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Soni TV, Patel SJ, Shah VK, Joshipura KM. Catastrophic spontaneous spinal epidural hematoma following thrombolysis: An intersection of neurosurgical and cardiological challenges - An institutional experience. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:371-374. [PMID: 39483830 PMCID: PMC11524568 DOI: 10.4103/jcvjs.jcvjs_62_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/01/2024] [Indexed: 11/03/2024] Open
Abstract
Catastrophic spontaneous spinal epidural hematoma (SSEH) following thrombolysis poses a complex intersection of neurosurgical and cardiological challenges. This case report presents the institutional experience of a 66-year-old female who developed rapid-onset compressive myelopathy after thrombolysis for inferior wall myocardial infarction with injection streptokinase. SSEH, although rare, demands prompt recognition due to its potential for permanent neurologic injury and mortality. The discussion highlights the clinical significance, anatomical considerations, and multidisciplinary approach requisite for accurate diagnosis and effective management of SSEH. The conclusion underscores the necessity for clinicians, particularly cardiologists administering thrombolytic therapies, to consider SSEH in postthrombolysis patients presenting with neurological deficits.
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Affiliation(s)
- Tushar V. Soni
- Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Shreyansh J. Patel
- Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Varshesh K. Shah
- Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Kavan M. Joshipura
- Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
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Vastani A, Baig Mirza A, Khoja AK, Bartram J, Shaheen S, Rajkumar S, China M, Lavrador JP, Bleil C, Bell D, Thomas N, Malik I, Grahovac G. Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis. Neurosurg Rev 2022; 46:21. [PMID: 36538111 DOI: 10.1007/s10143-022-01914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare disease defined as blood accumulation within the vertebral epidural space without a cause identified, which can lead to severe neurological deficits. We aim to provide a comprehensive understanding of the prognostic factors affecting surgical outcomes in true SSEH and propose a critical time frame for operative management. A systematic literature search was performed and registered, using OVID Medline and EMBASE, in line with the PRISMA guidelines. Relevant demographic, clinical, surgical, and outcome data were extracted. The ASIA scale was uniformly used throughout our systematic review. Statistical analysis was performed via logistic regression. Of the 1179 articles examined, we included 181 studies involving 295 adult patients surgically treated for SSEH. SSEH were most commonly found in the cervicothoracic spine, with 2-4 spinal segments most commonly involved. Multivariable logistic regression model showed that the following factors were statistically significant in the post-operative outcome: operation type (P = 0.024), pre-operative neurologic status (P < 0.001), use of warfarin (P = 0.039), and operative interval (P = 0.006). Our retrospective analysis confirms the reversibility of severe neurological deficits after surgical intervention, with a prognosis of post-operative outcomes determined by the use of warfarin, pre-operative ASIA grade, and above all surgical evacuation within 12 h.
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Affiliation(s)
- Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Abbas Khizar Khoja
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Safwan Shaheen
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Shivani Rajkumar
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Musa China
- Division of Medicine, University College London (UCL), London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Cristina Bleil
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - David Bell
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Irfan Malik
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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Koo JM, Hwang SH, Yoon J, Yoon SH, Cho BK. Recurrent Cervical Spontaneous Spinal Epidural Hematoma with Conservative Management: A Case Report. Korean J Neurotrauma 2021; 17:186-191. [PMID: 34760832 PMCID: PMC8558013 DOI: 10.13004/kjnt.2021.17.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/03/2022] Open
Abstract
Cervical spontaneous spinal epidural hematoma (CSSEH) is a rare condition that can be potentially fatal if not properly diagnosed and managed. While prompt surgical decompression and evacuation of the hematoma are generally considered as the first line of treatment, mild cases that were managed through observation and conservative treatment have been reported. Our patient was a 24-year-old man who experienced two CSSEH events 8 months apart, both of which were managed conservatively. This was a rare case of recurrent CSSEH in which recovery was achieved without surgical intervention. We believe conservative treatment with close observation may be effective in CSSEH patients presenting with mild neurologic symptoms who have a tendency towards spontaneous neurologic improvement.
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Affiliation(s)
- Jung Myung Koo
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sung Hwan Hwang
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Joonho Yoon
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Hoon Yoon
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
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Liu H, Zhang T, Qu T, Yang CW, Li SK. Spinal epidural hematoma after spinal manipulation therapy: Report of three cases and a literature review. World J Clin Cases 2021; 9:6501-6509. [PMID: 34435018 PMCID: PMC8362556 DOI: 10.12998/wjcc.v9.i22.6501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND 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.
CASE SUMMARY 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.
CONCLUSION 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.
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Affiliation(s)
- Hua Liu
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Tao Zhang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Tao Qu
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Cheng-Wei Yang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Song-Kai Li
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
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Gandhi D, Chowdhary A, Kichloo A, Singh J, Patel L, Shah J. An unusual case of ventral spontaneous spinal epidural hematoma: Case report with review of literature. Radiol Case Rep 2021; 16:2207-2210. [PMID: 34178193 PMCID: PMC8213979 DOI: 10.1016/j.radcr.2021.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous spinal epidural hematoma is a rare predominantly idiopathic entity which can prompt acute neurologic symptoms and if not managed in time can lead to devastating outcomes. High index of suspicion is required for early diagnosis on MRI for a prompt management of patients showing sudden neurologic deficits. Our patient was 42-year-old female who presented with sudden onset of numbness followed by weakness in both lower limbs and urinary retention without any comorbidity or any medication. MRI whole spine done within 14 hours of symptom onset showed ventral epidural hematoma without any vascular malformation. Immediate decompressive laminectomy with evacuation of hematoma improved power in both lower limbs with regaining bowel and bladder function. The key here is timely surgical decompression of the hematoma for a favorable neurosurgical outcome. Although there is a recent development towards non–surgical treatment, it needs to be well established yet and require such approach on case-to-case basis.
