Nontraumatic spinal epidural hematomas

Purpose: Spinal epidural hematoma (SEH) is a rare clinical entity with a bleak outcome. The aim of our study was to establish the value of MR findings in the diagnosis of nontraumatic SEH. Material and Methods: Seven patients with nontraumatic SEH were examined by MR at 1.5 T. Two patients were under anticoagulation therapy with heparin, and 2 others were taking salicylic acid. One patient had lupus erythematodes with a marked thrombocytopenia. One patient had a spinal arteriovenous malformation. Results: MR imaging permitted the accurate localization of extradural intraspinal expansive lesions which exhibited the characteristic signal intensities of blood. Five patients underwent laminectomy and evacuation of the hematoma. In the acute phase, the hematomas appeared isointense when compared with the spinal cord on T1-weighted images and hyperintense on T2-weighted images. Later the hematomas were hyperintense on T1-weighted images and showed signals identical to those of cerebrospinal fluid (CSF) on T2-weighted images Conclusion: MR imaging established the exact diagnosis and localization of SEH in all cases. MR also can provide useful information about the age of the hematomas.

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Spontaneous spinal epidural hematoma associated with thrombolysis and anticoagulation therapy: report of three cases

Clinical Neurology and Neurosurgery ◽

10.1016/s0303-8467(98)00044-4 ◽

1998 ◽

Vol 100 (4) ◽

pp. 283-287 ◽

Cited By ~ 40

Author(s):

Patrick Van Schaeybroeck ◽

Frank Van Calenbergh ◽

Frans Van De Werf ◽

Philippe Demaerel ◽

Jan Goffin ◽

...

Keyword(s):

Epidural Hematoma ◽

Anticoagulation Therapy ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

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MR Imaging and Clinical Findings of Spontaneous Spinal Epidural Hematoma

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2000.42.1.37 ◽

2000 ◽

Vol 42 (1) ◽

pp. 37

Author(s):

Sam Soo Kim ◽

Moon Hee Han ◽

Hyun Beom Kim ◽

Hye Kyung Yoon ◽

In One Kim ◽

...

Keyword(s):

Mr Imaging ◽

Epidural Hematoma ◽

Clinical Findings ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

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Spinal Epidural Hematoma Associated with Oral Anticoagulation Therapy

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/01.phm.0000107498.91919.44 ◽

2004 ◽

Vol 83 (3) ◽

pp. 220-223 ◽

Cited By ~ 40

Author(s):

Yesim Kirazli ◽

Yesim Akkoc ◽

Selcen Kanyilmaz

Keyword(s):

Oral Anticoagulation ◽

Epidural Hematoma ◽

Anticoagulation Therapy ◽

Spinal Epidural Hematoma ◽

Oral Anticoagulation Therapy ◽

Spinal Epidural

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Early Diagnosis of Spontaneous Spinal Epidural Hematoma with Echo-Planar Gradient-Echo T2*-Weighted MR Imaging

Neuroscience &amp Medicine ◽

10.4236/nm.2015.61004 ◽

2015 ◽

Vol 06 (01) ◽

pp. 20-23

Author(s):

Koichi Iwatsuki ◽

Toshiki Yoshimine ◽

Yu-Ichiro Ohnishi ◽

Koshi Ninomiya ◽

Toshika Ohkawa ◽

...

Keyword(s):

Early Diagnosis ◽

Mr Imaging ◽

Epidural Hematoma ◽

Spinal Epidural Hematoma ◽

Gradient Echo ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural ◽

Echo Planar

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Spinal epidural hematoma in a patient on chronic anticoagulation therapy performing self-neck manipulation: a case report

Chiropractic & Manual Therapies ◽

10.1186/s12998-019-0264-9 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 1

Author(s):

Jesse Cooper ◽

Patrick Battaglia ◽

Todd Reiter

Keyword(s):

Cervical Spine ◽

Epidural Hematoma ◽

Anticoagulation Therapy ◽

Rare Condition ◽

Inpatient Rehabilitation ◽

Spinal Epidural Hematoma ◽

Case Presentation ◽

First Case ◽

Spinal Epidural ◽

Neck Manipulation

Abstract Background Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. To the best of our knowledge, we present the first case of a patient with an iatrogenic hypercoaguable state performing self-neck manipulation, which resulted in a spinal epidural hematoma and subsequent quadriparesis. Case presentation A 63-year-old man presented to the emergency department with worsening interscapular pain radiating to his neck 1 day after performing self-manipulation of his cervical spine. He was found to be coagulopathic upon admission, secondary to chronic warfarin therapy for the management of atrial fibrillation. Approximately 48 h after the manipulation, the patient became acutely quadriparetic and hypotensive. Urgent magnetic resonance imaging revealed a multilevel spinal epidural hematoma from the lower cervical to thoracic spine. Conclusions Partial C7, complete T1 and T2, and partial T3 bilateral laminectomy was performed for evacuation of the spinal epidural hematoma. Following a 2-week course of acute inpatient rehabilitation, the patient returned to his baseline functional status. This case highlights the risks of self-manipulation of the neck and potentially other activities that significantly stretch or apply torque to the cervical spine. It also presents a clinical scenario in which practitioners of spinal manipulation therapy should be aware of patients undergoing anticoagulation therapy.

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Spontaneous Spinal Epidural Hematoma after use of Anticoagulation Therapy

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2008.15.2.111 ◽

2008 ◽

Vol 15 (2) ◽

pp. 111

Author(s):

Young-Sang Lee ◽

Woo-Sung Kim ◽

Jun-Cheol Choi ◽

Hwa-Yeop Na ◽

Min-Ho Shin

Keyword(s):

Epidural Hematoma ◽

Anticoagulation Therapy ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

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Experience in the surgical management of spontaneous spinal epidural hematoma

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.100.1.0038 ◽

2004 ◽

Vol 100 (1) ◽

pp. 38-45 ◽

Cited By ~ 33

Author(s):

Cheng-Chih Liao ◽

Shih-Tseng Lee ◽

Wen-Chin Hsu ◽

Li-Rong Chen ◽

Tai-Ngar Lui ◽

...

