Spontaneous spinal epidural hematoma

Spontaneous spinal epidural hematoma (SSEH) is a rare emergent condition. It may result in paraplegia, quadriplegia and even death. Prompt diagnosis and emergent decompressive surgical management have been recommended to prevent mortality and morbidity. Although several factors have been associated with prognosis, controversy remains, partly due to its rarity. Thus, the history, clinical presentation, physical examination findings, radiological images, and surgical and pathological records of 30 patients with SSEH (21 male, nine female [sex ratio of 2.3:1], average age of 35 years) treated between January 2002 and September 2010 have been reviewed. The association of age, sex, hypertension, vascular malformation, vertebral level, position and extension of the hematoma, progression interval, operative interval, spinal cord edema, and preoperative neurological condition with the prognosis is discussed. The outcome was better for patients with incomplete neurological deficit (p = 0.001), lesions extending <4 vertebral segments (p = 0.026), and lesions in the thoracolumbar and lumbar region. A shorter progression interval often led to a less favorable prognosis (p = 0.017). Patients with spinal cord edema experienced a worse preoperative neurological deficit (p = 0.005) and a worse outcome (p = 0.000). Patients with a progression interval ?12 hours presented with a worse preoperative neurological deficit (p = 0.026). Early surgical intervention to evacuate the hematoma remains the main treatment for most symptomatic patients. Conservative treatment may be used only for those in a good preoperative neurological condition. Prognosis is associated with the preoperative neurological condition, progression internal, spinal cord edema, and extension and vertebral level of the SSEH. Patients with SSEH in the cervical or cervicothoracic region with a complete preoperative motor deficit have a higher mortality rate.     

Spontaneous spinal epidural hematoma mimicking Guillain-Barre Syndrome

Background

The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS. Case Report: A previously healthy 6-year-old girl presented with a 2-day history of progressive pain in the lower extremities and an inability to walk. On initial evaluation, she was completely paraparetic in the lower extremities. Deep tendon reflexes were absent in the lower extremities, and Babinski reflexes were positive on both sides. She exhibited reduced response to light touch and pinprick with a sensory level below T10, and experienced difficulty during urination. However, the strength, sensation and flexion of upper extremities were normal. Because her presentation and examinations were consistent with GBS, we initiated intravenous immunoglobulin therapy. The next day, she also developed pain and muscle weakness of the right upper extremity. Three days after admission, respiratory depression progressed rapidly. Spinal MRI showed a mass extending from the level of C7-T3, with spinal cord compression. The patient underwent an emergency laminectomy with evacuation of hematoma, and was diagnosed with SSEH. Sixty days after admission, she was transferred to the rehabilitation hospital with severe neurologic sequelae of paralysis in both legs. Conclusion: SSEH might have severe consequences, including neurologic deficits and risk of death. This case report serves to raise the awareness of SSEH that mimics the initial presentation of GBS.     

Spontaneous spinal epidural hematoma: Pre-operative diagnosis by MRI

A case of “spontaneous” spinal epidural hematoma diagnosed by MRI confirms the accuracy of the procedure in establishing the nature of the lesion, in delineating its topography and its effects on the spinal cord. MRI, when available, should be regarded as a primary method of investigation.     

Spontaneous spinal epidural hematoma in an 8-year-old boy

Spontaneous spinal epidural hematoma was confirmed by myelography in an 8-year-old boy. The hematoma was removed more than 21 hours after the onset of paraplegia, and there was no evidence of vascular malformation. The patient made a complete recovery.     

Spontaneous spinal epidural hematoma. Report of two cases]

In the paper 2 cases of non-traumatic spinal epidural haematomas are presented. The possible aetiological factors--vascular malformation, coagulopathy, anticoagulants and neoplasm are discussed. Neurological state, diagnostic procedure and treatment are described. Taking into account our experience we state that only early diagnosis and operation-surgical decompression of spinal cord, could result in complete recovery.     

Spontaneous spinal epidural hematoma in a toddler—a case report

Objects Spontaneous spinal epidural hematoma (SSEDH) is rare in children below the age of 2 years. It can produce rapidly progressive neurological deficits.Methods The authors report a case of SSEDH in a 15-month-old boy diagnosed by MRI. Suspension laminotomy and evacuation of the clot were done 48 h after the onset of symptoms. The patient made excellent neurological recovery. Computed tomography (CT) and MRI scanning carried out 6 months after surgery revealed good fusion of the laminotomy. A brief review of relevant literature is presented.Conclusion Although rare SSEDH requires immediate surgical decompression to avoid any permanent neurological deficit. Reconstructive surgical procedures like laminotomy are preferred in children where the incidence of spinal deformity is high following laminectomy.     

Spontaneous spinal epidural hematoma: an uncommon presentation of a rare disease

INTRODUCTION: Spontaneous spinal epidural hematoma is rare in children. The presenting symptoms are usually pain, either local or radicular, followed by progressive bilateral weakness, and sensory loss hours and even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies the diagnosis is usually delayed, and it is not until the full picture of severe cord compression is developed, that MRI is done and the diagnosis is finally made. CASE REPORT: We describe a case of 10-year-old girl who presented with pain and pure brachial plexus radiculopathy as the only clinical manifestations of spinal epidural hematoma. CONCLUSION: A high index of suspicion can lead to the correct diagnosis even before the development of full cord compression and thus improve the overall prognosis.     

Spontaneous spinal epidural hematoma with uncommon clinical presentation: a case report

Spinal epidural haematoma (SEH)--posttraumatic or spontaneous (SSEH) is a rare entity, usually associated with severe neurological deficit. Urgent surgical decompression of the spinal cord is mandatory procedure. A case of SSEH with unusual transient clinical symptomatology and subsequent spontaneous resolution during conservative management is reported.     

Spontaneous epidural hematoma recurred three times

Spontaneous spinal epidural hematoma (SSEH) is a rare space-occupying disease. The pathogenesis of SSEH is unclear, but anticoagulant therapy, arteriovenous malformation, coagulopathy, tumors and infection are risk factors. Ventral SSEH is even more rare, as the ventral sac is fixed firmly to the posterior longitudinal ligament. The authors report a very rare case, a 16-year-old previously healthy female who had repeated relapse of cervico-thoracic SSEH. This occurred three times in the ventral epidural space with subsequent syringomyelia, without structural abnormality and coagulopathy. The patient underwent conservative care twice, and two operations. The diagnosis was made by magnetic resonance imaging. In rapidly progressing SSEH, the clinician should make the diagnosis as early as possible to enable spinal decompression surgery.     

Spontaneous spinal epidural haematoma

Two Chinese patients with spontaneous spinal epidural haematoma are presented. The clinical picture and the possible site of bleeding are discussed.     

Spontaneous spinal epidural hematoma: a case report and review of the literatures

Purpose: To emphasize the importance of early recognition and emergent surgery for spontaneous spinal epidural hematoma (SSEH). Case Report: A 61-year-old female presented with sudden onset of severe neck and back pain after finishing worshiping Buddha followed by quadriparesis, sensory deficits below C4 level and sphincter dysfunction. MR imaging demonstrated acute extensive epidural hematoma of cervico-thoracic spinal segments (C2-T7). Idiopathic SSEH was diagnosed and emergent decompressive laminectomy with hematoma evacuation was performed within 12 hours of symptoms onset. Good functional and neurological outcomes were obtained. Conclusion: SSEH is a rare but disabling or even fatal entity. Early diagnosis and prompt surgery improve the neurological and functional outcome but still remain a clinical challenge. Relevant physicians should pay attention to the typical symptoms of the rare entity and SSEH should be one of differential diagnoses.