• cervical compression myelopathy
• cervical epidural fluid collection
• lung cancer
• metastatic spinal tumor
• rapid accumulation

• anesthesia, conduction
• anticoagulants
• injections, spinal
• nerve block
• regional anesthesia

• Anticoagulants
• Injections, Spinal
• OUTCOMES
• Obstetrics
• Pediatrics

• Humans
• Hematoma, Epidural, Spinal/diagnostic imaging
• Hematoma, Epidural, Spinal/etiology
• Female
• Child
• Adult
• Risk Factors
• Anticoagulants/adverse effects
• Anticoagulants/administration & dosage
• Anesthesia, Conduction/adverse effects
• Anesthesia, Conduction/methods
• Pregnancy
• Treatment Outcome
• Male

• back pain
• laminectomy
• lower limb weakness
• spinal epidural hematoma
• surgical decompression

• Spontaneous spinal hematoma; subarachnoid hemorrhage; spinal arteriovenous malformation; digital subtraction angiography

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Hematoma/diagnostic imaging
• Hematoma/surgery
• Hematoma, Epidural, Spinal/surgery
• Hematoma, Epidural, Spinal/diagnostic imaging
• Hematoma, Subdural, Spinal/surgery
• Hematoma, Subdural, Spinal/diagnostic imaging
• Magnetic Resonance Imaging
• Retrospective Studies
• Subarachnoid Hemorrhage/diagnostic imaging
• Subarachnoid Hemorrhage/surgery

• Technische Universität München (1025)

• complication
• epidural
• hematoma
• massage
• spinal

• Epidural haematoma
• Spinal
• Spontaneous
• Surgical outcomes
• Systematic review

• Adult
• Humans
• Hematoma, Epidural, Spinal/surgery
• Hematoma, Epidural, Spinal/etiology
• Prognosis
• Warfarin
• Retrospective Studies
• Magnetic Resonance Imaging
• Treatment Outcome

• MRI
• Neurological severity
• Paralysis
• SSEH
• Spinal epidural haematoma

• Cervical Vertebrae
• Hematoma, Epidural, Spinal/diagnostic imaging
• Hematoma, Epidural, Spinal/etiology
• Humans
• Magnetic Resonance Imaging
• Paralysis/diagnostic imaging
• Paralysis/etiology
• Retrospective Studies

Spontaneous spinal epidural hematoma (SSEH) is an uncommon but serious condition with a high morbidity rate. Although SSEH is related to numerous risk factors, its etiology remains unclear. There is a paucity of data on its prognostic factors. We aim to evaluate prognostic factors for SSEH in this study.

A retrospective study was performed on patients who were admitted for SSEH in 3 academic neurosurgical centers from January 2010 to June 2021. Clinical parameters, including clinical condition on admission, anticoagulants use, imaging modality, the timing and type of surgery performed, and outcomes, were collected. Prognostic factors were analyzed. The Frankel scale was used to assess the clinical condition.

A total of 105 patients with SSEH were retrieved from medical records, with a mean age of 51.3 years. Eighty-three patients (79%) complained of acute onset of severe neck or back pain. Eighty-two patients (78%) suffered from moderate to severe neurologic deficits (Frankel scale A–C). Anticoagulation usage was found in 20% of cases. Lower thoracic spine (p = 0.046), use of anticoagulants (p = 0.019), sphincter function disfunction (p = 0.008), severe neurologic deficits at admission (p < 0.001), and rapid deterioration (<1 hour, p = 0.004) were found to be associated with poor outcomes. Surgical decompression was performed in 74 (70%) cases. The univariate and multivariate analysis revealed that preoperative severe neurologic deficits (p = 0.005) and extended paraplegia time (>12 hours, p = 0.004) were independent adverse prognostic factors. The univariate analysis revealed that lower thoracic spine location (p = 0.08) and rapid progression (<6 hours, p = 0.005) were correlated with poor prognosis, but the multivariate analysis failed to identify them as independent prognostic factors.

Adverse prognostic factors for SSEH might include thoracic segment location, use of anticoagulation, severe neurologic deficits on admission, sphincter dysfunction, and rapid progression. Preoperative neurologic deficit and extended paraplegia time were strongly correlated with the prognosis in the subset of patients who underwent surgical decompression. Timely surgical decompression is recommended for patients with moderate/severe neurologic deficits or progressive neurologic deterioration.

