At the time of diagnosis spontaneous recovery had started in each patient and therefore they were all treated conservatively. The mr finding of an acute spinal epidural hematoma seh can mimic epidural neoplastic or inflammatory lesions, because acute seh appears hypointense on t1weighted images and hyperintense on t2weighted images. Recovery from paraplegia caused by spontaneous spinal. Spontaneous spinal epidural haematoma sciencedirect. Patients with spontaneous spinal edh typically present with acute onset of severe back pain and rapidly develop signs of compression of the spinal cord or cauda equina 5. The ct appearance of the hematoma may be similar to that of a large extruded disc, and a chronic spinal epidural hematoma may mimic a disc if it is small and located near the disc space 8, 9, 12. Their study showed that arteries in the epidural space were free anastomotic. We report on two cases of acute seh with unusual contrast enhancement patterns on mr images.
Epidural hematoma epidural hematoma clinical presentation. Spinal epidural hematoma seh is a rare clinical entity with a bleak out come. Spinal epidural hematoma can complicate procedures that involve a spinal dural puncture, usually in patients with approach to neck stiffness in children view in chinese sternocleidomastoid muscle and the chin towards the muscle in patients with atlantoaxial subluxation. Acute spontaneous spinal epidural hematomas american. A literature survey with metaanalysis of 6 patients. Epidural hematoma from lumbar puncture annals of internal. Spinal epidural hematoma is bleeding into the epidural space in the spine. An 80 year old man was admitted to our hospital presenting sciatica followed by rapid development of. Like acute spinal epidural hematomas, these asshs can expand rapidly and extend over many spinal segments, caus ing sudden spinal cord andor cauda equina compression 119. 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. Spinal subdural or epidural hematoma neurologic disorders. Often there is loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again. It is usually found in the temporoparietal region where a skull fracture will cross the path of the middle meningeal artery or the dural branches.
Information about epidural hematoma edh general information. Epidural hematoma is usually found on the same side of the brain that was impacted by the blow, but on very rare occasions it can be due to a contrecoup injury. Traumatic spinal epidural hematoma journal of emergency. A hematoma occurs when blood leaks from a large blood vessel. Spinal epidural hematoma radiology reference article. Hematoma, epidural, spinal definition of hematoma, epidural. Acute spinal subdural hematoma american journal of. Magnetic resonance imaging mri is the modality of choice to diagnose. Spinal cord injury sci is one of the common complications of spinal surgery. To the best of our knowledge, we present the first case of a patient with an iatrogenic hypercoaguable state performing selfneck manipulation, which resulted in a spinal epidural hematoma and subsequent quadriparesis. Epidural hematomas definition of epidural hematomas by. Contrast enhancement patterns of acute spinal epidural.
Mri done on the 7th day from symptom onset reveals posterior epidural region collection of the cervical spinal canal. Spinal epidural hematoma seh is a rare cause of nerve root or cord compression. Dec, 2019 spinal epidural hematoma seh is a very rare cause of acute spinal cord compression and is estimated to occur in approximately 0. This is followed by the onset of progressive neurological symptoms. In this article, learn about the causes and symptoms of hematomas as well as the different types and when to see a doctor. Spinal epidural hematoma after spinal anesthesia in a. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Extending through the dorsal epidural space of the thoracic and upper lumbar spinal region, there is a t1, t2, and stir hyperintense collection, compatible with an acute hematoma, partially.
Home dangerous drugs xarelto epidural hematoma lawsuit xarelto is a bloodthinning drug, and as such it affects the bodys natural clotting processes. Patients with mild symptoms may be managed conservatively after consultation with a. Register for a free account existing user log in existing user log in. This patient had a spinal epidural hematoma, which is defined as a spontaneous collection of blood in the spinal epidural space. Spontaneous recovery of paraplegia caused by spinal epidural hematoma after removal of epidural catheter. Spontaneous cervical epidural hematoma sceh is an uncommon cause of acute spinal cord compression. Epidural hematoma is a rapidly accumulating mass of blood, usually clotted, or a swelling confined to the space between the skull and the dura mater. In each case follow up mri confirmed rapid reduction in the size of the haematoma and no underlying. Etiopathogenesis of traumatic spinal epidural hematoma ncbi. Overall incidence approximately 1 per 1,000,000 people annually perron 20. Diagnosis is by mri or, if not immediately available, by ct myelography.