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Affiliation(s)
- Darshan Gandhi
- Department of Diagnostic Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611, USA
| | - Anisa Chowdhary
- Department of Medicine, Maulana Azad Medical College 2, Bahadur Shah Zafar Marg, New Delhi, Delhi 110002, India
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University School of Medicine, 1280 East Campus Dr, Mt Pleasant, MI 48858, USA
| | - Jagmeet Singh
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA 18510, USA
| | - Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, 800 E 28th Street, Minneapolis, MN 55407, USA
| | - Jayun Shah
- Department of Neurosurgery, Sterling Hospitals, Memnagar, Ahmedabad, Gujarat 380052, India
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Çankaya BY, Alper F, Karaman A, Akgün M. Hemorrhagic lesions associated with anticoagulant therapy: a pictorial review. J Thromb Thrombolysis 2020; 51:1067-1077. [PMID: 33034813 DOI: 10.1007/s11239-020-02305-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
Anticoagulant therapy is a treatment that can cause bleeding complications in many anatomical structures. Intracranial, intramuscular and intraabdominal bleeding are internal bleeding that can be secondary to anticoagulated therapy. The prognosis of these hemorrhages can be very good, depending on the anatomical region involved, or they can be fatal. Early recognition of especially intracranial and renal hemorrhages is important for prognosis. For diagnosis, CT and / or MRI should be evaluated according to the region. Internal bleeding should be kept in mind in cases such as sudden hemoglobin decrease or change in consciousness during anticoagulant therapy.
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Affiliation(s)
- Bahar Yılmaz Çankaya
- Department of Radiology, School of Medicine, Atatürk University, 25240, Erzurum, Turkey.
| | - Fatih Alper
- Department of Radiology, School of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Adem Karaman
- Department of Radiology, School of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Metin Akgün
- Department of Pulmonary Diseases, School of Medicine, Atatürk University, 25240, Erzurum, Turkey
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Morimoto D, Kim K, Kubota A, Kokubo R, Iwamoto N, Hattori Y, Morita A. Recurrent Cervical Spinal Epidural Hematoma: Case Report and Literature Review. NMC Case Rep J 2020; 7:157-160. [PMID: 33062561 PMCID: PMC7538460 DOI: 10.2176/nmccrj.cr.2019-0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/28/2020] [Indexed: 12/04/2022] Open
Abstract
Spinal epidural hematoma (SEDH) is an uncommon pathology. Here, we report a case of SEDH with recurrences, along with a literature review of relevant cases to identify characteristics of SEDH recurrence. A 13-year-old girl experienced sudden-onset of back pain and bilateral leg weakness. She was diagnosed with a cervical idiopathic epidural hematoma, and the symptoms subsided with conservative management. Four months after the event, she again experienced back pain due to recurrence of the cervical epidural hematoma, but she was observed because no neurological deficits could be detected. Fifteen months after the initial SEDH, she experienced severe back pain and tetra-paresis due to recurrence. The SEDH was located in the left ventral and dorsal aspect at the C6–T1 level, with severe spinal cord compression. The hematoma was removed through left hemilaminectomy. Bleeding was noted from the epidural venous plexus along the left C6 spinal root, which had coagulated. After hematoma resection, her symptoms gradually improved, and she was discharged 3 weeks after surgery without any neurological deficits. No hematoma recurrence has since been experienced. Recurrent SEDH is relatively rare, with only 11 cases previously reported. Recurrent hematoma cases are more common in young, female patients, while SEDH, in general, is more common in males in their late forties. The recurrence interval is shorter in non-surgical cases than those requiring surgery. Knowledge of these characteristics may be useful in the future management of SEDH.
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Affiliation(s)
- Daijiro Morimoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Rinko Kokubo
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan
| | - Naotaka Iwamoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Okazaki T, Nakagawa H, Hayase H, Irie S, Inagaki T, Saito O, Yamashina M, Nagahiro S, Saito K. Idiopathic and Chronic Epidural Hematoma in the Lumbar Spine: A Case Report and Review of Literatures. Neurol Med Chir (Tokyo) 2018; 58:138-144. [PMID: 29415912 PMCID: PMC5929923 DOI: 10.2176/nmc.cr.2017-0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Spontaneous and chronic epidural hematoma (SSEH) in the lumbar spine is rare, and idiopathic and chronic SSEH in the lumbar spine is extremely rare disease. Most of lumbar SSEH were acute and secondary with trauma, hematologic disorders, drug, and surgical procedure. Only 20 cases of chronic SSEH in the lumbar spine have been reported and 14 cases among them were considered to be idiopathic. Definitive guidelines for management of this condition are not clear and surgical total evacuation was performed in most of the cases. Some authors reported the epidural bleeding originates in the rupture of Batson’s plexus due to a rise in intra-abdominal pressure, but the mechanism is not clearly clarified. We report a surgical case of idiopathic and chronic SSEH. A 61-year-old woman suffered a sudden onset of severe lumbar pain during sleep. She had no history of trauma, spinal surgery, or hypertension. Magnetic resonance imaging revealed a lumbar chronic epidural hematoma which compressed the dural sac behind and extended from L2 to L5. This patient underwent the partial evacuation of the hematoma with partial hemilaminectomy on left at L2/3, resulting in immediate pain relief and resolution of symptoms and almost absorption of the hematoma within 1 week of the procedure. We presented this rare case and reviewed idiopathic and chronic epidural hematoma in the lumbar spine.
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Affiliation(s)
- Toshiyuki Okazaki
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital.,Department of Neurosurgery, Tokushima University
| | | | - Hitoshi Hayase
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | - Shinsuke Irie
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | - Toru Inagaki
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | - Osamu Saito
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | | | | | - Koji Saito
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
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Chan KM, Law KL, Chung CH. Case Report: Thoracic Spinal Epidural Haematoma – an Unusual Cause of Chest Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chest pain is a common presentation to the emergency department. Aetiologies to be considered are usually cardiac or pulmonary in origin. We reported a rare case of thoracic spinal epidural haematoma initially presenting to the emergency department with chest pain. The patient re-attended the emergency department four hours after discharge with symptoms of cord compression. Magnetic resonance imaging of the thoracic spine showed an epidural haematoma causing cord compression. Surgical decompression was performed with gradual resolution of symptoms. Simply ruling out acute coronary syndrome may not be sufficient in patients presenting with chest pain.
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Maddali P, Walker B, Fisahn C, Page J, Diaz V, Zwillman ME, Oskouian RJ, Tubbs RS, Moisi M. Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia. Cureus 2017; 9:e1032. [PMID: 28357164 PMCID: PMC5354393 DOI: 10.7759/cureus.1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.
