Spontaneous Spinal Epidural Hematoma: Report of Two Cases and Literature Review

Spontaneous spinal epidural hematoma (SSEH) is a rare disease but may lead to life-threatening consequences if not timely diagnosed and managed. Emergent hematoma evacuation is indicated before neurological deficits become irreversible. We report two cases. The first case was a 45-year-old man brought to hospital because of an acute onset of quadriparesis and urinary incontinence. His cervical magnetic resonance imaging (MRI) showed an epidural hematoma at the C5-C6 level with severe spinal cord compression. He underwent an emergency C5-C6 right hemi-laminotomy to remove the clot and decompress the cord. Postoperatively, his left-sided deficits immediately resolved. His urinary function returned to normal two weeks after the surgery. He could independently walk two months later. The second case was a 57-year-old man admitted to the hospital because of severe neck pain and paresthesia in both arms. He had been using an antiplatelet for two months. His MRI revealed an epidural hematoma from C2 to C4 with spinal cord compression on the right. This patient was successfully treated with conservative treatment. If SSEH is left undiagnosed and untreated, the neurological deficits may be permanent. Early emergent hematoma evacuation contributes to a favorable outcome. Conservative management is reasonable if neurological deficits are not severe.

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Spontaneous Spinal Epidural Hematoma: A Case Report

Case Reports in Orthopedic Research ◽

10.1159/000490067 ◽

2018 ◽

Vol 1 (1-3) ◽

pp. 27-34

Author(s):

Bin Zuo ◽

YueHui Zhang ◽

Jing Zhang ◽

Jia Song ◽

Shao Jiang ◽

...

Keyword(s):

Spinal Cord ◽

Epidural Hematoma ◽

Inverse Correlation ◽

Cord Compression ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Venous Plexus ◽

Decompressive Laminectomy ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord and leading to acute neurological deficits. MRI provides the most valuable visualization of the location and hematoma mass as well as the presence of the spinal cord compression. SSEH can occur in any segments of the spinal cord but predominantly at the posterior cervicothoracic (C5–T2) and thoracolumbar (T10–L2) levels. The source of hemorrhage SSEH can be both vertebral venous plexus system or arterial source. Decompressive laminectomy and hematoma evacuation are the standard surgical procedures upon diagnosis of SSEH, although spontaneous recoveries have been reported. The degree of preoperative neural deficit is a major prognostic factor. Conservative management has proven effective, although feasible only if spontaneous recovery is manifested. Decompressive laminectomy should continue to remain readily available, given the inverse correlation between operative interval and recovery.

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Spontaneous Spinal Epidural Hematoma With Spinal Cord Compression Complicating Plasma Cell Myeloma

Spine ◽

10.1097/00007632-199811150-00015 ◽

1998 ◽

Vol 23 (22) ◽

pp. 2432-2435 ◽

Cited By ~ 13

Author(s):

Gilles Hayem ◽

Eric Deutsch ◽

Sophie Roux ◽

Elisabeth Palazzo ◽

Maggy Grossin ◽

...

Keyword(s):

Spinal Cord ◽

Plasma Cell ◽

Spinal Cord Compression ◽

Epidural Hematoma ◽

Cord Compression ◽

Spinal Epidural Hematoma ◽

Plasma Cell Myeloma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

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Spontaneous spinal epidural hematoma (SSEH): A rare cause of spinal cord compression

Visual Journal of Emergency Medicine ◽

10.1016/j.visj.2018.06.007 ◽

2018 ◽

Vol 12 ◽

pp. 13-14

Author(s):

Joshua Ring ◽

Rebecca Theophanous ◽

Joshua Broder

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Epidural Hematoma ◽

Cord Compression ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

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Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience

Journal of Neurosurgery Spine ◽

10.3171/2009.4.spine08904 ◽

2009 ◽

Vol 11 (4) ◽

pp. 480-486 ◽

Cited By ~ 49

Author(s):

Cheng-Chih Liao ◽

Po-Chuan Hsieh ◽

Tzu-Kang Lin ◽

Chih-Lung Lin ◽

Yang-Lan Lo ◽

...

