Acute spinal epidural hematoma

doi:10.1016/0736-4679(93)90247-5

The Journal of Emergency Medicine

Volume 11, Issue 4, July–August 1993, Pages 437-441

https://doi.org/10.1016/0736-4679(93)90247-5 Get rights and content

Abstract

A 17-year-old female presented to the Emergency Department with a history of recent onset of severe upper thoracic back pain, urinary retention, weakness and paraesthesia in the lower limbs. Magnetic Resonance Imaging (MRI) Scan demonstrated a spinal epidural hematoma at the C7-T2 level. This report highlights a rare, but eminently treatable condition; the use of MRI Scan as a specific diagnostic tool; and the need for urgent surgical decompression to ensure good recovery of function.

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Cited by (19)

Back Pain in the Elderly
2007, Clinics in Geriatric Medicine
Citation Excerpt :
Causes of SCC include spinal epidural metastases, infectious processes such as spinal epidural abscess (SEA), and spinal epidural hematoma (SEH). Of these, spinal epidural metastases account for the majority of cases [38–40]. SEH typically occurs in patients receiving oral anticoagulant medications [41].
Back pain in the elderly is a complex chief complaint, because numerous life-threatening or disabling conditions may present with signs and symptoms similar to those of more benign disease processes. An understanding of the limitations of physical examination and history distinguishing dangerous from benign causes is essential to avoid misdiagnosis and patient morbidity or mortality. This article describes the presentation and evaluation of dangerous causes of back pain, including vascular catastrophes, spinal cord compression syndromes, and infectious diseases. Less emergent musculoskeletal injuries are discussed briefly.
Spontaneous spinal epidural hematoma in children
1998, Pediatric Neurology
Spontaneous spinal epidural hematoma is rare in children. It is usually confined to the dorsal epidural space. Ventral spontaneous spinal epidural hematoma (SSEH) is rarer, with only two previous reports. The authors present three children, two with dorsal and one with ventral spinal epidural hematoma, and review the literature. No etiology of the hematoma was found in the authors’ patients and there was no history of trauma. A review of 24 patients of children younger than 18 years of age reported in the literature and the authors’ three patients revealed that the cervicothoracic region was the most common site of SSEH, the mode of onset was frequently subacute, and there was no male preponderance as has been reported in adults. We found that the initial symptoms were often nonspecific, leading to a delay in diagnosis, especially in younger children. Follow-up data revealed that 15 of the 27 patients recovered completely, 11 had residual neurologic deficits, and one patient died. Irritability and neck pain with restricted movements of the cervical spine in an afebrile child may be early signs of SSEH and often precede onset of neurologic deficits by several hours to days. These signs should alert the clinician to consider spinal epidural hematoma and the need for urgent magnetic resonance imaging (MRI) of the spine for early diagnosis and treatment to minimize morbidity.
Outcome after spontaneous spinal epidural hematoma in children: Case report and review of the literature
1998, Archives of Physical Medicine and Rehabilitation
Objective: Spontaneous spinal epidural hematoma (SSEH) is an idiopathic accumulation of blood in the vertebral epidural space without identifiable predisposing factors. First reported in 1869, the clinical outcome in children younger than 18 years old has not been clearly delineated.
Design: A comprehensive review of the English language literature revealed 26 patients younger than 18 years old with reported clinical outcomes. The 27th case is presented.
Results: Complete neurologic recovery occurred in 14 of 27 (52%) patients, partial recovery in 12 of 27 (44%) patients, and death in 1 of 27 (4%) patients.
Conclusion: There is an overall good prognosis for neurologic recovery in children who experience SSEH.
Spinal epidural hematoma progressing to brown-sequard syndrome: Report of a case
1997, Journal of Emergency Medicine
A 51-yr-old woman was transferred to the emergency department with nonspecific interscapular pain and a progressive right-sided hemiparesis. Physical examination and laboratory examination revealed moderate right-sided hemiparesis, with no other fecal neurologic deficits. A computed axial tomography scan of the brain was negative. Emergency arteriography revealed bilateral highgrade fibromuscular dysplasia involving the origins of the left and right common carotid arteries. The patient was admitted with the presumptive diagnosis of embolic cerebrovascular accident. Subsequently, the patient developed a left-sided sensory deficit, and magnetic resonance imaging of the cervical spine revealed a C5-T2 epidural hemorrhage. The patient underwent emergent surgical evacuation of the clot and recovered without incident. Spinal epidural hematomas are rare and typically present as cord compressions with or without pain rather than as unilateral hemiplegia.
Acute spontaneous spinal epidural hematoma: The influence of magnetic resonance imaging on diagnosis and treatment
1996, Surgical Neurology
Spinal epidural hematoma associated with cocaine abuse
1994, American Journal of Emergency Medicine

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Acute spinal epidural hematoma

Abstract

Lancet

Surg Neurol

Ann Emerg Med

Surg Neurol

Spontaneous spinal epidural hematoma

Zentralbl Neurochir.

Spontaneous cervical epidural hematoma: a consideration of aetiology

J Neurosurg

Spinal epidural hematoma

Surg Neural

Spontaneous spinal epidural hematoma

Int Surg

Spinal extradural hematoma