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Affiliation(s)
| | | | | | - Jeni Page
- Neurosurgery, Swedish Neuroscience Institute
| | - Vicki Diaz
- Neurological Surgery, Wayne State University
| | | | - Rod J Oskouian
- Neurosurgery, Complex Spine, Swedish Neuroscience Institute
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Wu ZY, Zhu YJ, Chu L, Cheng CY, Chen CM, Hui-Ting H. Full-Endoscopic Transforaminal Approach for Removal of a Spontaneous Spinal Epidural Hematoma. World Neurosurg 2017; 98:883.e13-883.e20. [DOI: 10.1016/j.wneu.2016.07.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 01/30/2023]
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Spinal Epidural Hematoma Due To Tyre-Blast Injury: A Case Report. Spine (Phila Pa 1976) 2017; 42:E125-E127. [PMID: 27270639 DOI: 10.1097/brs.0000000000001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case report. OBJECTIVE The objective of this article is to report a spinal epidural hematoma (SEH) due to shock wave. SUMMARY OF BACKGROUND DATA SEH is an infrequent condition. Most of SEH's are spontaneous. We have reported an SEH traumatic case without bone lesions due to exploding truck tire. A different category of blast injuries is the one related with exploding tyres. Shock waves are the main mechanism that is responsible for blast injuries. We are presenting the first report of acute SEH due to shock wave. METHODS A 33-year-old man was brought to the emergency department with complaints of weakness and numbness of the upper extremities. There was an epidural high-signal density without osseous lesion in computerized tomography from the level of C2 to C5, and there was a T2-weighted hyperintense lesion in magnetic resonance imaging from the level of C2 to C5 with compression of the spinal cord the anterior and posterior which proved to be an SEH. RESULTS The patient was discharged from the hospital with complete neurologic recovery. CONCLUSION SEH should be considered possible in the blast injury. SEH condition carries a significant risk of morbidity and mortality without early recognition and rapid management. LEVEL OF EVIDENCE 5.
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Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma. Case Rep Surg 2016; 2016:5430708. [PMID: 27088028 PMCID: PMC4819082 DOI: 10.1155/2016/5430708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/01/2016] [Indexed: 01/30/2023] Open
Abstract
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.
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Babayev R, Ekşi MŞ. Spontaneous thoracic epidural hematoma: a case report and literature review. Childs Nerv Syst 2016; 32:181-7. [PMID: 26033378 DOI: 10.1007/s00381-015-2768-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/22/2015] [Indexed: 12/23/2022]
Abstract
Spinal epidural hematoma is a rare neurosurgical emergency in respect of motor and sensory loss. Identifiable reasons for spontaneous hemorrhage are vascular malformations and hemophilias. We presented a case of spontaneous epidural hematoma in an 18-year-old female patient who had motor and sensory deficits that had been present for 1 day. On MRI, there was spinal epidural hematoma posterior to the T2-T3 spinal cord. The hematoma was evacuated with T2 hemilaminectomy and T3 laminectomy. Patient recovered immediately after the surgery. Literature review depicted 112 pediatric cases (including the presented one) of spinal epidural hematoma. The female/male ratio is 1.1:2. Average age at presentation is 7.09 years. Clinical presentations include loss of strength, sensory disturbance, bowel and bladder disturbances, neck pain, back pain, leg pain, abdominal pain, meningismus, respiratory difficulty, irritability, gait instability, and torticollis. Most common spinal level was cervicothoracic spine. Time interval from symptom onset to clinical diagnosis varied from immediate to 18 months. Spinal epidural hematoma happened spontaneously in 71.8 % of the cases, and hemophilia was the leading disorder (58 %) in the cases with a definable disorder. Partial or complete recovery is possible after surgical interventions and factor supplementations.
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Affiliation(s)
- Rasim Babayev
- Department of Neurosurgery, National Center of Oncology, Baku, Azerbaijan
| | - Murat Şakir Ekşi
- Department of Orthopedic Surgery-Spine Center, University of California at San Francisco, 500 Parnassus Avenue MU320 West, San Francisco, CA, 94143-0728, USA.
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15
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Karataş L, Mengi G, Özyemişçi-Taşkıran Ö. A missed Behçet's case presenting with spontaneous epidural hematoma. Eur J Rheumatol 2015; 2:167-168. [PMID: 27708958 DOI: 10.5152/eurjrheum.2015.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022] Open
Abstract
Spinal vascular events related to Behçet's disease are relatively uncommon. Deep vein thrombosis is the most frequent vascular involvement. Anticoagulant therapy is a debated issue in Behçet's disease. In this case report, we present a patient with a delayed diagnosis of Behçet's disease after development of cervical epidural hematoma following anticoagulant therapy due to deep venous thrombosis. Anticoagulant therapy without immunosuppressive therapy leading to uncontrolled systemic inflammation may be the cause of spinal epidural hematoma. On the other hand, epidural vascular involvement as a vasculitic manifestation of Behçet's disease in conjunction with anticoagulant therapy may have predisposed to spontaneous bleeding via increased fragility or microaneurysms in epidural arteries. In this case report, the importance of a multidisciplinary approach to Behçet's disease is emphasized.
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Affiliation(s)
- Levent Karataş
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gönen Mengi
- Department of Rheumatology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Özden Özyemişçi-Taşkıran
- Department of Physical Medicine and Rehabilitation, Koç University Faculty of Medicine, İstanbul, Turkey
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Banczerowski P, Bognár L, Rappaport ZH, Veres R, Vajda J. Novel surgical approach in the management of longitudinal pathologies within the spinal canal: the split laminotomy and "archbone" technique: alternative to multilevel laminectomy or laminotomy. Adv Tech Stand Neurosurg 2014; 41:47-70. [PMID: 24309920 DOI: 10.1007/978-3-319-01830-0_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Multilevel laminectomy to open the spinal canal carries the risk of spinal deformities and instability. With the aim of preserving and reconstructing the posterior structures the authors developed a novel, minimally invasive, multilevel spinous process splitting and distracting laminotomy approach with or without complementary corticocancellous iliac crest or PEEK cage "archbone" grafting. The technique allows exploration of the spinal canal and the removal of intramedullary pathologies. Moderate enlargement of the spinal canal with preservation of the majority of posterior structures is also possible, so that muscle attachments remain intact and postoperative complications are substantially reduced.This surgical approach, while fulfilling the requirements of previous laminotomy techniques, helps to prevent damage to the crucial posterior stabilizers of the spine. In contrast to conventional spinal canal approaches, preservation of the majority of posterior structures is possible, leaving muscle attachments on the spinous processes and laminae completely intact.Furthermore, the procedure for exposure and decompression of the spinal canal is a suitable method for all spinal segments, the cervical, thoracic, and the lumbar spine in all age groups.
