Spontaneous spinal epidural hematoma

Abstract

A 31-year-old male came into our clinic's emergency room complaining of a somatosensory disorder that had worsened considerably in the previous few hours as well as motor dysfunction in the right upper and lower extremities. The patient also reported sudden, initially acute pain in the back of his neck on the right side. This condition had definitely not been the result of trauma.Due to the rapidly progressing symptoms, the patient was sent, on an urgent basis, for an MR imaging scan of the entire neurological axis.This revealed a circumscribed lesion in the spinal canal dorsolateral right epidural at C3 to C5, which, in relation to the spinal cord, was situated isointense in T1-weighted scans and hyperintense in T2-weighted scans, and displayed absolutely no pathological bone marrow impregnation ( Figure 1). The images produced by the MR scan gave rise to suspicion of a spontaneous spinal epidural hematoma. The lesion was noticeably exerting pressure on the spinal cord. At the time of the examination, the MR scan provided no indication of myelopathy.Thereafter, neurosurgical decompression was performed via hemilaminectomy and hematoma evacuation. Immediately after these procedures were performed, the neurological symptoms subsided substantially. DiscussionSpontaneous spinal epidural bleeding -defined as epidural bleeding in the absence of a traumatic or iatrogenic cause -is a rare occurrence with an incidence of 0.1/100,000 per year [1]. Men are more frequently affected than women [2].Among the risk factors cited for the occurrence of a spontaneous epidural hematoma are the ingestion of anticoagulants, coagulopathies, vascular malformations and trivial traumas [1,2]. However, in most cases -including that of our patient -no underlying cause is found.The imaging method of choice is magnetic resonance imaging, which makes it possible to draw conclusions with respect to not only the location and extent of the bleeding but also how old the hematoma is. Thus, acute bleeding reveals in T1-weighted scans isointense and in T2-weighted scans hyperintense signal with hypointense foci; subacute bleeding in T1-and T2-weighted scans exhibits a hyperintense signal [2,3].In the differential diagnosis, an intraspinal tumor or an abscess formation must be considered, whereby the contrast medium facilitated the diagnosis in this case. Fat saturated sequences help to differentiate between a hematoma and epidural fat [1]. DisclosureNo conflicts of interest. No grants or financial support.

Two Patients with Spontaneous Spinal Epidural Hematoma Carrying a Good Prognosis without Surgical Operations

“…The most common site of hemorrhage in SSEH is the posterior epidural space at the cervicothoracic level (C5 to Th2) and the thoracolumbar level (Th10 to L2) [ 2 , 5 , 6 , 8 , 10 , 13 ]. Hematoma of SSEH is delineated as an iso-intensity mass on T1-weighted MRI images and a hyper-intensity mass with inside heterogeneity (hypointense-foci) on T2-weighted MRI images in the acute stage within the first 24 h [ 1 , 3 , 4 , 8 , 13 , 14 , 15 ].…”

“…Spontaneous spinal epidural hematoma (SSEH) is a rare disease that affects only 1 in 100,000 people per year [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. SSEH occurs predominantly in patients between the ages of 40 and 80 years, with a mean age of 71 years [ 10 ].…”

“…SSEH occurs predominantly in patients between the ages of 40 and 80 years, with a mean age of 71 years [ 10 ]. Men are slightly more frequently affected than women [ 1 , 5 , 7 ]. SSEH can produce devastating neurological deficits such as severe paraplegia and sphincter-rectal dysfunction [ 1 ], and this condition points to the formation of hematoma caused by the collection of blood within the epidural space of the spinal cord in the absence of traumatic or iatrogenic causes [ 1 , 2 , 3 , 4 , 5 , 6 , 10 , 11 , 12 , 13 , 14 ].…”

“…Men are slightly more frequently affected than women [ 1 , 5 , 7 ]. SSEH can produce devastating neurological deficits such as severe paraplegia and sphincter-rectal dysfunction [ 1 ], and this condition points to the formation of hematoma caused by the collection of blood within the epidural space of the spinal cord in the absence of traumatic or iatrogenic causes [ 1 , 2 , 3 , 4 , 5 , 6 , 10 , 11 , 12 , 13 , 14 ]. It is characterized by progressive palsy of the extremities, sensory disturbances, and sphincter-rectal dysfunction.…”

“…It is characterized by progressive palsy of the extremities, sensory disturbances, and sphincter-rectal dysfunction. These clinical features are subsequent to severe neck or back pain with acute onset, which are caused by compression of the spinal cord and the nerve radicles [ 1 , 2 , 3 , 4 , 5 , 6 , 8 , 10 , 12 , 13 , 14 ]. In principle, Emergent surgical treatment is indicated in patients with progressive neurological deficits [ 10 ].…”