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

Abstract

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.

Spontaneous Thoracic Spinal Subarachnoid Hemorrhage Diagnosed with Brain Computed Tomography

“…Intraspinal hematoma is divided into extradural hematoma, subdural hematoma, subarachnoid hemorrhage and hematomyelia, depending on the location (Hoshimaru 2005). Spinal extradural hematoma is the most frequent entity of spinal bleeding (Sarubbo et al 2009). However, spinal subarachnoid hemorrhage is rare.…”

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

“…The chronic form of spontaneous epidural hematoma is the rarest and its most frequent location is the lumbar spine [10]. But Morio et al [6] reported a chronic SCEH presenting with radicular symptoms, and no other cases have been reported worldwide.…”

Idiopathic Late Subacute Epidural Hematoma: An Uncommon Cause of Pure Lumbar Radiculopathy with MR of Spinal Epidural Lesions Differentials; Revisited

“…SEHs are classified etiologically into: (a) secondary; if it is associated with an underlying cause as trauma, coagulopathy and spinal procedures, etc. (b) spontaneous; if it is associated with a minor traumatic event with no identifiable underlying etiologic factor and (c) idiopathic when non-of the above events are present [2].…”

“…The increased recognition of idiopathic spinal epidural hematoma (ISEH) acknowledges the advance of MR imaging [1,2]. On the basis of its morphological findings, specific signal intensity changes and enhancement pattern, SEH can be easily recognized on MR imaging [3].…”