Transient edema of the spinal cord as a result of spontaneous acute epidural hematoma in the thoracic spine

Abstract

We present an unusual case of spontaneous epidural hemorrhage in the thoracic spine resulting in rapid onset of transient and extensive edema in the spinal cord. The patient presented with acute onset of midscapular back pain, bilateral lower extremity weakness, and bladder dysfunction. Repeat MRI 20 days after decompression of the hematoma showed residual hematoma and complete resolution of the spinal cord edema. The implications and differential diagnosis of spinal cord edema in this clinical setting are discussed.

Spontaneous spinal epidural hematoma

“…This might rupture the vessels of the epidural venous plexus in the dorsal epidural space where the majority of hematomas originate. 10,18 However, the pressure of the epidural venous plexus is lower than the intrathecal pressure, hematomas usually form quickly, and arterial hypertension may sometimes coexist, all of which may suggest an epidural arterial source. 7,19 The most common clinical presentation of SSEH is a sudden severe pain in the back or neck at the involved vertebral level with radiating pain, followed by rapid and progressive signs and symptoms of spinal cord compression.…”

“…In our conservatively treated group, only patients with a favorable primary neurological examination returned to normal. Conservative treatment should be considered only for those with mild or non-progressive neurologic deficit, 10,19 especially in infants or children. Close follow-up is recommended.…”