• Spinal epidural hematoma
• neurological deficits
• paraplegia time
• progression interval
• sphincter dysfunction

Spinal epidural hematoma is a rare disease that may present as motor paralysis, sensory disturbance, and a sudden radiating pain from the hematoma site. Herein, we report two cases of cervical epidural hematoma diagnosed as left hemiplegia and treated with surgery. Case 1 was a 62-year-old woman who presented to our hospital with the chief complaint of posterior neck pain and left upper and lower limb paralysis. Cervical magnetic resonance imaging (MRI) showed a cervical epidural hematoma at the C4-C6 level. Case 2 was a 67-year-old man who presented to our hospital with a history of hypertension. Both patients had left hemiparesis, numbness in the left upper and lower limbs, and hypersensitivity. They were diagnosed with idiopathic cervical epidural hematoma and underwent emergency surgery (hematoma removal + laminoplasty). In case 1, the paralysis improved immediately after the surgery. In case 2, the paralysis and hypersensitivity improved markedly after the surgery, and the manual muscle testing grade of the left upper and lower limbs improved from 3 to 5 on the second day. Both patients were subsequently discharged home unaided. In cases where the paralysis does not improve, it is important to exclude stroke, diagnose cervical epidural hematoma as soon as possible, and consider surgery aggressively.

• Horner syndrome
• Spinal compression
• Spontaneous spinal epidural hematoma

Spinal epidural hematomas are rare, with trauma being the most common cause. Spinal epidural hematomas caused by coagulation dysfunction are even rarer; however, long-term warfarin therapy increases the risk. The clinical manifestations of spinal epidural hematoma are neurological deficits below the corresponding spinal cord segment level. Magnetic resonance imaging (MRI) is the preferred method for diagnosis, and the main treatment for epidural hematoma with typical symptoms is urgent decompression of the lumbar spine. We describe an almost 80-year-old female patient who received long-term oral warfarin therapy for atrial fibrillation. She developed sudden onset waist pain, and 2 days later, she developed pain and weakness in both lower limbs. Computed tomography (CT) of the thoracolumbar spine showed no obvious hematoma. Eight days after admission, contrast-enhanced CT of the thoracolumbar spine showed intraspinal hematomas at T5–T8 and T12–L2 levels. We performed T3–T7 laminectomy, T5–T8 hematoma removal, and spinal dural repair. The clinical symptoms did not improve significantly, postoperatively. The low incidence of spinal epidural hematoma after anticoagulation treatment means this condition is not recognized timely, and it is misdiagnosed easily. Clinicians should consider this condition when patients treated with anticoagulants have neurological deficits below a spinal segmental plane.

• Warfarin
• anticoagulation therapy
• contrast-enhanced CT
• epidural hematoma
• incidence
• neurological deficit
• spinal canal surgery
• symptom

Spinal manipulation therapy (SMT) has been widely used worldwide to treat musculoskeletal diseases, but it can cause serious adverse events. Spinal epidural hematoma (SEH) caused by SMT is a rare emergency that can cause neurological dysfunction. We herein report three cases of SEH after SMT.

The first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT. Her symptoms persisted after 3 d of conservative treatment, and she was admitted to our hospital. Magnetic resonance imaging (MRI) demonstrated an SEH, extending from C6 to C7. The second case was a 55-year-old man with sudden back pain 1 d after SMT, numbness in both lower limbs, an inability to stand or walk, and difficulty urinating. MRI revealed an SEH, extending from T1 to T3. The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT. He was unable to stand or walk and experienced mild back pain. MRI revealed an SEH, extending from T1 to T2. All three patients underwent surgery after failed conservative treatment. The three cases recovered to ASIA grade E on day 5, 1 wk, and day 10 after surgery, respectively. All patients returned to normal after 3 mo of follow-up.

SEH caused by SMT is very rare, and the condition of each patient should be evaluated in full detail before operation. SEH should be diagnosed immediately and actively treated by surgery.

• Spinal epidural hematoma
• Spinal manipulation therapy
• Spinal cord injury
• Magnetic resonance imaging
• Surgery
• Case report

Although spontaneous spinal epidural hematoma is a rare entity with an unknown origin, it may occur secondary to the use of anticoagulant and/or antiplatelet agents, which are particularly used for the treatment of cardiovascular and cerebrovascular diseases. Since it occurs rarely and its initial symptoms are usually non-specific, early and accurate diagnosis can be challenging which affects survival rate and the quality of life. Herein, we present a 65-year-old male case who developed acute severe neck pain and headache on the third day of acute coronary syndrome treatment, followed by neurological deficits in bilateral upper and lower extremities.

