Spontaneously Resolved Recurrent Cervical Epidural Hematoma in a 37-Week Primigravida

Abstract

Study Design Case report. Objective To describe a patient with a recurrent spontaneous spinal epidural hematoma (SSEH) during pregnancy that had spontaneous remission. Methods A 27-year-old primigravida at 37 weeks' gestation suddenly felt a strong left shoulder pain without any trauma. She had a history of fenestration for a spontaneous cervical hematoma when she was 18 years old. An emergency magnetic resonance imaging revealed a recurrence of the cervical epidural hematoma at the C4–T1 level, but she had no paralysis. Results The patient subsequently underwent a cesarean section and delivered a healthy male infant. Her spinal epidural hematoma disappeared. Multislice computed tomography showed no evidence for a vascular malformation or tumor. Three years after the initial cesarean section, she underwent a second one and delivered another male infant. Conclusions We report on a rare case of recurrent SSEH during pregnancy with no neurologic deficits that was treated nonoperatively with close observation and resulted in spontaneous resolution. In such patients with no neurologic deficits, nonoperative management with close observation may be a reasonable alternative.

Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review

“…In the last few years, some case reports describing conservative treatment (control of symptoms and corticoid therapy) have been published [3,8,20] . In some cases, serial MRIs have shown the blood has been reabsorbed, in one case within 4 months [29,30] . Candidate patients for conservative measures are those without neurological symptoms or those who recovered spontaneously within the first few hours of symptom onset.…”

Spontaneous spinal epidural hematoma: literature review

“…If a patient is to be treated nonoperatively, the patient needs to be monitored with serial examinations while on strict bed rest (8). Although the hemorrhage may resorb on serial MRI's even within four months (10,11), the outcomes typically are poor without surgical intervention (10). Thus, non-operative management is reserved only for those who are not surgical candidates or who are asymptomatic (8,9).…”

“…This may be due to the fact that our reported patient presented with a subacute on chronic SSEH. Although extremely rare, there have been cases of individuals presenting with recurrent episodes of hemorrhage, with one recurrence roughly a decade later (10) and one repeating at both four and 19 months out from the initial presentation (11).…”

Recurrent Cervical Spinal Epidural Hematoma: Case Report and Literature Review

“…The three cases that recurred after surgical treatment had long durations until recurrence of 6 months, 6 years, and 9 years, respectively. 5 , 12 , 13) In the other nine cases that showed recurrence after observation, the duration to the first recurrence was comparatively short; the median time was 3 months. This may be explained by the fact that surgical hemostasis may make the patient less susceptible to re-bleeding than natural hemostasis.…”