自发性脊髓硬膜外血肿MRI诊断

目的:探讨自发性脊髓硬膜外血肿MRI表现及其鉴别诊断。材料与方法:9例自发性脊髓硬膜外血肿,男4例,女5例,年龄9~57岁,平均36岁。所有病例均无明确外伤史。常规行SE T1WI矢状位及轴位,T2WI矢状位及轴位。7例注射Gd-DTPA行增强扫描。结果:9例自发性脊髓硬膜外血肿中,位于椎管内背侧8例,仅1例位于椎管内腹侧,累及3~5个椎体节段,平均4个椎体节段。颈段4例,颈胸段4例,腰段1例。血肿呈新月形及长条状。3例血肿呈T1WI及T2WI高信号,4例血肿T1WI呈等信号,T2WI呈高信号。2例T1WI及T2WI均呈等高混杂信号。血肿与脊髓间T1WI及T2WI均可见低信号线相隔,以T2WI明显。增强扫描3例见血肿壁强化,4例未见强化。结论:MRI是自发性脊髓硬膜外血肿最佳检查方法,可清楚显示血肿部位、范围、血肿的新旧程度及脊髓受压受损情况。     

自发性脊髓硬膜外血肿的MRI诊断及鉴别诊断

目的探讨自发性脊髓硬膜外血肿的MRI表现及鉴别诊断。方法11例自发性脊髓硬膜外血肿，男7例，女4例，年龄27—74岁，平均53岁。本组病例均无明确外伤史。常规行SE T1WI、T2WI矢状位及T2WI轴位，部分患者行脂肪抑制。6例注射Gd—DTPA增强扫描。结果11例自发性脊髓硬膜外血肿中，9例位于椎管内背侧，2例位于椎管内背外侧。病变范围累及4—5个锥体节段，颈段8例，胸段3例。血肿呈长条状及长梭形。5例血肿呈T1WI、T2WI高信号，4例血肿呈T1WI、T2WI等、低、高混杂信号，2例呈T1WI及T2WI等信号。增强扫描，2例血肿壁强化，4例未见强化。结论MRI是脊髓硬膜外血肿最佳检查方法，能清楚显示血肿部位、范围，区分急慢性血肿，判定脊髓受压受损情况。     

Complete nonsurgical resolution of a spontaneous spinal epidural hematoma

Spontaneous spinal epidural hematomas (SSEH) are heralded by spinal pain and progressive cord compression syndromes which may lead to permanent neurological disability or death if emergent neurosurgical intervention is delayed. It therefore must be considered early in the differential diagnosis of acute spinal cord compression syndrome. A case of spontaneous spinal epidural hematoma presenting as an acute myelopathy in a clarinet player who chronically used a nonsteroidal anti-inflammatory medication is presented. The case was remarkable for the rare complete spontaneous resolution of neurological function. Approximately 250 cases of SSEH have been reported in the medical literature, although only a handful of these patients have recovered spontaneously. This is the sixth report of such an event. The etiologies, contributing factors, disease progression, and treatment recommendations are discussed.     

Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms

Post-traumatic spinal epidural hematomas are uncommon, usually requiring emergent neurosurgical evacuation. We present a symptomatic delayed post-traumatic epidural hematoma of the T-spine that resolved within hours of administration of high dose steroids. A 22-year-old man presented 10 days after sustaining blunt trauma during a motor vehicle crash. He developed signs of acute cord compression with loss of sensation and motor function in bilateral lower extremities with priapism. Magnetic resonance imaging demonstrated a spinal epidural hematoma with 50% canal stenosis at the T4 level. His symptoms improved 1 h after the administration of high dose steroids. All symptoms resolved completely while the patient was in the Emergency Department and he was treated conservatively by Neurosurgery with no further sequelae. Thoracic spinal epidural hematoma is an uncommon condition that may present in delayed fashion after trauma with significant neurologic compromise. If neurologic symptoms improve with initial steroid therapy, patients with this condition may be treated conservatively with steroids and observation.     

A rare case of multiple spinal epidural abscesses and cauda equina syndrome presenting to the emergency department following acupuncture

Background

Acupuncture is a form of traditional Chinese medicine being increasingly used as complementary therapy in many countries. It is relatively safe and rarely associated with deep infections.

Case presentation

In this case report, we describe a middle-aged Chinese patient who presented acutely to our emergency department with cauda equina syndrome secondary to acupuncture-related epidural abscesses, which were treated with surgical decompression and intravenous antibiotics. We also present a review of case reports of this rare condition in available literature.

