Spontaneous spinal epidural hematomas

Xian, Hua; Xu, Long; Li, Cong-Han; Jian-ming, Hao; Wan, Wei-Xia; Feng, Guodong; Lian, Kejian; Li, Lin

doi:10.1097/md.0000000000008473

Cited by 12 publications

(17 citation statements)

References 24 publications

(40 reference statements)

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“…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 ]. Men are slightly more frequently affected than women [ 1 , 5 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Ogawa

Akimoto

Hara

et al. 2023

Neurology International

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(1) Introduction: Spontaneous spinal epidural hematoma (SSEH) points to hematoma within the epidural space of the spinal cord without traumatic or iatrogenic causes. (2) Case Reports: One patient showed paraplegia, numbness of both legs with acute onset, acute myelopathic signs, subsequent to back pain. Magnetic resonance imaging (MRI) showed hematoma in the posterior part of the thoracic spinal cord. Another patient showed acute numbness in the shoulder, upper part of the back, and the upper extremity on the right side after pain in the back, shoulder, and neck on the right side. Sagittal computed tomography (CT) images of the cervical bone showed a high-density area behind the spinal cord between C4 and C7. MRI analysis showed hematoma in the right diagonally posterior part of the cervical spinal cord. These 2 patients lacked traumatic or iatrogenic events, and their symptoms abated without surgical operation. (3) Conclusions: The location of hematoma correlated with symptoms in each patient. SSEH is rare but should be taken into account in patients with myelopathy or radiculopathy with acute onset subsequent to back pain. The usefulness of emergent CT scans of the spinal cord prior to MRI analysis was shown in the diagnosis of SSEH.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ogawa

Akimoto

Hara

et al. 2023

Neurology International

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“…[ 15 ] SSEHs can occur along at any spinal cord level, with the thoracic spine being historically the most compromised region in adults while the lumbar being the most commonly affected in children. [ 17 , 20 ] Regarding the area of interest, the cervical spine, 16% of SSEH cases are within this region, with much of these cases continuing into the upper thoracic spine. [ 17 ] With its increasingly high morbidity, the SSEH diagnosis potentially requires immediate surgical care, as the condition could cause potentially irreversible neurological deficits by the hour.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

Jarrah

Fiani²,

Runnels

2021

Surgical Neurology International

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Background: First characterized in the 19th century, spontaneous spinal epidural hematoma (SSEH) is known as the idiopathic accumulation of blood within the spinal canal’s epidural space, causing symptoms varying from general back pain to complete paraplegia. With varying etiologies, a broad spectrum of severity and symptoms, a time-dependent resolution period, and no documented diagnosis or treatment algorithm, SSEH is a commonly misunderstood condition associated with increasing morbidity. While SSEH can occur at any vertebrae level, 16% of all SSEH cases occur in the cervical spine, making it a region of interest to clinicians. Case Description: Herein, the authors present two case examples describing the clinical presentation of SSEH, while also reviewing the literature to provide a comprehensive overview of its presentation, pathology, and treatment. The first case is a patient with nontraumatic sudden onset neck pain with rapidly progressing weakness. The second case is a patient with painless weakness that developed while taking 325 mg of aspirin daily. Conclusion: Clinicians should keep SSEH in their differential diagnosis when seeing patients with nontraumatic sources of weakness in their extremities. The appropriate steps should be followed to diagnose and treat this condition with magnetic resonance imaging and surgical decompression if there are progressive neurological deficits. There is a continued need for more extensive database-driven studies to understand better SSEHs clinical presentation, etiology, and ultimate treatment.

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“…Epidural hematoma may result from an intrathecal puncture (either needle or catheter) to the blood vessels, congenital vascular malformation, or spontaneous hemorrhage. [ 1 , 2 ] Clinical symptoms vary in accordance with the degree of spinal compression. In patients using anticoagulant drugs, intrathecal anesthesia is a common cause of epidural hematoma in the clinic.…”

Section: Introductionmentioning

confidence: 99%

Good outcomes after the delayed removal of an epidural hematoma

Li¹,

Sun²

2018

Medicine

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Rationale:Epidural hematomas can develop following intrathecal puncture, spinal vascular malformation, or spontaneous hemorrhage. Prompt recognition of symptoms and referral to neurosurgical services are crucial for recovery. We report a rare case of delayed removal of an epidural hematoma that resulted in good patient outcomes.Patient concerns:A 69-year-old woman weighing 58 kg presented with back pain that had persisted for 12 years. Her medical history was notable for hypertension. Cervical computed tomography angiography indicated a giant abdominal aortic aneurysm measuring 11.58 × 17.34 × 13.00 cm in her abdominal cavity. Stent graft implantation was scheduled by the interventional therapy group to treat her abdominal aortic aneurysm under single-dose spinal anesthesia. Postoperatively, the patient complained of numbness and swelling of her lower extremities, with progressive paralysis developing in both legs accompanied with sensory disturbances.Diagnoses:Delayed magnetic resonance imaging detected an epidural hematoma.Interventions:Eighty hours after the onset of sensorimotor symptoms, lumbar decompression and removal of the hematoma were performed via laminectomy under general anesthesia.Outcomes:The patient was discharged 2 months after the operation with a 3/5 score on the Muscle Strength Grading System.Lessons:Laminectomy may be effective in achieving a good prognosis despite a considerable delay in diagnosis.

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Spontaneous spinal epidural hematomas

Abstract: Supplemental Digital Content is available in the text

Cited by 12 publications

References 24 publications

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

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

Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

Good outcomes after the delayed removal of an epidural hematoma

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