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Affiliation(s)
- Peter Banczerowski
- National Institute of Neurosurgery, Amerikai út 57, 1145, Budapest, Hungary,
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Kim JK, Kim TH, Park SK, Hwang YS, Shin HS, Shin JJ. Acute spontaneous cervical epidural hematoma mimicking cerebral stroke: a case report and literature review. KOREAN JOURNAL OF SPINE 2013; 10:170-3. [PMID: 24757481 PMCID: PMC3941760 DOI: 10.14245/kjs.2013.10.3.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 08/25/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022]
Abstract
Spontaneous cervical epidural hematoma (SCEDH) is a rare disease, but can cause severe neurologic impairment. We report a case of a 68-year-old female who presented with sudden onset, posterior neck pain, right shoulder pain, and progressive right hemiparesis mimicking stroke with no trauma history. Initial brain CT and diffusion MRI performed to rule out brain lesion did not show any positive findings. Laboratory examination presented only severe thrombocytopenia (45,000/mm3). Subsequent cervical MRI revealed a cervical epidural mass lesion. We confirmed that it was pure hematoma through C5 unilateral total laminectomy and C6 partial hemilaminectomy. She achieved complete neurologic recovery with active rehabilitation. Early surgical decompression for SCEDH with neurologic impairment should be recommended for better outcome.
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Affiliation(s)
- Jin Kyu Kim
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae Hong Kim
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sang Keun Park
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yong Soon Hwang
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyung Shik Shin
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Sanggye-Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Fuster S, Castañeda S, Ferrer E, Wang J, Poblete J. Spontaneous chronic epidural hematoma of the lumbar spine mimicking an extradural spine tumour. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 3:S337-40. [PMID: 22718047 DOI: 10.1007/s00586-012-2402-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/03/2012] [Indexed: 01/30/2023]
Abstract
PURPOSE Spontaneous chronic epidural hematomas are extremely rare and can be extremely challenging to diagnose and differentiate. The clinical findings, computed tomographic scan and magnetic resonance imaging does not always enough to complete differentiate this condition. Our purpose is to report a case of a spontaneous chronic epidural hematoma presenting as an extradural mass leading to compressive radicular symptoms with images of bony scalloping which are sparsely reported in the literature. METHODS We describe a 61-year-old woman who was evaluated after 18-month history of pain, disestesias and mild weakness in both lower extremities with significant radicular symptoms on the right side associated to neurogenic claudication. RESULTS CT scans revealed a nodular image of soft tissue density located in the right anterolateral epidural space at the L4-L5 level demonstrating resorption of the bony margins. MRI studies revealed a round mass in the vertebral canal displacing the dural sac and scalloping the posterior wall of the L4 vertebral body. Diagnosis was established between a degenerative cyst versus an atypical neurinoma. Surgical findings demonstrated an isolated well-formed chronic hematoma. CONCLUSION Spontaneous chronic epidural hematomas are rare, even more when they produce scalloping of bony structures becoming a diagnostic challenge. Therefore they should be always considered as a differential diagnosis in patients with extradural chronic compressions taking into account that also chronic epidural hematomas can cause bone involvement.
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Affiliation(s)
- Salvador Fuster
- Spine Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Catalunya, Spain
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Postoperative spinal epidural hematoma at a site distant from the main surgical procedure: a case report and review of the literature. Spine J 2010; 10:e21-5. [PMID: 20362244 DOI: 10.1016/j.spinee.2010.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 02/05/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Postoperative spinal epidural hematomas are known complications of spinal surgery. However, to our knowledge, there are no known cases of postoperative spinal epidural hematoma that occurred distant from the portion of the procedure that breached the spinal canal. PURPOSE To report a case and review the literature on the development of postoperative spinal epidural hematoma at a site distant from the portion of the surgical procedure that breached the spinal canal. STUDY DESIGN Case report and review of the literature. METHODS One patient at our institution developed a hematoma at a site distant from the surgical procedure that breached the spinal canal. We retrospectively reviewed the patient's clinical charts, radiographs, and computed tomography scans. RESULTS A 57-year-old woman with adult scoliosis and junctional kyphosis underwent a pedicle subtraction osteotomy and long spinal fusion from T3 to the sacrum. Three hours postoperatively, she developed paraplegia with a neurologic deficit at a level distant from the site at which the spinal canal was surgically breached. A computed tomography myelogram revealed a spinal epidural hematoma that was causing compression of the spinal cord in the upper thoracic spine. The patient was returned to the operating room emergently and underwent laminectomy and hematoma evacuation. She had near-complete recovery 5 months after surgery. CONCLUSION Spinal epidural hematomas are rare but dangerous complications that can result in severe neurologic deficits. A neurologic examination should always be conducted in the operating room immediately after surgery; if it is abnormal, spinal epidural hematoma should be suspected. If the examination indicates a deficit at a site distant from the original surgery, then diagnostic reimaging (magnetic resonance imaging or computed tomography myelogram) is indicated.