Conclusion

Emergency physicians should be aware that spinal abscesses may occur after acupuncture, with a broad spectrum of clinical presentations. If a history of recent acupuncture over the symptomatic area is elicited, a high index of suspicion should be maintained and appropriate imaging performed to establish the diagnosis. Treatment is directed by a number of factors, such as severity and duration of neurological deficit and progression of symptoms.

     

Sudden cervical pain: spontaneous cervical epidural hematoma

Three cases of cervical epidural hematoma are reported. Acute neck pain usually associated with a mild effort, closely followed by radicular pain and a neurologic deficit below the lesion is the typical presentation of this extremely rare and difficult diagnosis. As prognosis depends on preoperative neurologic state, the authors emphasize the importance of prompt identification of this lesion. The diagnosis is confirmed by computed tomography, and emergency neurosurgical laminectomy is mandatory.     

Acute spontaneous cervical spinal epidural hematoma with hemiparesis as the initial presentation.

Acute onset of hemiparesis is a common initial presentation of cerebral vascular accidents, but many differential diagnoses should be considered. Hemiparesis results from an upper motor neuron lesion above the midcervical spinal cord, and the absence of cranial nerve signs or facial palsy suggests a lesion in the high cervical spinal cord. Most spinal cord lesions, however, result in quadriparesis or paraparesis, but not hemiparesis. We present a rare case of acute spontaneous cervical spinal epidural hematoma, with initial presentation of right hemiparesis and mild neck pain.     

Spontaneous spinal epidural hematoma: a case report

A 59-year-old man presented to the emergency department (ED) the day after a minor motor vehicle crash for evaluation of bilateral shoulder pain. He underwent ED evaluation for his back pain two more times before it was found that he had a spontaneous spinal epidural hematoma (SSEH). On the third visit, the patient had waxing and waning neurologic symptoms including lower extremity weakness and urinary retention. The diagnosis was made by MRI, and the patient was successfully treated with cervical hemilaminectomy at the cervicothoracic junction for evacuation of the epidural hematoma 5 days after the onset of back pain.     

Spontaneous spinal epidural hematoma of thoracic spine: a rare case report and review of literature

Spontaneous spinal epidural hematoma is a rare condition of spinal cord compression, and emergent decompressive surgery is strictly indicated. Early recognition, accurate diagnosis, and rapid treatment may result in decreased morbidity and improved outcome. Here, we present a case of a 50-year-old man who sustained sudden onset of severe back pain, followed by progressive weakness and numbness over bilateral lower limbs. Magnetic resonance imaging of thoracic spine demonstrated an epidural mass extending from T6 through T8, causing spinal cord compression. Emergent decompressive surgery was performed, and epidural hematoma was diagnosed postoperatively; the patient had significant improvement of neurologic deficits. The relevant literature is also reviewed.     

Acute spontaneous thoracic epidural hematoma associated with intraspinal lymphangioma: A case report

BACKGROUNDSpontaneous spinal epidural hematoma is a rare neurosurgical emergency.CASE SUMMARYA 53-year-old healthy woman suffered from complete paraplegia in both legs and loss of all sensation below the xiphoid process. She was diagnosed as acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma. The primary lab survey showed all within normal limits. Presence of a posteriorly epidural space-occupying lesion at the T4-T8 level of the spinal canal was confirmed on magnetic resonance imaging. A decompressive laminectomy was performed from the T4 to T7 levels at the sixth hour following abrupt onset of complete paraplegia. The lesion was confirmed as lymphangioma. This patient recovered well within one month.CONCLUSIONThis study reports a case of acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma with well recovery after surgical intervention.     

Spinal epidural hematoma: not always an obvious diagnosis

Spinal epidural hematoma (SEH) is a rare neurosurgical emergency. SEH is characterized by an archetypal clinical presentation including abrupt spinal pain followed more or less rapidly by various degrees of neurological deficit. The diagnosis of SEH, often based on a clinical presumption, represents a clinical challenge. Several reports have outlined missed or delayed diagnosis due to unusual and confusing onsets or unawareness of this diagnosis by physicians. Therefore, physicians should keep in mind the possibility of SEH in their differential diagnosis when confronted with patients complaining of sudden onset of acute spinal pain with or without neurological sign, because the impact of a delayed diagnosis can be disabling catastrophic neurological sequelae. We suggest that SEH is a dynamic disease, which occurs in patients with an abnormal vasculature structural degenerative change. The bleeding is probably of multifactorial origin incriminating veins as well as arteries. Therefore, we proposed a classification of SEH, according to the most probable etiology whatever the associated factors, in six groups: spontaneous, secondary, iatrogenic, traumatic, recurrent, and idiopathic SEH.