Spinal epidural hematoma (SEH)
Spinal epidural hematoma is an uncommon entity that was first reported as long ago as the 17th century. Jackson is generally credited with the first report of a spontaneous case in 1869 1) 2).
Till 1988, over 200 reports appeared in the literature, and numerous etiologies have been described 3) 4) 5)
Classification
Acute spinal epidural hematoma
Chronic spinal epidural hematoma
Chronic SEHs are rarer than acute SEHs.
see Cervical spinal epidural hematoma.
Spontaneous spinal epidural hematoma
Traumatic spinal epidural hematoma
Delayed spinal epidural hematoma (SEH): most symptomatic SEH occur within 72 hours of surgery; however, longer delays have been reported 6).
Etiology
Spinal epidural hematoma etiology.
Clinical
see Spontaneous spinal epidural hematoma clinical features
Diagnosis
MRI poor for studying blood early.
Differential diagnosis
In the presence of an epidural mass with clear clinical symptomatology, rare entities like chronic epidural hematoma or posterior migrated disk material should be always considered as a differential diagnosis in patients with suspicion of extradural chronic compressions. In these cases, only the intraoperatory and histopathological exams can provide a clear diagnosis 7).
Complications
Treatment
Recovery of the neurologic deficit without surgery is rare (only a handful of case reports in the literature 8), therefore optimal treatment is immediate decompressive laminectomy in those patients who can tolerate surgery 9). In one series, most patients who recovered underwent decompression within 72 hrs of the onset of symptoms. 10) In another, decompression within 6 hours was associated with a better outcome 11). High-risk patients: for medically high-risk patients (e.g. acute MI) on anticoagulation, surgical mortality, and morbidity is extremely high, and this must be considered when making the decision of whether or not to operate. In patients not operated on, anticoagulants should be stopped and reversed if possible. Consider the use of high-dose methylprednisolone to minimize cord injury
Percutaneous needle aspiration may be a consideration in high-risk patients.
Case reports
see Spinal epidural hematoma case reports.