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Cauda equina syndrome in an eleven-month-old infant following sacrococcygeal teratoma tumor resection and coccyx excision: case report. Spine (Phila Pa 1976) 2010; 35:E22-4. [PMID: 20042943 DOI: 10.1097/brs.0b013e3181b8eeb2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report of cauda equina syndrome (CES) in an 11-month-old infant, following sacrococcygeal teratoma tumor resection and coccyx excision leading to a spinal epidural hematoma (SEH). OBJECTIVE To illustrate a rare case of CES and SEH in an infant, and discuss the need for sealing access to the spinal canal after sacrococcygeal surgical resection and reconstruction. SUMMARY OF BACKGROUND DATA To the authors' knowledge, this is the youngest patient reported to develop a SEH and CES, and the only patient reported in the literature to develop a SEH after coccyx excision. METHODS Seventeen days after undergoing sacrococcygeal tumor resection and coccyx excision, the patient presented to the emergency room with a large distended bladder, loss of rectal tone, and significant weakness in the lower extremities. Magnetic resonance imaging of the thoracic and lumbar spine showed a large lesion in the dorsal epidural space extending from T12 to the tip of the communicating with the prior operative site by means of the previous coccyx resection. The infant was emergently brought to the operating room for decompression. RESULTS The patient was discharged 6 days later with diminished neurologic function, but demonstrated significant improvement over the next 18 months and currently remains disease free and neurologically normal at age 7. CONCLUSION This case demonstrates the need for future examination of sacrococcygeal surgical resection and subsequent reconstruction of excised structures to decrease the risk of communication with the epidural space.
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Postoperative spinal epidural hematoma resulting in cauda equina syndrome: a case report and review of the literature. CASES JOURNAL 2009; 2:8584. [PMID: 19830087 PMCID: PMC2740261 DOI: 10.4076/1757-1626-2-8584] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 06/27/2009] [Indexed: 01/30/2023]
Abstract
Spinal epidural hematoma is a well known complication of spinal surgery. Clinically insignificant small epidural hematomas develop in most spinal surgeries following laminectomy. However, the incidence of clinically significant postoperative spinal epidural hematomas that result in neurological deficits is extremely rare. In this report, we present a 33-year-old female patient whose spinal surgery resulted in postoperative spinal epidural hematoma. She was diagnosed with lumbar disc disease and underwent hemipartial lumbar laminectomy and discectomy. After twelve hours postoperation, her neurologic status deteriorated and cauda equina syndrome with acute spinal epidural hematoma was identified. She was immediately treated with surgical decompression and evacuation of the hematoma. The incidence of epidural hematoma after spinal surgery is rare, but very serious complication. Spinal epidural hematomas can cause significant spinal cord and cauda equina compression, requiring surgical intervention. Once diagnosed, the patient should immediately undergo emergency surgical exploration and evacuation of the hematoma.
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Banczerowski P, Vajda J, Veres R. Exploration and decompression of the spinal canal using split laminotomy and its modification, the "archbone" technique. Neurosurgery 2008; 62:ONS432-40; discussion ONS440-1. [PMID: 18596526 DOI: 10.1227/01.neu.0000326031.31843.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To develop a novel minimally invasive approach suitable for exploring different pathologies located in the spinal canal, allowing moderate enlargement of the canal with preservation of the majority of posterior structures so muscle attachments remain intact and postoperative complications are reduced. METHODS The authors developed a multilevel spinous process splitting and distracting laminotomy technique with or without complementary corticocancellous iliac crest "archbone" autografting. Technical details are discussed. The multilevel spinous process splitting and distracting laminotomy technique with or without complementary iliac bone grafting was used in 19 patients with different pathologies of the spinal canal. RESULTS Satisfactory surgery of the lesions located within the spinal canal, especially intramedullary, was achieved in all patients using this new approach. The affected area of the spine was cervical in seven patients, cervicothoracic in four patients, thoracic in five patients, and thoracolumbar in three patients. The average number of split laminae was three (range, 2-6). Histological results were as follows: seven intramedullary astrocytomas, eight ependymomas, two cavernous hemangiomas, one dural arteriovenous malformation, and one hemangioblastoma. Of the eight ependymomas, 75% were removed completely and 25% were partially removed. Of the seven astrocytomas, 28.7% were removed completely, 14.3% were removed subtotally, and 57% were partially removed. The cavernous hemangiomas and the hemangioblastoma were completely removed. The approach used did not affect the extent of resection or neurological outcome. The spinous processes were closed directly in 13; in six cases, a tricortical iliac bone graft was placed between the facing bony parts of the spinous processes. The mean duration of splitting and distracting the spinous process was 16 minutes (range, 11-28 min) for the first process and 8 minutes (range, 5-14 min) for each additional spinous process. The mean duration of the whole surgical procedure, including intraspinal surgery, was 159 minutes (range, 90-290 min). The mean blood loss was 158 ml (range, 48-442 ml). The average length of hospital stay was 7.2 days. The average follow-up period was 15.4 months. Fifty-one of the 57 (89.5%) spinous process computed tomographic scans demonstrated bony healing with or without a graft between the osteotomized faces. Of the 57 spinous process computed tomographic scans, fracture of the spinous process was seen in nine (15.8%) and traumatic bony changes of the body of the vertebra in the midline in three (5.2%); these were without clinical significance and they later showed complete healing. CONCLUSION This surgical approach fulfills the requirements of other laminotomy techniques and helps prevent damage to the crucial posterior stabilizers of the spine. In contrast to conventional spinal canal approaches, preservation of the majority of posterior structures leaves muscle attachments on the spinous processes and laminae completely intact. Furthermore, the technique for exposure and decompression of the spinal canal is a suitable method for all spinal segments, the cervical, thoracic, and the lumbar spine in all age groups.
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25
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Gurkanlar D, Acikbas C, Cengiz GK, Tuncer R. Lumbar epidural hematoma following lumbar puncture: the role of high dose LMWH and late surgery. A case report. Neurocirugia (Astur) 2007; 18:52-5. [PMID: 17393048 DOI: 10.1016/s1130-1473(07)70312-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spinal epidural hematoma (SEH) is a known complication of spinal surgery, but the incidence of post-surgical SEHs that result in neurologic deficits is extremely rare (0.1%). Patients that require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk of developing an epidural hematoma. The introduction of higher dose of low molecular weight heparin (LMWH) twice daily 30 mg regimen) increased the reported incidence of neuroaxial hematomas. Surgery performed within 8 hours makes good or partial recovery of neurologic function. Our patient was also started on higher dose of LMWH and developed neurological deficits due to a SEH following lumbar puncture. She underwent operation after six days and she had a mild recovery following the operation. Current administration of high doses of LMWH can cause SEH even after a lumbar puncture, which was performed without multiple attempts. Although surgery performed within 8 hours makes good or partial recovery of neurologic function, laminectomy and epidural hematoma evacuation performed after three days can also have successful results.