Keyword(s):

Spinal Cord ◽

Hospital Stay ◽

Functional Recovery ◽

Epidural Hematoma ◽

Length Of Hospital Stay ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Management Options ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

Object Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The goal of this study was to clarify the treatment results and management options in SSEH. Methods Patients with SSEH who were surgically treated in the authors' center between June 2003 and June 2008 were included in this study. Patients were treated as early as possible if their neurological deficits were incomplete or had been complete for 12 hours or less. The patients were assigned to 1 of 2 groups based on completeness of preoperative cord dysfunction (complete vs incomplete deficit). Surgical outcomes of the 2 groups were compared by functional performance, coded as Nurick grades at 1, 3, and 6 months after the operation. Also compared were duration of hospital stay and the number of days needed to regain the ability to function independently (defined as Nurick Grades 1 and 2) after the operation. Results There were 17 patients (7 female and 10 male) with pathologically confirmed SSEH. Coagulopathy, greater size (length) of SSEH, and preoperative complete spinal dysfunction were found to contribute to poor postoperative functional recovery (p < 0.05). Patients with incomplete preoperative deficits (ASIA Impairment Scale Grades B, C, and D) were able to achieve functional independent recovery within a month after surgery and had significantly better outcomes (lower Nurick grades) at 1, 3, and 6 months postoperatively than those with complete deficits (p < 0.001, p = 0.027, and p = 0.027, respectively). Median time to independent functional recovery and median length of hospital stay were significantly shorter in patients with incomplete preoperative deficits than in those with complete deficits (6 vs 110 and 9 vs 58 days, respectively; both p < 0.001). Conclusions Impaired preoperative hemostasis contributes to larger size of SSEH, high probability of postoperative recurrence of spinal epidural hematoma, and poor functional recovery following surgical evacuation. Incomplete spinal cord dysfunction before surgery predicts good outcome and warrants emergent evacuation of SSEH especially in the cervical and thoracic regions, where the clots are located in proximity to the spinal cord.

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A Spontaneous Spinal Epidural Hematoma Case Report

Callosum Neurology ◽

10.29342/cnj.v3i1.96 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Alvin Hendellyn

Keyword(s):

Spinal Cord ◽

Epidural Hematoma ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Factors Associated ◽

Significant Clinical Improvement ◽

History Of ◽

Acute Paraparesis ◽

Spinal Epidural

Hematoma epidural spinal spontan atau spontaneous spinal epidural hematoma (SSEH) adalah akumulasi darah di ruang epidural tulang belakang yang menekan medula spinalis dan menimbulkan defisit neurologis. SSEH dapat terjadi di segmen mana saja dari medula spinalis dan penyebab pasti serta sumber perdarahan yang pasti hingga saat ini masih belum diketahui. Diagnosis SSEH dapat ditegakkan dengan pemeriksaan penunjang MRI. Tatalaksana pilihan untuk kasus SSEH adalah laminektomi dekompresi dan evakuasi hematoma. Pada kasus ini, pasien datang dengan keluhan paraparesis inferior tipe UMN dan gangguan sensibilitas yang akut tanpa riwayat trauma dan faktor risiko yang berhubungan dengan SSEH. Pasien menjalani laminektomi dan menunjukkan perbaikan klinis yang signifikan. Spontaneous spinal epidural hematoma (SSEH) is an accumulation of blood in epidural space of the spine compressing spinal cord and causing neurological deficits. SSEH can occur in any segments of the spinal cord and the definite etiology and source of bleeding is still unknown until now. MRI can be used to support SSEH diagnosis. Treatment of choice for SSEH cases is decompression laminectomy and hematoma evacuation. In this case, the patient came with acute paraparesis upper motor neuron type and sensibility disturbances, without history of trauma and any risk factors associated with SSEH. The patient underwent laminectomy and showed significant clinical improvement.

