing anticoagulant therapy that had a pure cervical radiculopathy and cervical epidural hematoma was resolved spontaneously [7].…”

“…The most common symptoms are cervical or thoracic pain followed by cord compression signs [1,4,5]. Radicular involvement is very rare [6,7].…”