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MESH Headings
- Anticoagulants/administration & dosage
- Anticoagulants/adverse effects
- Decompression, Surgical
- Female
- Hematoma, Epidural, Spinal/chemically induced
- Hematoma, Epidural, Spinal/etiology
- Hematoma, Epidural, Spinal/surgery
- Heparin, Low-Molecular-Weight/administration & dosage
- Heparin, Low-Molecular-Weight/adverse effects
- Humans
- Hypesthesia/etiology
- Intervertebral Disc Displacement/complications
- Laminectomy
- Lumbar Vertebrae
- Middle Aged
- Muscle Weakness/etiology
- Reflex, Abnormal
- Sciatica/etiology
- Spinal Cord Compression/etiology
- Spinal Puncture/adverse effects
- Tomography, X-Ray Computed
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Affiliation(s)
- D Gurkanlar
- Department of Neurosurgery, Akdeniz University, School of Medicine, Antalya, Türkiye
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26
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Hida S, Naito M, Arimizu J, Morishita Y, Nakamura A. The transverse placement laminoplasty using titanium miniplates for the reconstruction of the laminae in thoracic and lumbar lesion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:1292-7. [PMID: 16612643 PMCID: PMC3233967 DOI: 10.1007/s00586-006-0099-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 03/03/2006] [Accepted: 03/06/2006] [Indexed: 10/24/2022]
Abstract
Laminoplasty for thoracic and lumbar spine surgery enables surgeons to preserve the posterior arch of the spine while preventing invasion of hematoma and scar tissue, postoperative instability, subluxation, and kyphotic deformities. The authors have developed a new surgical technique: namely, transverse placement laminoplasty (TPL) using titanium miniplates. Eight patients and 18 laminae underwent TPL using a titanium mini-plate. The preoperative diagnoses were six intradural tumors, one ossification of a yellow ligament and one spontaneous spinal cord herniation. The mean blood loss was 219 g and the mean duration of surgery was 3 h and 54 min. The mean postoperative follow-up period was 2 years and 1 month. All eight patients started to sit with a soft brace within the second postoperative day, and were able to walk within the fifth postoperative day. There were no cases of spinal deformity, an invasion of hematoma or scar tissue into the spinal canal on magnetic resonance imaging, or back pain. TPL simultaneously enables surgeons to obtain sufficient field of vision and rigid early fixation of the reduced lamina at the time of surgery. Moreover, our novel technique also simplifies the postoperative treatment, while preserving the posterior arch of the spine, and also preventing an invasion of a hematoma and scar tissue, postoperative instability, subluxation, and kyphotic deformities.
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Affiliation(s)
- Shinichi Hida
- Department of Orthopaedic Surgery, School of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonanku, 814-0180, Fukuoka, Japan.
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27
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Hsieh CF, Lin HJ, Chen KT, Foo NP, Te AL. Acute spontaneous cervical spinal epidural hematoma with hemiparesis as the initial presentation. Eur J Emerg Med 2006; 13:36-8. [PMID: 16374247 DOI: 10.1097/00063110-200602000-00009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Acute onset of hemiparesis is a common initial presentation of cerebral vascular accidents, but many differential diagnoses should be considered. Hemiparesis results from an upper motor neuron lesion above the midcervical spinal cord, and the absence of cranial nerve signs or facial palsy suggests a lesion in the high cervical spinal cord. Most spinal cord lesions, however, result in quadriparesis or paraparesis, but not hemiparesis. We present a rare case of acute spontaneous cervical spinal epidural hematoma, with initial presentation of right hemiparesis and mild neck pain.
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Affiliation(s)
- Chun-Fu Hsieh
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
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28
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Adamson DC, Bulsara K, Bronec PR. Spontaneous cervical epidural hematoma: case report and literature review. ACTA ACUST UNITED AC 2004; 62:156-9; discussion 159-60. [PMID: 15261513 DOI: 10.1016/j.surneu.2003.10.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2003] [Accepted: 10/06/2003] [Indexed: 12/19/2022]
Abstract
BACKGROUND Spontaneously occurring epidural hematomas for which no etiology is identified are rare phenomenon. These are often neurosurgical emergencies; therefore, prompt diagnosis and treatment are paramount. Because of the rarity of this condition, we have illustrated in this recent case its presentation, evaluation and management. METHODS A 63-year-old male presented to our emergency room with right-sided hemiparesis and contralateral hypesthesia, consistent with a C5 Brown-Séquard syndrome. An initial evaluation for cerebral infarction was unremarkable, including a negative brain magnetic resonance image. Further imaging revealed a cervical epidural hematoma of unknown etiology. RESULTS The patient underwent emergent laminectomy for decompression and evacuation of the hematoma within 24 hours of his presentation to the emergency room. The patient's symptoms improved remarkably after surgery and a 4-month follow-up imaging evaluation revealed no recurrence of his hematoma. CONCLUSION This report highlights the various presentations, evaluation, and management options for this rare diagnosis. It emphasizes the necessity of prompt diagnosis for possible emergent intervention.
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Affiliation(s)
- David C Adamson
- Division of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA
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Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC. Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg 2004; 100:38-45. [PMID: 14748572 DOI: 10.3171/spi.2004.100.1.0038] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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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Affiliation(s)
- Cheng-Chih Liao
- Department of Neurosurgery, Chang Gung University, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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30
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Abstract
STUDY DESIGN A case-control retrospective analysis comparing patients who developed a postoperative spinal epidural hematoma with patients who did not develop this complication. OBJECTIVES To identify risk factors for the development of an epidural hematoma following spinal surgery. SUMMARY OF BACKGROUND DATA Neurologic deterioration following spinal surgery is a rare but devastating complication. Epidural hematomas should be suspected in the patient who demonstrates a new postoperative neurologic deficit. The risk factors that predispose a patient to a postoperative spinal epidural hematoma have not been identified. METHODS Patients who underwent spinal surgery at a single institution over a 10-year period were retrospectively reviewed. Twelve patients who demonstrated neurologic deterioration after surgery and required surgical decompression because of an epidural hematoma were identified. All cases involved lumber laminectomies. A total of 404 consecutive patients that underwent lumbar decompression and did not develop an epidural hematoma formed the control group. Factors postulated to increase the risk of postoperative spinal epidural hematoma were compared between the two groups using logistic regression. RESULTS Multilevel procedures (P = 0.037) and the presence of a preoperative coagulopathy (P < 0.001) were significant risk factors. Age, body mass index, perioperative durotomies, and postoperative drains were not statistically significant risk factors. CONCLUSIONS Patients who require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk for developing a postoperative epidural hematoma.