Keyword(s):

Epidural Hematoma ◽

Anticoagulation Therapy ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Time Interval ◽

Content Type ◽

Spontaneous Spinal Epidural Hematoma ◽

History Of ◽

Spinal Epidural ◽

Fine Print

Object. Spontaneous spinal epidural hematoma (SSEH) is a rare disease entity. Although many cases have been reported in the literature, controversy persists as to its origin, diagnosis, and timing of treatment. The authors conducted a study in patients treated in their hospital and report the results. Methods. Clinical data obtained in 35 patients with SSEH were retrospectively reviewed. Age, sex, history of hypertension, and history of anticoagulation therapy were recorded, and data were analyzed to clarify the possible predisposing factors of SSEH. Neurological outcomes were reappraised using a standardized grading system and correlated with the time interval from initial ictus to surgery, duration of complete neurological deficits, and the rapidity of deterioration of paralysis. Nonparametric methods and Spearman rank-correlation coefficients were used for statistical analysis. Conclusions. Surgery is a safe and effective procedure to treat SSEH. The disease-related mortality rate was 5.7%, the surgery-related complication rate was 2.9%, and there were no operation-related deaths. Neurological outcome after surgery is positively correlated with preoperative neurological deficits (88.9% complete recovery in patients with incomplete neurological deficits compared with 37.5% in those with complete deficits [p < 0.001]). In patients in whom the time interval from initial ictus was shorter (< 48 hours) and in whom the duration of complete neurological symptoms was also briefer (< 12 hours), there is a positive correlation with better neurological and functional recovery (p < 0.05).

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Spontaneous spinal epidural hematoma: findings at MR imaging and clinical correlation.

Radiology ◽

10.1148/radiology.199.2.8668786 ◽

1996 ◽

Vol 199 (2) ◽

pp. 409-413 ◽

Cited By ~ 200

Author(s):

S Holtås ◽

M Heiling ◽

M Lönntoft

Keyword(s):

Mr Imaging ◽

Epidural Hematoma ◽

Spinal Epidural Hematoma ◽

Clinical Correlation ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

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Timing and risks of chemoprophylaxis after spinal surgery: a single-center experience with 6869 consecutive patients

Journal of Neurosurgery Spine ◽

10.3171/2017.3.spine161076 ◽

2017 ◽

Vol 27 (6) ◽

pp. 681-693 ◽

Cited By ~ 6

Author(s):

Ekamjeet S. Dhillon ◽

Ryan Khanna ◽

Michael Cloney ◽

Helena Roberts ◽

George R. Cybulski ◽

...

Keyword(s):

Spinal Surgery ◽

Epidural Hematoma ◽

Anticoagulation Therapy ◽

Spinal Epidural Hematoma ◽

Rank Test ◽

Patient Demographics ◽

Single Center Experience ◽

Estimated Blood Loss ◽

History Of ◽

Spinal Epidural

OBJECTIVEVenous thromboembolism (VTE) after spinal surgery is a major cause of morbidity, but chemoprophylactic anticoagulation can prevent it. However, there is variability in the timing and use of chemoprophylactic anticoagulation after spine surgery, particularly given surgeons’ concerns for spinal epidural hematomas. The goal of this study was to provide insight into the safety, efficacy, and timing of anticoagulation therapy after spinal surgery.METHODSThe authors retrospectively examined records from 6869 consecutive spinal surgeries performed in their departments at Northwestern University. Data on patient demographics, surgery, hospital course, timing of chemoprophylaxis, and complications, including deep venous thrombosis (DVT), pulmonary embolism (PE), and spinal epidural hematomas requiring evacuation, were collected. Data from the patients who received chemoprophylaxis (n = 1904) were compared with those of patients who did not (n = 4965). The timing of chemoprophylaxis, the rate of VTEs, and the incidence of spinal epidural hematomas were analyzed.RESULTSThe chemoprophylaxis group had more risk factors, including greater age (59.70 vs 51.86 years, respectively; p < 0.001), longer surgery (278.59 vs 145.66 minutes, respectively; p < 0.001), higher estimated blood loss (995 vs 448 ml, respectively; p < 0.001), more comorbid diagnoses (2.69 vs 1.89, respectively; p < 0.001), history of VTE (5.8% vs 2.1%, respectively; p < 0.001), and a higher number were undergoing fusion surgery (46.1% vs 24.7%, respectively; p < 0.001). The prevalence of VTE was higher in the chemoprophylaxis group (3.62% vs 2.03%, respectively; p < 0.001). The median time to VTE occurrence was shorter in the nonchemoprophylaxis group (3.6 vs 6.8 days, respectively; p = 0.0003, log-rank test; hazard ratio 0.685 [0.505–0.926]), and the peak prevalence of VTE occurred in the first 3 postoperative days in the nonchemoprophylaxis group. The average time of initiation of chemoprophylaxis was 1.46 days after surgery. The rates of epidural hematoma were 0.20% (n = 4) in the chemoprophylaxis group and 0.18% (n = 9) in the nonchemoprophylaxis group (p = 0.622).CONCLUSIONSThe risks of spinal epidural hematoma among patients who receive chemoprophylaxis and those who do not are low and equivalent. Administering anticoagulation therapy from 1 day before to 3 days after surgery is safe for patients at high risk for VTE.

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