Spontaneous spinal extradural hematoma in children

Tewari, Manoj Kumar; Tripathi, L.; Mathuriya, S. N.; Khandelwal, N.; Vk, Kak

doi:10.1007/bf00316564

Cited by 35 publications

(11 citation statements)

References 10 publications

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“…In people, the chief complaint of spinal cord extraparenchymal hematoma in the majority of patients is pain and variable degrees of neurologic dysfunction 18, 19, 20. Neurologic function was variable in this retrospective review of affected dogs.…”

Section: Discussionmentioning

confidence: 82%

“…There is controversy in the human literature regarding the time of removal of the hematoma related to outcome. In 1 study, rapidly evacuated hematomas had a good prognosis,18, 27 whereas other studies indicate there is no correlation between time to surgery and outcome 19, 20…”

Section: Discussionmentioning

confidence: 85%

“…Many hypotheses have been proposed: increased blood pressure spikes associated with coughing or straining causes increased intra‐abdominal or intrathoracic pressure which increases the pressure on valveless veins in the internal vertebral plexus, axial movement of the thecal sac, and abnormal vessels 18, 19. Although none of the cases in this report had histopathologic evidence of extruded disk material present in the material removed surgically, it is possible that the amount of this material was so small that it was not sampled during surgery.…”

Section: Discussionmentioning

confidence: 99%

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Clinical, Magnetic Resonance Imaging, and Histopathologic Findings in 6 Dogs with Surgically resected Extraparenchymal Spinal Cord Hematomas

Hague

Joslyn

Bush³

et al. 2015

Veterinary Internal Medicne

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BackgroundExtraparenchymal spinal cord hematoma has been described in veterinary medicine in association with neoplasia, intervertebral disk disease, and snake envenomation. There are rare reports of spontaneous extraparenchymal spinal cord hematoma formation with no known cause in human medicine. Multiple cases of spontaneous extraparenchymal spinal cord hematoma have not been described previously in veterinary medicine.ObjectivesTo describe the signalment, clinical findings, magnetic resonance imaging (MRI) features, and surgical outcomes in histopathologically confirmed extraparenchymal spinal cord hematomas in dogs with no identified underlying etiology.AnimalsSix dogs had MRI of the spinal cord, decompressive spinal surgery, and histopathologic confirmation of extraparenchymal spinal cord hematoma not associated with an underlying cause.MethodsMulti‐institutional retrospective study.ResultsSix patients had spontaneous extraparenchymal spinal cord hematoma formation. MRI showed normal signal within the spinal cord parenchyma in all patients. All hematomas had T2‐weighted hyperintensity and the majority (5/6) had no contrast enhancement. All dogs underwent surgical decompression and most patients (5/6) returned to normal or near normal neurologic function postoperatively. Follow‐up of the patients (ranging between 921 and 1,446 days) showed no progression of neurologic clinical signs or any conditions associated with increased bleeding tendency.Conclusions and Clinical ImportanceBefore surgery and histopathology confirming extraparenchymal hematoma, the primary differential in most cases was neoplasia, based on the MRI findings. This retrospective study reminds clinicians of the importance of the combination of advanced imaging combined with histopathologic diagnosis. The prognosis for spontaneous spinal cord extraparenchymal hematoma with surgical decompression appears to be favorable in most cases.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Clinical, Magnetic Resonance Imaging, and Histopathologic Findings in 6 Dogs with Surgically resected Extraparenchymal Spinal Cord Hematomas

Hague

Joslyn

Bush³

et al. 2015

Veterinary Internal Medicne

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“…3,7 There is no significant sex difference in adults, but in children older than two years, males outnumber females. 3,4,7 The majority of lesions occur in the thoracic region and extend into the cervicothoracic or thoracolumbar area. 2,3,8,9 In a literature review of 155 cases of spinal epidural hematoma, Foo and Rossier concluded that the majority of cases (41%) were idiopathic.…”

Section: Discussionmentioning

confidence: 99%

“…3,4,6 The patients' age in the cases reported in the literature range from six months to 79 years, but SSEH is most frequently seen in the middleaged or elderly. 3,7 There is no significant sex difference in adults, but in children older than two years, males outnumber females. 3,4,7 The majority of lesions occur in the thoracic region and extend into the cervicothoracic or thoracolumbar area.…”

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confidence: 99%

Spontaneous Recovery of Spinal Epidural Hematoma

Eskandary

1998

Ann Saudi Med

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Spinal epidural hematomas are rare clinical entities that present with severe and acute pain followed by progressive motor and sensory deficit, and which have been associated with trauma, coagulopathies, arteriovenous malformation and neoplasm. [1][2][3] In the absence of significant trauma or other discernible cause, they have been described as spontaneous. [3][4] We report a case of spontaneous spinal epidural hematoma (SSEH) in a 45-year-old patient with typical presentation, diagnosed by magnetic resonance imaging (MRI) scan, who was managed conservatively in view of his rapid neurological improvement. Case ReportA 45-year-old man admitted to our hospital had suddenly developed severe pain at the lower neck and upper thoracic spine, and became paraplegic a few days before admission. He had some pain relief and experienced improvement in the weakness in his legs. There was previous history of fecal and urinary dysfunction. Apart from that there was no past medical history of note, and he was on no medication. Examination revealed a fit normotensive man with no abnormalities in the chest or cardiovascular system. There was no sign of meningeal irritation. Examination of cranial nerves was unremarkable. Tone and muscle power were normal in the upper limbs, but decreased in the proximal and distal part of the lower limbs. The deep tendon reflexes were present with reinforcement in the upper limbs but were exaggerated in the lower limbs. There was sensory loss below the T2 bilaterally. Laboratory investigations including CBC, prothrombin time, partial thromboplastin time, and platelet count, were normal. Electrocardiogram was unremarkable and random blood glucose and electrolytes were normal, as well as chest and plain x-ray of the spine. MRI showed a space-occupying lesion in the posterior part of the spinal canal at the level of D1 and D2 vertebrae, which was hypointense in T1 and T2-weighted image (Figure 1). The sagittal MR view clearly demonstrated the epidural location of the lesion and the spinal cord compression toward the anterior aspect of the spinal canal.On admission, the patient was found to have improved symptomatically. This was confirmed by a physical examination that showed paraparesis, and not complete paralysis as before. The patient's neurological state after admission, both subjectively and objectively, continued to improve dramatically. An operative approach was initially postponed, and ultimately abandoned. At follow-up two weeks later, the patient had no complaints, and he could stand and walk normally. On examination, his motor function and reflexes were normal, and he had no sensory deficit. An MRI two weeks later showed that the lesion had disappeared completely (Figure 2). DiscussionMattel et al. found over 300 cases of spinal hematoma in the world literature up to 1987. 5 Bruyn and Bosmu found 174 cases in the literature up to 1974. More than half the cases are spontaneous. 3,4,6 The patients' age in the cases reported in the literature range from six months to 79 years, but SSEH is m...

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