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Affiliation(s)
- J Kou
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA
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31
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Uber-Zak LD, Venkatesh YS. Neurologic complications of sit-ups associated with the Valsalva maneuver: 2 case reports. Arch Phys Med Rehabil 2002; 83:278-82. [PMID: 11833035 DOI: 10.1053/apmr.2002.27378] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We present 2 cases of potentially catastrophic neurologic consequences occurring in healthy individuals engaged in sit-up exercises. Two young healthy men were engaged in sit-ups when one developed a stroke and the other developed a spinal epidural hematoma. The Valsalva maneuver involved in the sit-up exercise can produce supraphysiologic increases in blood pressure, which can lead to vascular injury and serious neurologic consequences. Proper breathing should be encouraged and patients with known predisposing factors should avoid such exercises. Prompt recognition of neurologic signs and symptoms during exercise can be life saving. This is the first report of the neurologic complications of sit-ups.
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Affiliation(s)
- Lori D Uber-Zak
- Dept of Neurology, Loma Linda University, Loma Linda, CA 92354, USA
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32
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Borges G, Bonilha L, Maldaum MV, Menezes JR, Zanardi V. Acute cervical epidural hematoma: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:726-30. [PMID: 10973117 DOI: 10.1590/s0004-282x2000000400021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT) scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH) is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.
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Affiliation(s)
- G Borges
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brasil.
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Takahashi K, Koiwa F, Tayama H, Satomi A, Akizawa T, Ideura T. A case of acute spontaneous epidural haematoma in a chronic renal failure patient undergoing haemodialysis: successful outcome with surgical management. Nephrol Dial Transplant 1999; 14:2499-501. [PMID: 10528685 DOI: 10.1093/ndt/14.10.2499] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- K Takahashi
- Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
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Abstract
PURPOSE The purpose of this work was to determine the MR findings that characterize acute spinal epidural hematomas (ASEHs). METHOD The MR findings of 17 patients with ASEH (9 cervical, 7 thoracic, and 2 lumbar) were reviewed. Fifteen of the hematomas were secondary to trauma and two were spontaneous. Correlation with CT (8 cases) and surgical findings (11 cases) was also performed. RESULTS Imaging findings in ASEH were the following: (a) a variable signal intensity (on T1-weighted images, 10 showed isointensity to cord and 7 were slightly hyperintense; T2-weighted images showed hyperintensity with areas of hypointensity); (b) capping of epidural fat; (c) direct continuity with the adjacent osseous structures; (d) compression of epidural fat, subarachnoid sac, and spinal cord; (e) usually posterolateral location in the spinal canal. CONCLUSION Epidural hematomas in the spinal canal are lesions capable of producing sudden spinal cord and/or cauda equina compression. MR provides characteristic findings that allow a prompt diagnosis of acute epidural hematomas.
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Affiliation(s)
- E M Sklar
- Department of Radiology, University of Miami School of Medicine, FL 33136, USA
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Nagata K, Ariyoshi M, Ishibashi K, Hashimoto S, Inoue A. Chronic lumbar epidural hematoma in a patient who had spondylolysis at the third lumbar vertebra. Report of a rare case involving a seventeen-year-old adolescent. J Bone Joint Surg Am 1998; 80:1515-20. [PMID: 9801220 DOI: 10.2106/00004623-199810000-00013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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36
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Abstract
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.
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Affiliation(s)
- H Patel
- Department of Neurology, Indiana University School of Medicine, Indianapolis, USA
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Pecha MD, Able AC, Barber DB, Willingham AC. Outcome after spontaneous spinal epidural hematoma in children: case report and review of the literature. Arch Phys Med Rehabil 1998; 79:460-3. [PMID: 9552116 DOI: 10.1016/s0003-9993(98)90151-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- M D Pecha
- Department of Rehabilitation Medicine, The University of Texas Health Science Center, San Antonio 78284-7798, USA
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38
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Hematomas epidurales espinales. Neurocirugia (Astur) 1998. [DOI: 10.1016/s1130-1473(98)71018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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39
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Abstract
A previously healthy 13-year-old boy began to manifest radiating pain in his left leg after heavy physical exertion during judo training. He also had a sensation of numbness in his left buttock and leg. Initially, the patient was treated conservatively with a clinical diagnosis of disc herniation. However, following 3 months of conservative treatment, there was no relief of pain. Magnetic resonance imaging of the lumbar spine demonstrated an epidural mass causing compression of the dural sac at the L4-L5 disc level. During surgery, the L5 nerve root was found to be severely compressed in the spinal canal because of a chronic epidural hematoma. Following microsurgical removal of this hematoid mass, the patient had a good recovery. Spontaneous epidural hematomas in the lumbar region are rare, and only a few cases presenting with features simulating those caused by a disc herniation have been reported. Our patient represents the first such case described in a child.
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Affiliation(s)
- E M Kotilainen
- Department of Neurosurgery and Surgery, University of Turku, Finland
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40
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Hancock JB, Field EM, Gadam R. Spinal epidural hematoma progressing to Brown-Sequard syndrome: report of a case. J Emerg Med 1997; 15:309-12. [PMID: 9258779 DOI: 10.1016/s0736-4679(97)00010-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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 focal 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.