Most cases of acute spontaneous spinal epidural hematoma occur in older patients and are likely caused by the rupture of an epidural venous plexus. Spontaneous spinal epidural hematoma sseh is a rare disease that can lead to the acute onset of severe neurological deficits, 1 requiring early diagnostics and rapid treatment to reduce the. No apparent extravasation or abnormal accumulation of the contrast medium was observed. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not diagnosed early can lead to catastrophic consequences. Three surgically treated cases of paraplegia caused by spontaneous spinal epidural hematoma are reported, along with summarized findings from 32 previously reported cases. A spinal subdural or epidural hematoma is an accumulation of blood in the subdural or epidural space that can mechanically compress the spinal cord. Spinal epidural hematomas are a rare occurrence, accounting. This article is from asian spine journal, volume 8. Magnetic resonant imaging scan revealed haematoma in post epidural space at the level of lumbar 2 and 3.
Acute spontaneous spinal epidural hematoma bleeding and. Although spinal epidural hematoma is rare, this disease can. Spinal epidural hematoma seh is a rare emergency that transpires as a complication of several disorders, including trauma, diabetes, arteriovenous malformations, coagulopathies, and malignancy. Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. The causes of seh range from iatrogenic to idiopathic. Pdf drainage of an acute spinal epidural hematoma that.
The short article by laglia and colleagues, spinal epidural hematoma after lumbar puncture in liver disease 1, publicizes a clinical problem one often encounters in obtunded alcoholic patients with abnormalities of hemostasis and coagulation. Significant bleeding can lead to spinal cord damage, causing neurological injury and deficit. Can spontaneous spinal epidural haematoma be managed. They are typically considered a surgical emergency. Spinalepidural hematoma following epidural anesthesia in the. Twelve of these cases resulted from spinal surgery, seven from epidural catheters. Management and outcomes of spinal epidural hematoma during v.
A diagnosis of acute, cervical, spontaneous spinal epidural hematoma was made in two patients by combining clinical signs and myelographic findings. Owing to a rich vascular supply, spinal epidural hematoma is the most common intraspinal hematoma but remains a rare condition, with an estimated incidence of 0. Spontaneous spinal epidural haematoma sseh is a rare clinical condition with. Spinal epidural hematoma is a collection of blood in the potential space between the dura and the bone, along the spinal canal. Spontaneous spinal epidural hematoma edh is a rare condition requiring urgent diagnosis 1. Contrast enhancement can be an mr finding of acute seh. Spinal epidural hematomas edh are a rare spinal pathology which can result in serious morbidity with delayed or nontreatment. However, one of the side effects of this medication is spinal or epidural hematoma. In the cervical spine, patients can present with neurological deficits ranging from focal cervical radiculopathy to complete quadriplegia. Patients with sseh suffer from severe paresis and pain.
However, the patient complained of persistent neck pain. Spinalepidural hematoma following epidural anesthesia in. Spinal epidural hematoma and epidural analgesia article pdf available in canadian journal of anaesthesia 504. If surgical decompression can be accomplished early, the results are favorable. Pdf spinal epidural hematoma and epidural analgesia. In 40% of cases, the ailment occurs spontaneously 2 3. Spinal epidural hematoma due to anticoagulant therapy. Spinal epidural hematoma seh is a very rare cause of acute spinal cord compression and is estimated to occur in approximately 0. Spontaneous spinal epidural hematoma sseh is caused by unknown causes. Spinal epidural hematoma after spinal anesthesia in a patient.