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Spontaneous Spinal Epidural Hematoma

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v23i2.1165 ◽

2018 ◽

Vol 23 (2) ◽

pp. 157-159

Author(s):

Ronnyson Susano Grativvol ◽

Raquel Portugal Guimarães Amaral ◽

Fabrizio Borges Scardino ◽

Paulo César Mariano Henrique ◽

Tharson Susano Grativvol

Keyword(s):

Spinal Cord ◽

Thoracic Spine ◽

Neurological Deficit ◽

Epidural Hematoma ◽

Signs And Symptoms ◽

Cord Compression ◽

Radicular Pain ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

A case of spontaneous spinal epidural hematoma (SSEH) in the thoracic spine (T10-12) is reported. This is a rare cause of neurological deficit (represents 0,3-0,9% of the lesions that occupy epidural space in vertebral canal) requiring immediate diagnosis and treatment. Patients with SSEH typically present with acute onset of severe back pain and signs of neurological deficit. We report the case of a woman admitted to the emergency room with abdominal pain (radiating radicular pain) with signs and symptoms of spinal cord compression. A magnetic resonance imaging (MRI) of the thoracic spine showed expansive extramedullary formation located at T10-T12 level which pressed and displaced the spinal cord anterolaterally to the right. The patient underwent surgery on an emergency basis, and permanent neurological deficit was avoided.

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Acute Cervical Spontaneous Spinal Epidural Hematoma Presenting with Minimal Neurological Deficits: A Case Report

Anesthesiology and Pain Medicine ◽

10.5812/aapm.40067 ◽

2016 ◽

Vol 6 (5) ◽

Cited By ~ 6

Author(s):

Jisoon Huh ◽

Ho-young Kwak ◽

You-Nam Chung ◽

Sun Kyung Park ◽

Yun Suk Choi

Keyword(s):

Case Report ◽

Epidural Hematoma ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural

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IgG4-Related Sclerosing Disease Causing Spinal Cord Compression: The First Reported Case in Literature

Case Reports in Immunology ◽

10.1155/2019/3618510 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Nooraldin Merza ◽

Ahmed Taha ◽

John Lung ◽

Anthony W. Benderman ◽

Stephen E. Wright

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Spinal Cord ◽

Cord Compression ◽

Neurological Deficits ◽

Pathological Examination ◽

Tissue Mass ◽

Systemic Steroids ◽

First Case

Immunoglobulin G4-related disease (IgG4-RD) is known for forming soft tissue mass lesions that may have compressive effects. It is an extremely rare disease that most frequently affects the pancreas causing autoimmune pancreatitis. It can also affect the gallbladder, salivary glands, and lacrimal glands causing respective organ-specific complications. In our report, we describe an IgG4-RD case that affected the spinal cord. A 60-year-old female presented with cervical spinal cord compression caused by IgG4-RD leading to several neurological deficits. Pathological examination of the excisional biopsy of the mass revealed dense lymphoplasmacytic cells infiltration and stromal fibrosis with IgG4 and plasma cells. The patient showed a dramatic response to the administration of systemic steroids with almost resolution of her neurological symptoms. This case highlights the first case in literature for IgG4-RD of the extradural tissue causing spinal compression. Hereby, we also demonstrate the dramatic response of IgG4-RD to the administration of systemic steroids as the patient had no recurrence after 5 years of close follow-up, the longest reported period of follow-up reported in the literature to date.

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Conservative Treatment of Acute Spontaneous Spinal Epidural Hematoma

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100033795 ◽

1998 ◽

Vol 25 (2) ◽

pp. 159-163 ◽

Cited By ~ 27

Author(s):

Peter A. Pahapill ◽

Stephen P. Lownie

Keyword(s):

Epidural Hematoma ◽

Standard Treatment ◽

Surgical Intervention ◽

Operative Therapy ◽

Complete Recovery ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Spontaneous Spinal Epidural Hematoma ◽

Spinal Epidural ◽

Sustained Recovery

ABSTRACT:Background:In cases of acute spontaneous spinal epidural hematoma producing neurological deficits, emergency surgical evacuation is the standard treatment.Methods:Such a case is presented in which complete resolution of neurological deficits occurred without surgical intervention.Results:This is the fifth reported case of complete recovery in a patient managed conservatively. In most reports, significant and sustained neurological recovery had occurred within 12 hours of impairment of walking.Conclusion:In cases of acute spontaneous spinal epidural hematoma in which neurological deterioration is followed by early and sustained recovery, non-operative therapy may be considered.

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