• Anticoagulants
• laminectomy
• neck pain

Patient: Female, 79-year-old

Final Diagnosis: Cervical spinal epidural hematoma

Symptoms: Neck pain • unilateral weakness

Medication: —

Clinical Procedure: —

Specialty: Neurosurgery • Orthopedics and Traumatology

A spontaneous spinal epidural hematoma (SSEH) is a rare condition of intraspinal bleeding in the epidural space. It is often associated with disorders of anticoagulation, intraspinal tumors, vascular malformations, and pertinent to this case, anticoagulation therapy. This surgical emergency requires early diagnosis and management in order to minimize permanent neurologic deficits.

We report the case of a 72-year-old female with a past medical history of paroxysmal atrial fibrillation treated with rivaroxaban who presented to the emergency department with acute-onset, midline, lower back pain with no known trauma or injury to the area. At the time of emergency department (ED) admission, the patient was fully ambulatory and alert and oriented. However, within hours, she developed bilateral lower extremity motor paralysis and diminished sensation with urinary and bowel incontinence.

SSEHs are rare, progressive neurologic emergencies that can present with non-specific lower back pain. This condition presents a diagnostic challenge that can result in permanent neurologic defects if not recognized early. Emergency physicians regularly encounter patients with both acute lower back pain and atrial fibrillation. This case can contribute to the possibility of SSEH to a differential diagnosis.

• atrial fibrillation
• low back pain
• rivaroxaban
• spinal epidural hematoma
• xarelto

• Cervical epidural steroid injection
• Cervical interlaminar epidural injection
• Cervical radiculitis
• Epidural abscess
• Epidural hematoma
• Spinal cord injury

• Spinal epidural hematoma; Hemorrhage; MRI; Paraplegia; Hemophilia; Vascular malformation

• Acute limb ischaemia
• anticoagulation
• bleeding
• femoral artery
• iatrogenic injury
• paraplegia
• peripheral aneurysm
• rheolytic thrombectomy
• thrombolysis

Spontaneous spinal epidural hematomas (SEHs) due to the utilization of factor Xa inhibitors are rare.

A 66-year-old female presented with a Brown-Sequard syndrome attributed to a cervical epidural hematoma secondary to the utilization of rivaroxaban, one of the factor Xa inhibitors. Following a cervical laminectomy for the evacuation of the hematoma, the patient completely recovered.

A spinal hemorrhagic event should be suspected in patients receiving factor Xa inhibitor drugs. Here, we had an elderly female on rivaroxaban experienced the acute onset of neck/back pain associated with a Brown-Sequard syndrome. A literature review showed that this is the seventh example of SEH occurring as a result of the use of anticoagulation drugs (OACDs; e.g., including Xa inhibitors).

• Anticoagulant
• Factor Xa inhibitors
• Rivaroxaban
• Spinal epidural hematoma

• Dumbbell type
• Infant
• Spinal cord compression
• Spontaneous spinal epidural hematoma

• Female
• Hematoma/pathology
• Hematoma, Epidural, Spinal/complications
• Hematoma, Epidural, Spinal/pathology
• Humans
• Infant
• Paralysis/etiology
• Paraspinal Muscles/pathology

Spontaneous spinal epidural hematomas (SSEHs) are rare in childhood, especially in infants.

We present the case of a 17-month-old-boy with trisomy 21 and a large SSEH. He was hospitalized for acute onset paraplegia after 6 days of irritability. Nine days after symptom onset, magnetic resonance imaging (MRI) of the spine revealed an extensive epidural hematoma between C7 and T5 causing severe spinal cord compression. After a coagulation disorder was ruled out (12 days after onset), he underwent emergency hemilaminectomy with evacuation of the hematoma. His neurologic impairment gradually improved, and 4 months after surgery he was back to his neurologic baseline. At 18 months after surgery, he was walking independently, although he had some developmental disabilities due to trisomy 21.

Only 20 cases of SSEH in infancy have been previously reported, and this is the first report of SSEH in an infant with developmental disabilities. Because of the non-specific symptoms and difficulty obtaining MRIs in infants, particularly in those with developmental disabilities, the diagnosis and treatment of SSEH may be delayed. However, early diagnosis with MRI and early evacuation of SSEH in patients with severe neurological impairments is important for good outcomes. Attention must be paid to postoperative spinal deformity in infants.

• Developmental disability
• Infant
• Spontaneous spinal epidural hematomas

Patient: Male, 70

Final Diagnosis: Spontaneous spinal epidural hematoma

Symptoms: Abdominal pain • chest pain • complete paraplegia

Medication: —

Clinical Procedure: Conservative management

Specialty: Nephrology

Lumbar puncture is a well-known procedure. The indications for lumbar puncture vary among different medical and surgical disciplines, though obtaining a sample for cerebrospinal fluid analysis is the most common one. A normal coagulation profile is crucial prior to pursing the procedure. Occasionally, an urgent sample is needed to guide an appropriate treatment while the patient's coagulation status is suboptimum. In those specific critical situations, some may accept suboptimal correction owing to the urgency of the case.

