Spontaneous Spinal Epidural Hematoma After Seizure: A Case Report

Abstract

A 14-year-old girl applied to our pediatric emergency department with loss of consciousness and a generalized tonic-clonic seizure. Her seizure was treated with midazolam (0.1 mg/kg, a total of 5 mg). The seizures ceased right after the midazolam injection. To exclude possible intracranial abnormality as a cause of the seizure, cranial computed tomography was performed, and she was hospitalized for further evaluation. Cranial computed tomography scan showed no signs of intracranial abnormality. Twenty minutes after the cessation of seizures, she regained consciousness. Two hours later, she noticed sensory loss in her lower limbs and progressive back pain. Neurologic evaluation revealed paresis of the upper limbs, diplegia of the lower limbs, and urinary retention. Her body temperature, pulse, respiration, and blood pressure were 36.2°C (97.2°F), 78 beats/min, 22 breaths/min, and 150/90 mm Hg, respectively. Cranial nerves were intact. Deep-tendon reflexes were hyperactive on both upper extremities and absent on both lower extremities, and there were no pathologic reflexes. She had no sensation below the level of T6. Other clinical findings were tenderness in the upper thoracic region and absence of sphincter tone. There were no other pathologic physical examination findings. The medical history was negative for anticoagulant therapy, vascular abnormality, trauma, and bleeding disorders.Initial investigations including a complete blood cell count, serum electrolytes, liver function tests,

Spontaneous Spinal Epidural Hematomas: Case Series with Review of Literature

“…Its incidence as estimated by Holtas et al was 0.1 per 100,000 people (14) . Epidemiology Spontaneous spinal epidural hematomas are most frequent in the fourth or fifth decade of life (15) . Its occurrence has been noted in all age groups, however it is a very rarely encountered in children.…”

“…Most investigators suggest that SSEHs originate from the epidural venous plexus in the spinal epidural space because of the absence of venous valves. Therefore the fluctuating pressure from the thoracic and abdominal cavities can influence it directly (15,20,21) . Few authors have suggested that spinal epidural arteries may be a source of hemorrhage (19) .…”

“…The two most frequent locations of a spontaneous spinal epidural hematoma is the cervicothoracic region, followed by thoracolumbar region (15,22) .…”

Spontaneous Spinal Epidural Hematoma Causing Paraplegia: A Case Report

“…Up to now, there have been disputes about the origin of these hematomas. Most researchers assert that SSEHs arise from the epidural venous plexus in the spinal epidural space [13], [16]- [18], although several authors have proposed the spinal epidural arteries as a source of hemorrhage [19]. Proof of either is difficult because, in most cases, there is lack of angiographic documentation of the lesion and, even with open surgical exploration and clot removal, the specific cause is often not evident [1] [20].…”

Spontaneous spinal epidural haematoma during Factor Xa inhibitor treatment (Rivaroxaban)

“…The anterior haematoma in our case is rare in SSEH. Several risk factors including anticoagulant, platelet-aggregation-inhibitor therapy, coronary thrombolysis, factor XI deficiency, haemophilia B, leukaemia and vascular malformation [4,8] have been proposed. Most researchers assert that the lack of venous valves in epidural veins and the undulating thoracic and abdominal pressure causes an acute increase in venous pressure and bleeding.…”