Clinical management for spontaneous spinal epidural. Spinal epidural hematoma seh is an uncommon condition usually characterized by acute back pain. Thirty patients were treated surgically for spinal epidural hematoma seh. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 515% of patients with fatal head injuries. Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain dura mater and the skull. Spinal epidural hematoma is a rare condition that is thought caused by coagulopathies, hypertension, increased venous pressure, vascular malfomations, and insignificant straining effort. Clinical management for spontaneous spinal epidural hematoma. Sep 19, 2019 spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy.
The scan revealed a slightly highdensity mass posterolateral to the spinal cord extending from c2 to c3, compatible with an epidural hematoma fig. An 80 year old man was admitted to our hospital presenting sciatica followed by rapid. Review the current literature regarding spontaneous spinal epidural hematomas ssehs and report on the known risk factors, evaluation, and. Chronic spontaneous lumbar spinal epidural hematoma. An epidural hematoma edh occurs when blood accumulates between the skull and the dura mater, the thick membrane covering the brain. The presentation, investigation, and management of four patients with spontaneous spinal epidural haematoma is presented. Here, we report a 26yearold female patient presented with. The mr imaging characteristics of epidural hematomas are variable and are probably related to the timing of imaging relative to the age of the. Acute spinal subdural hematoma assh is an uncommonly recognized condition that if left untreated can result in severe irreversible neu rologic deficits 17. Epidural hematoma with spinal cord puncture wound youtube. We report the conservative treatment of a spontaneous spinal epidural haematoma attending with acute extensive neurological deficits, which resolved spontaneously. Spontaneous spinal epidural hematoma sseh is a relatively rare but potentially disabling disease, and the classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression.
A metaanalysis of spinal hematomas showed that 75% are epidural in origin. Hyperintense on t2, isointense on t1 rim enhancement on gadolinium injection and blooming on gradient echo sequences. In the cervical spine, the network of free or bridging. Spontaneous spinal epidural hematoma on the ventral portion of whole spinal canal.
They typically occur when a skull fracture tears an underlying blood vessel. Spinal epidural hematoma following a thoracic epidural in a child with sickle cell disease. Iatrogenic causes have been outlined, namely surgical procedures, lumbar puncture and chronic anticoagulant therapy 1. Mar 29, 2019 a hematoma occurs when blood leaks from a large blood vessel. Pdf on jul 31, 2017, young deog cha and others published. Abstracta 26yearold male who had no underlying disease, including coagulopathy, underwent thoracotomy and. Despite maintaining a free interval of 7 days after the last clopidogrel intake, adhering to guidelines concerning low molecular heparin application, and despite the fact that clotting tests were normal, spinal epidural hematoma developed after spinal anesthesia.
Spontaneous remission of spontaneous spinal epidural haematoma with severe neurological deficit is rare in the literature. Can spontaneous spinal epidural haematoma be managed safely. The posterior fossa is a rare location for traumatic injury, in general, including edh epidural hemorrhage epidural hematoma, extradural hemorrhage, or hematoma bleeding outside the outermost layer of the dural mater, which is thus stripped away from the inner table of the. Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. If the patient is not treated with prompt surgical intervention, death is likely to follow. Registered users can save articles, searches, and manage email alerts. Pdf surgical management of spinal epidural hematoma. The patients symptoms and signs will depend on the location of the edh, and degree of spinal cord cauda equina compression, but invariably there will be a. Jul 08, 2015 extending through the dorsal epidural space of the thoracic and upper lumbar spinal region, there is a t1, t2, and stir hyperintense collection, compatible with an acute hematoma, partially. Contrast enhancement can be an mr finding of acute seh, especially in bleeding. Tseh is a rare condition described in medical literature. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Therefore, a contrast enhanced ct was performed to rule out cervical lesions. Most cases of spinalepidural hematoma have been reported in patients who are receiving some kind of anticoagulation therapy or who have an otherwise compromised coagulation.