We report a case for a patient with Burkitt lymphoma who presented with mild neuroaxial symptoms. An urgent cerebrospinal fluid sample was required which was taken after correcting his platelets count to 53.4 × 10⁹/L. He developed a massive multi-compartmental thoracolumbar hematoma with acute cauda equine syndrome requiring surgical intervention. Despite aggressive management, he remained permanently paraplegic with functional status that negatively affected his overall outcome.

Lumbar puncture is a useful diagnostic and treatment tool. Although serious events are seldom, they can be detrimental. A precaution not to underestimate such events in practicing lumbar, especially in patients with suboptimum coagulation state. Image-guided procedure can be useful and should be considered in appropriately selected patients.

• Lumbar puncture
• spinal hematoma
• spinal tap

A 56-year-old man underwent cervical laminoplasty for cervical spondylosis. On the 7th postoperative day, he suddenly felt severe neck pain, and tetraplegia developed rapidly over 1.5 hrs. Computed tomography demonstrated a huge hematoma compressing the cervical spinal cord. Clot was evacuated 3 hrs after the onset of symptoms. The patient’s postoperative course was uneventful. His blood pressure could not be properly controlled in the perioperative period. Surgeons should keep in mind that delayed postoperative spinal epidural hematoma (DPSEH) can occur more than a week after surgery, and meticulous blood pressure control is important for more than a week after a spinal operation.

• delayed postoperative spinal epidural hematoma
• hypertension
• risk factor

Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease. Most SSEH cases involve back and/or neck pain. We report the cases of two men who experienced SSEH with dysstasia but without back or neck pain.

This study presents two cases involving elderly Japanese men who visited an emergency department because of sudden dysstasia without back or neck pain. The results of the neurological examinations revealed ataxic gait. Cervical spinal epidural hematomas were observed by computed tomography and magnetic resonance imaging. One patient underwent hematoma removal and decompression by corpectomy, whereas the other patient received conservative treatment and observation. The patients were discharged without sequelae.

Spinal epidural hematomas are difficult to diagnose, and a delayed diagnosis can adversely affect the patient's quality of life. These hematomas should be considered in the differential diagnosis of cerebrovascular diseases.

• Back pain
• corpectomy
• dysstasia
• elderly
• spontaneous spinal epidural hematoma

• Clopidogrel
• magnetic resonance imaging
• spinal epidural hematoma
• subarachnoid hemorrhage

Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression. Anesthetic management should also include measures to maintain the mean arterial pressure to improve spinal cord perfusion. Furthermore, spine surgery in pregnant patients needs special consideration in terms of positioning and in the postoperative period.

We present a case of a 35-year-old white woman at 21 weeks of gestation with a spontaneous cervical epidural hematoma. Fiberoptic bronchoscope-guided nasal intubation was a safe option to ensure a higher rate of successful endotracheal intubation while minimizing the risk of aggravating the injury. Her care posed other multiples challenges that required a multidisciplinary team approach.

The case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia.

• Anesthesia
• Fiberoptic bronchoscope intubation
• Pregnancy
• Spontaneous cervical epidural hematoma

• cervical spondylotic myelopathy
• magnetic resonance imaging
• spinal epidural hematoma
• spontaneous cervical epidural hematoms
• surgical treatment

• Neurological disorders
• Neurological manifestations
• Neurosurgery
• Outcomes research
• Prognosis

• Outcomes research
• Quality of life
• Rehabilitation

• Coronary angiogram
• Epidural spinal hematoma
• Paraplegia

Spontaneous spinal epidural hematoma (SSEH) has been reported as a rare cause of spinal cord compression, especially in children. Clinical features are usually nonspecific, although cervicothoracic location of hematoma could be presented with progressive paraplegia. Guillian-Barré syndrome (GBS) is clinically defined as an acute peripheral neuropathy causing progressive limb weakness. Because SSEH and GBS have very similar signs and symptoms, SSEH could be misdiagnosed as GBS. Nevertheless, they can be presented together. We describe a rare case of SSEH coexisting with GBS.

• Guillain-Barré syndrome
• Pediatrics
• Spinal epidural hematoma

Iatrogenic or spontaneous spinal hematomas are rarely seen and present with multiple symptoms that can be difficult to localize. Most spontaneous spinal hematomas are multifactorial, and the pathophysiology is varied. Here, we present a case of a scattered, multicomponent, combined subdural and epidural spinal hematoma that was managed conservatively.

