Recovery from paraplegia caused by spontaneous spinal epidural hematoma

Three surgically treated cases of paraplegia caused by spontaneous spinal epidural hematoma are reported, along with summarized findings from 32 previously reported cases. Patients who recovered within 6 months had endured a shorter interval between loss of their ability to walk and surgical decompression than patients who did not recover (26 hours versus 48 hours; p less than 0.02). When this interval exceeded approximately 36 hours, the probability of recovery fell below 50 percent.     

Acute hemiparesis: A rare presentation of spontaneous spinal epidural hematoma mimicking acute stroke

Acute hemiparesis is an extremely rare presentation of spontaneous spinal epidural hematoma, which may be misdiagnosed as acute ischemic stroke and improperly treated with an intravenous thrombolytic agent. Here, we report a case of a 54-year-old woman who presented with acute neck pain and right-sided weakness. She was initially suspected of having ischemic stroke and therefore treated with an intravenous thrombolytic agent. However, she developed progressive tetraparesis, and subsequent magnetic resonance images confirmed cervical spontaneous spinal epidural hematoma.

Stroke is a leading cause of mortality and morbidity in Taiwan.1 Acute hemiparesis is one of the most indicative manifestations of acute stroke. Administration of recombinant tissue plasminogen activator (rtPA), a thrombolytic agent, within 3 to 4.5 hours of symptom onset is the standard treatment for acute ischemic stroke.2 However, various diseases such as slipped cervical discs, epilepsy, and spinal epidural hematoma may present along with acute hemiparesis, mimicking acute stroke, and thus be inappropriately treated with rtPA.3 Spontaneous spinal epidural hematoma (SSEH) is a rare condition of unknown etiology and requires urgent surgical intervention.3-5 The characteristic manifestation of SSEH is sudden-onset neck pain following by motor paralysis or tetraparesis.4 However, SSEH presenting with acute hemiparesis has been rarely reported in the literature. Therefore, we reported a case of SSEH with acute hemiparesis wrongly treated with rtPA in the emergency department (ED).     

Case report of spontaneous cervical epidural hematoma in elderly]

Spontaneous spinal epidural hematomas (SSEH) are relatively rare clinical entities and associated with coagulopathies, tumors, or vascular malformation. In addition, these are often neurosurgical emergencies; therefore, prompt diagnosis and treatment are paramount. We reported a case of an 87-year-old woman with spontaneous cervical epidural hematoma. She presented with the sudden onset of neck pain, rt. upper arm sensory disturbance and rt. hemiparesis. MRI revealed a C3-Th1 dorsally placed extradural lesion. The lesion was iso-to hypointense on T1-weighted images and was hyperintense on T2-weighted images. She underwent surgery within 9 hours after symptom onset, removal of hematoma through the right hemilaminectomy was performed. She was a very high age, but she was discharged from the hospital without neurological deficit. To obtain good prognosis for patients with SSEH, early diagnosis and treatment are important. We also review the current literature concerning diagnosis and treatment of SSEH.     

Chronic spontaneous lumbar epidural hematoma

We report an exceptional case of cauda equina syndrome, caused by a chronic epidural hematoma of the lumbar spine, (L2-L3). A 53 year old man without history of trauma, lumbar punctures or antiagregant medication, suffered from progressive back pain and minor motor deficit in the legs. The etiology, MRI, intraoperative findings and microscopical study are presented and discussed. After surgery there was a complete resolution of the clinical picture.     

Acute epidural hematoma caused by contrecoup injury]

We report a rare case of the acute epidural hematoma caused by contrecoup injury. A 59-year-old woman came to our hospital on foot because of her head injury. She slipped on a stone and hit her occiput against the concrete floor without loss of consciousness. On admission she was alert and complained of dizziness and nausea without neurological deficits. She had a subcutaneous hematoma in the occiput. There was no Battle's sign nor cerebrospinal fluid leakage. Skull film revealed a linear fracture of the occipital bone. Computed Tomography(CT) of the brain showed the acute epidural hematoma at the left frontal region. She was treated conservatively and discharged 19 days after injury without neurological deficits. The mechanism of this lesion is speculated as follows: the deformation of the skull and the negative pressure produced in the frontal region with the occipital injury stripped the dura mater from the calvarium, which lead to the rupture and hemorrhage of the small interposed vessels resulting in the epidural hematoma.     

Chronic cervical epidural hematoma diagnosed by magnetic resonance imaging

The clinical picture of spinal epidural hematoma is usually characterized by the sudden onset of pain and acute paraplegia within a few hours. The reports of chronic spinal epidural hematoma above the lumbar level is extremely rare. Here we added one case whose hematoma was at cervical level. A 31-year-old previously healthy male suffered from continuous sharp pain in the back of his neck about 10 weeks before admission. He took analgesic drugs and treated with head traction by his home doctor with minimal relief. 4 weeks later from onset progressive weakness and numbness appeared at his right hand and arm. Physical examination on admission revealed mild monoparesis and sensory disturbance in his right upper limb. There was hyporeflexia of both upper extremities. Magnetic resonance imaging (MRI; Hitachi 0.2 T) visualized a dorsal epidural space occupying lesion extending from C3 to Th1 vertebral body level. This revealed high signal intensity in T2 weighted image and mixed (low and iso) signal intensity in T1 weighted image corresponding to old hematoma. All his medication was stopped and he treated with collar brace, which improved his neurological status. 3 weeks later, he recovered fully and follow-up MRI revealed the total absorption of the hematoma. Left vertebral angiogram showed that a part of posterior cerebral venous blood drained to cervical vertebral plexus. This finding suggested his epidural bleeding was venous in origin. Rupture of internal vertebral venous plexus that has no valves was considered as the source of spinal epidural hematoma.(ABSTRACT TRUNCATED AT 250 WORDS)     

