Spontaneous Spinal Epidural Hematoma: A Retrospective Study on Prognostic Factors and Review of the Literature

Abstract

ObjectivesThe spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Patients typically present with sudden onset back pain followed by neurological deficits.MethodsDiagnosis of SSEH is usually made with MRI and standard treatment is surgical evacuation. In 1996, Groen published the most comprehensive review on the SSEH in which he analyzed 333 cases. We review 104 cases of SSEH presented in the English literature since the last major review and add three of our own cases, for a total of 107 cases.ResultsOur patients presented with back pain and neurologic deficits. Two made excellent functional recovery with prompt surgical decompression while one continued to have significant deficits despite evacuation. Better postoperative outcome was associated with less initial neurological dysfunction, shorter time to operation from symptom onset and male patients.ConclusionWe discuss the etiology of SSEH and report current trends in diagnosis, treatment, and outcome.

Spontaneous cervical epidural hematoma with incomplete Brown-Sequard Syndrome

“…One of the first extensive reviews on spontaneous spinal epidural hematoma was reported by Groen in 1996 (15). A more recent one, by Kim et al in 2011 (9), identified a total of 107 cases of spontaneous spinal epidural hematoma published in neurosurgical series between 1996 and 2011.…”

“…In recent years, there have been increased reports of spontaneously resolving spinal epidural hematomas, due to quick diagnosis by higher resolution MRI (9). A conservative treatment under close neurologic observation is recommended for patients with no, or mild neurologic deficits and for patients who show definite progressive improvement prior to the MRI diagnosis of SCEH (9,13,27).…”

“…A conservative treatment under close neurologic observation is recommended for patients with no, or mild neurologic deficits and for patients who show definite progressive improvement prior to the MRI diagnosis of SCEH (9,13,27).…”

“…The major factors determining neurological recovery after spontaneous cervical epidural hematoma are the localization of the hematoma (cervical segments involved), the preoperative neurological condition and the operative interval (9,15). Initial neurological dysfunction was the strongest predictor for a patient's outcome.…”

“…The Brown-Sequard syndrome is an exceptional result of SCEH (7,16,28). Surgical evacuation of the hematoma is the standard therapy, although conservatively treated SCEH cases have been reported (9). We presented a case of a cervical spontaneous epidural hematoma presenting with an incomplete Brown-Sequard syndrome and treated by surgical evacuation.…”