A 38-year-old woman came to the emergency department (ED) complaining of severe neck and back pain. She had undergone a caesarean section under epidural anesthesia 4 days prior to her arrival in the ED. She was placed on heparin and then warfarin to treat a pulmonary embolism that was diagnosed immediately postpartum. Her neurological examination at presentation demonstrated solely the existence of clonus in the lower extremities and localized cervical and low thoracic pain. In the ED, the patient's international normalized ratio was only mildly elevated. Spinal magnetic resonance imaging revealed a large thoracolumbar subdural hematoma with some epidural components in the upper thoracic spine levels. Spinal cord edema was also noted at the T6-T7 vertebral level. The patient was admitted to the neurosurgical intensive care unit for close surveillance and reversal of her coagulopathy. She was treated conservatively with pain medication, fresh frozen plasma, and vitamin K. She was discharged off of warfarin without any neurological deficit.

Conservative management of spinal hematomas secondary to induced coagulopathies can be effective. This case suggests that, in the face of neuroimaging findings of significant edema and epidural blood, the clinical examination should dictate the management, especially in such complicated patients.

• Caesarean section
• hematoma
• intensive care unit
• subdural–epidural

Spontaneous spinal epidural hematoma (SSEH) is an uncommon but potentially fatal condition. The increased bleeding tendency associated with anticoagulant medications has been proven to increase the risk of SSEH. The symptoms of SSEH usually begin with sudden severe neck or back pain and are followed by neurological deficits. However, some cases present with only axial pain or with radicular pain similar to herniated disc disorders.

A 28-year-old healthy man developed a sudden onset of severe neck and right shoulder pain with mild arm weakness. The MRI revealed an SSEH that was compressing his spinal cord in the right posterolateral epidural space from C2-C6. On the second hospital day, his symptoms suddenly improved, and most of the hematoma had spontaneously resolved.

Currently, the incidence of SSEH is expected to increase. Pain physicians must include SSEH in their differential diagnosis for patients with axial pain or radicular symptoms alone, particularly when risk factors are present.

• Cervical
• Epidural Hematoma
• Spinal

A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS). The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI) showed an image of a mass compressing the medulla.

We report a case of paraplegia without neurologic deficit of upper extremities following cervical epidural catheterization using air during the loss of resistance technique. A 41-year-old woman diagnosed with complex regional pain syndrome had upper and lower extremity pain. A thoracic epidural lead was inserted for a trial spinal cord stimulation for treating lower extremity pain and cervical epidural catheterization was performed for treating upper extremity pain. Rapidly progressive paraplegia developed six hours after cervical epidural catheterization. Spine CT revealed air entrapment in multiple thoracic intervertebral foraminal spaces and surrounding epidural space without obvious spinal cord compression before the decompressive operation, which disappeared one day after the decompressive operation. Her paraplegia symptoms were normalized immediately after the operation. The presumed cause of paraplegia was transient interruption of blood supply to the spinal cord through the segmental radiculomedullary arteries feeding the spinal cord at the thoracic level of the intervertebral foramen caused by the air.

• Air
• Cervical
• Complication
• Paraplegia
• Spinal cord ischemia

• Epidural
• Hematoma
• Laminectomy
• Laminoplasty
• Magnetic resonance
• Spine

• Functional recovery
• Quadriplegia
• Spontaneous spinal epidural hematoma
• Surgical treatment

• cervical
• cesarean section
• epidural hematoma
• pregnancy
• recurrent
• spontaneous resolution
• spontaneous spinal epidural hematoma

• Acenocoumarol
• Oral anticoagulants
• Spontaneous epidural hematoma of the spine

• multiregional spinal stenosis
• ossified posterior longitudinal ligament
• ossified yellow ligament
• tandem stenosis

A 45-year-old female patient visited the hospital complaining of severe sudden headache and posterior neck pain. The patient did not have any traumatic history or abnormal neurologic finding. The patient had sudden quadriplegia and sensory loss. Cervical spine MRI scan was taken, and the compatible findings to acute epidural hematoma were shown. The emergency operation was performed. After the operation, the patient recovered all motor and senses. As there was CSF leakage in the postoperative wound, this was confirmed by cervical spinal computed tomography (CT). Then lumbar drainage was thus performed. The opening pressure upon lumbar puncture was not measured as it was very low. As a result of continous CSF leakage, dural repair was performed. After the operation, the patient had been discharged without neurologic deficits. In this case, it is sensible to suspect intracranial hypotension as a possible cause of spinal EDH.

• Cerebrospinal fluid leakage
• Headache
• Neck pain
• Spinal epidural hematoma

• Cervical epidural hematoma
• cervical trauma
• traumatic spinal hematoma