自发性脊髓硬膜外血肿的临床特征

目的对自发性脊髓硬膜外血肿的临床表现、影像学特点和病因进行总结。方法回顾4例经MRI证实的脊髓硬膜外血肿患者的资料，其中2例进行了脊髓硬膜外血肿清除术和病理学检查。结果4例患者均为急性起病，伴明显的胸背部疼痛，截瘫和尿潴留等脊髓受压的症状和体征。腰穿脑脊液检查结果正常。急性期MRI检查均可见受压节段脊髓硬膜外呈条形或梭形异常信号影，T1W等信号。T2W稍高信号，高信号中间杂小斑片状低信号。病理学结果为1例肉芽肿合并血肿。1例血管畸形合并血肿。2例外科手术的患者术后神经功能迅速恢复。2周后出院。未手术患者3-4周后出院。结论胸背部剧烈疼痛、单侧和双下肢截瘫、尿便障碍、影像学改变是诊断自发性脊髓硬膜外血肿的主要依据。脑脊液正常对诊断常有帮助。手术治疗可缩短病程和减少复发。也是病因检查的最有效方法。     

自发性硬脊膜外血肿的诊断和治疗策略

目的探讨自发性硬脊膜外血肿的临床特征、治疗及影响预后的因素。方法对16例自发性硬脊膜外血肿患者的临床特征、手术治疗时机以及手术后神经功能恢复情况进行回顾总结,并结合文献分析影响预后的因素。所有自发性硬脊膜外血肿患者均行MRI检查。结果16例患者的硬脊膜外血肿分别位于下颈段（2例）、颈胸段（6例）、胸段（7例）及胸腰段（1例）。MRI检查T1WI表现为等信号或略高信号,T2WI以高信号为主,其中可见混杂低信号。12例施行手术治疗的患者中10例预后良好;4例保守治疗者中3例神经功能完全恢复。结论脊髓MRI检查是诊断自发性硬脊膜外血肿的首选方法,早期诊断和外科手术治疗是恢复神经功能、提高疗效的关键。手术疗效主要与自发性硬脊膜外血肿患者手术前的神经功能缺损程度和手术间隔时间有关;症状较轻者在密切观察下可予以保守治疗,其神经功能的恢复主要取决于神经功能缺损程度。目的探讨自发性硬脊膜外血肿的临床特征、治疗及影响预后的因素。方法对16例自发性硬脊膜外血肿患者的临床特征、手术治疗时机以及手术后神经功能恢复情况进行回顾总结,并结合文献分析影响预后的因素。所有自发性硬脊膜外血肿患者均行MRI检查。结果16例患者的硬脊膜外血肿分别位于下颈段（2例）、颈胸段（6例）、胸段（7例）及胸腰段（1例）。MRI检查T1WI表现为等信号或略高信号,T2WI以高信号为主,其中可见混杂低信号。12例施行手术治疗的患者中10例预后良好;4例保守治疗者中3例神经功能完全恢复。结论脊髓MRI检查是诊断自发性硬脊膜外血肿的首选方法,早期诊断和外科手术治疗是恢复神经功能、提高疗效的关键。手术疗效主要与自发性硬脊膜外血肿患者手术前的神经功能缺损程度和手术间隔时间有关;症状较轻者在密切观察下可予以保守治疗,其神经功能的恢复主要取决于神经功能缺损程度。     

自发性脊髓硬膜外血肿临床特点分析

目的 探讨自发性脊髓硬膜外血肿(SSEH)的发病特点、临床表现及诊治方法. 方法 总结珠江医院骨科自1995年1月至2010年12月收治的12例SSEH患者临床表现、诊治经过及随访情况.12例患者中采用经椎管减压血肿病灶清除术10例,非手术治疗2例.所有患者均随访6-18个月. 结果 12例患者发病前均无明显诱因,发病后均表现为受累肢体肌力丧失或减弱、大小便功能障碍.手术治疗患者中2例术后受累肢体运动、神经功能完全恢复,8例患者除大小便功能略微改善外,肢体的运动感觉功能无恢复.非手术治疗的患者中1例神经功能完全恢复.1例神经功能部分恢复. 结论 SSEH进展迅速,脊髓运动、神经功能障碍是其主要临床表现,及时的手术治疗可有效改善预后,是SSEH首选的治疗方式.     

Relapsed spontaneous spinal epidural hematoma associated with aspirin and clopidogrel

An acute spontaneous spinal epidural hematoma (SSEH) is a rare spinal pathology. A 57-year-old man who had hypertension and had been on dual antiplatelet therapy with aspirin and clopidogrel for primary prevention presented with the sudden onset of mid back pain and monoplegia of the left lower extremity. Magnetic resonance imaging revealed an epidural hematoma, and the patient underwent emergency hemilaminectomy for evacuation. However, the symptoms worsened, and complete paraplegia developed. A second procedure to remove the recurrent hematoma was performed. No vascular malformation or other possible cause for SSEH was found other than the aspirin and clopidogrel medication. This case report describes relapsed SSEH caused by the combination of aspirin and clopidogrel medication and urges caution in prescribing dual antiplatelet agents.     

Recurrent paraplegia with total recovery from spontaneous spinal epidural hematoma

A 51-year-old man had three episodes of complete paraplegia and anesthesia, each lasting 30 to 120 minutes, over the course of five hours. Myelography and computerized tomographic scanning showed an epidural hematoma at T11–T12 for which no cause was found. Complete spontaneous recovery occurred.