Spontaneous spinal epidural hematoma: literature review

Figueroa, Jessica; DeVine, John G.

doi:10.21037/jss.2017.02.04

Cited by 80 publications

(150 citation statements)

References 17 publications

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“…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.…”

Section: Discussionmentioning

confidence: 70%

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Spontaneous spinal epidural hematoma

Roper-Kelmayr¹,

Voglmayr²,

Gruber³

et al. 2018

Glob Imaging Insights

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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.

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Section: Discussionmentioning

confidence: 70%

“…Spontaneous 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].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous spinal epidural hematoma

Roper-Kelmayr¹,

Voglmayr²,

Gruber³

et al. 2018

Glob Imaging Insights

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“…2 There has been some suggestion of possible association with arteriovenous malformations and coagulopathies; however, little is definitively known on the subject. [3][4][5] Multiple case series [5][6][7][8][9][10] have demonstrated varying clinical presentations of SSEH with sudden onset back or neck pain, with potential progression to paresthesia and even complete quadriplegia. As a result, SSEH can produce devastating deficits that require immediate medical attention.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Spinal Epidural Hematoma: An Atypical Clinical Presentation and Discussion of Management

2020

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Introduction: Spontaneous spinal epidural hematoma (SSEH) is a rare but potentially devastating condition if not appropriately identified and managed. A few case series exist regarding SSEH and certain risk factors have been described; however, much continues to be unknown regarding the pathophysiology and optimal management.Case Presentation: We present the case of SSEH in a healthy 33-year-old African American woman with no identifiable risk factors who initially presented with significant neurologic compromise. This case reports discusses pertinent clinical presentation, imaging findings, and surgical management. The patient demonstrated near-complete neurologic recovery, highlighting the need for prompt identification and intervention.Conclusions: We believe this case adds to the limited literature surrounding the topic, particularly in regard to diagnosis and surgical management. It is essential for clinicians to be cognizant of SSEH for timely diagnosis and treatment, even in patients without obvious risk factors. Cervical Spine

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“…It is important to consider a differential diagnosis in pregnancy that may include haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, preeclampsia, thrombophilia, anticoagulants and drug misuse (e.g. amphetamines) [2,[7][8]. Radicular vessels are more prominent in the lower cervical and thoracic spine where arterio-venous malformations in the epidural space could develop and rupture explaining the more common occurrence in these locations [9].…”

Section: Discussionmentioning

confidence: 99%

“…coagulopathy/anticoagulation, vascular malformation) or iatrogenic (e.g. spinal surgery, lumbar puncture) [2]. Of the reported cases in pregnancy, lesions are more commonly found at the upper thoracic level [1,3].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous cervical spinal epidural haematoma in late pregnancy

Wong

Low

2018

Anaesthesia Cases

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Summary Spontaneous spinal epidural haematoma (SSEH) is rare, especially in pregnancy, and may lead to permanent neurological damage. Presentation varies from altered sensation to paralysis depending on the location and severity of the haematoma. A multi‐disciplinary approach is essential for effective management of such cases. A 39‐week primigravida presented to a district general hospital with an acute cervical neurological deficit. She was transferred to a specialist centre for urgent magnetic resonance imaging followed by sequential caesarean section and cervical epidural haematoma evacuation. The combined procedures were uneventful with a healthy baby delivered and recovering maternal neurology. Co‐ordinating multiple specialties from geographically separate sites created a number of peri‐operative challenges.

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Spontaneous spinal epidural hematoma: literature review

Cited by 80 publications

References 17 publications

Spontaneous spinal epidural hematoma

Spontaneous spinal epidural hematoma

Spontaneous Spinal Epidural Hematoma: An Atypical Clinical Presentation and Discussion of Management

Spontaneous cervical spinal epidural haematoma in late pregnancy

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