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Affiliation(s)
- J B Hancock
- Department of Emergency Medicine, Saint Mary's Medical Center, Saginaw, Michigan, USA
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41
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Abstract
Spontaneous spinal epidural haematoma is an unusual but well recognized cause of compressive myelopathy or cauda equina syndrome. Radicular pain is one of the earliest symptoms and a hallmark of spontaneous spinal epidural haematoma, as in the case of cervical spondylosis and disc prolapse. Should an epidural haematoma be located in the cervical spine, the resultant cervical radicular pain may sometimes be erroneously attributed to a cardiac cause, especially in the setting of pre-existing cardiac disease. The error in diagnosis can lead to another pitfall, the addition of heparin. If the etiology of the pain is a cervical epidural haematoma this can have grave consequences. Moreover, patients with cardiac ischemia who are treated with anticoagulants may rarely develop a cervical epidural haematoma. The resulting radicular pain can overlap with cardiac pain and escape recognition. Symptoms of neck and upper extremity pain with bilateral signs of myelopathy with a sensory level should lead to a suspicion of acute cervical cord compression. The addition of heparin can only compound the disastrous consequence of a rapidly expanding spinal epidural haematoma. The following cases illustrate this diagnostic and therapeutic conundrum.
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Affiliation(s)
- G Phookan
- Penn State University Hospital, Milton Hershey Medical Center, Hershey 17033, USA
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42
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Mastronardi L, Carletti S, Frondizi D, Spera C, Maira G. Cervical spontaneous epidural hematoma as a complication of non-Hodgkin's lymphoma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1996; 5:268-71. [PMID: 8886740 DOI: 10.1007/bf00301331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Epidural hematoma is a rare cause of spinal cord compression, which usually provokes severe neurological deficits. It is presumed to originate from venous or, more probably, arterial bleeding. Thrombocytopenia and other disorders of coagulation may precipitate the onset of epidural hematoma and facilitate the evolution of the disease. We report the case of a patient suffering from a non-Hodgkin's lymphoma with severe thrombocytopenia during a MACOP-B schedule, who presented with a spontaneous cervical epidural hematoma. We discuss the etiopathological aspects, diagnosis, and treatment of this rare cause of acute cervical spinal cord compression.
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Affiliation(s)
- L Mastronardi
- Department of Neurological Sciences, Civilian Hospital Santa Maria Terni, Italy
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43
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Brunori A, Scarano P, Simonetti G, Delitala A, Chiappetta F. Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1996; 5:264-7. [PMID: 8886739 DOI: 10.1007/bf00301330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently "spontaneous", required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in "spontaneous" SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.
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Affiliation(s)
- A Brunori
- Division of Neurosurgery G. M. Lancisi, Ospedale San Camillo, Rome, Italy
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44
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Abstract
PURPOSE Presentation of a case of simultaneous lumbar disk herniation and epidural hematoma. MATERIAL AND METHODS An 85-year old patient with symptoms of compression of one or more nerve roots was examined with CT of the 3 lower lumbar intervertebral spaces. RESULTS CT showed a high-density mass in the left side of the spinal canal, lying on the flaval ligament and extending laterally under the left pedicle of the 3rd lumbar vertebra. The correct diagnosis was not established before surgery. At surgery, a lumbar disk herniation and an epidural hematoma, located in the 3rd lumbar intervertebral space, were found. CONCLUSION Retrospectively, the CT appearance was well in accordance with the findings at operation, but further examination, preferably MR imaging, is suggested in cases of atypical masses in the spinal canal.
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Affiliation(s)
- D B Mikkelsen
- Department of Radiology, Sønderborg Hospital, Denmark
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45
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Sawin PD, Traynelis VC, Follett KA. Spinal epidural hematoma following coronary thrombolysis with tissue plasminogen activator. Report of two cases. J Neurosurg 1995; 83:350-3. [PMID: 7616284 DOI: 10.3171/jns.1995.83.2.0350] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Two cases of spinal epidural hematoma following intravenous administration of recombinant tissue-type plasminogen activator are presented. Both patients received thrombolytic therapy for acute myocardial infarction; back pain and progressive neurological dysfunction ensued, secondary to spinal cord compression caused by epidural hematoma. Both individuals underwent emergency surgery for decompression and hematoma evacuation, resulting in improvement in neurological function. The current status of thrombolytic therapy is reviewed, with emphasis on complications of therapy that require neurosurgical intervention.
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Affiliation(s)
- P D Sawin
- Division of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, USA
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46
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Muhonen MG, Piper JG, Moore SA, Menezes AH. Cervical epidural hematoma secondary to an extradural vascular malformation in an infant: case report. Neurosurgery 1995; 36:585-7; discussion 587-8. [PMID: 7753359 DOI: 10.1227/00006123-199503000-00019] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We present a report of a 22-month-old infant with a spontaneous spinal epidural hematoma arising from a purely epidural vascular malformation. Although often suspected as a cause of spontaneous epidural hemorrhage, vascular malformations have rarely been demonstrated. The important aspects of the presenting symptoms in this young age group are highlighted. We discuss the entity of spontaneous epidural hemorrhage and the characteristics that distinguish purely epidural from dural arteriovenous malformations.
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Affiliation(s)
- M G Muhonen
- Division of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, USA
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47
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Cervical Epidural Hematoma Secondary to an Extradural Vascular Malformation in an Infant. Neurosurgery 1995. [DOI: 10.1097/00006123-199503000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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48
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Abstract
Spontaneous cervical epidural hematoma is a rare cause of neck pain. We present the case of a 64-year-old woman who presented to the emergency department with neck pain from a partial Brown-Sequard syndrome secondary to spontaneous cervical epidural hematoma. The prompt recognition of this entity resulted in a favorable outcome.
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Affiliation(s)
- J M Williams
- Comanche County Memorial Hospital, Lawton, Oklahoma
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49
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Hematoma epidural espontáneo lumbar simulando hernia discal extruida. Neurocirugia (Astur) 1994. [DOI: 10.1016/s1130-1473(94)71112-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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50
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Abstract
Nontraumatic spinal cord compression can have very dramatic clinical presentations with rapid onset of symptoms and quickly ensuing paralysis. The manifestations may be much more subtle. This text will discuss the four most common causes of myelopathy, including spinal canal hemorrhage, spinal abscess, compression by tumor, and skeletal disease. Compressive lesions to the spinal cord from other than these etiologies are rare.
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Affiliation(s)
- R D Schmidt
- Department of Emergency Medicine, Denver General Hospital, CO 80204-4507
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