spinal_epidural_hematoma

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

Brown-Séquard syndrome.

Cauda equina syndrome.

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.

1) , 3)
Bruyn GW, Bosma NJ: Spinal extradural haematoma, in Vinken PJ, Bruyn GW (eds): Injuries of the Spine and Spinal Cord, Part II. Handbook of Clinical Neurology, Vol 26. Amsterdam: North-Holland, 1976, pp 1-30
2)
Jackson R: Case of spinal apoplexy. Lancet 2:5-6, 1869
4)
Wisoff HS: Spontaneous intraspinal hemorrhage, in Wilkins RH, Rengachary SS (eds): Neurosurgery. New York: McGraw-Hill, 1985, Vol 2, pp 1500-1504
5)
Wittebol MC, van Veelen CWM: Spontaneous spinal epidural haematoma. Clin Neurol Neurosurg 86:265-270, 1984
6)
Parthiban CJKB, Majeed SA. Delayed spinal extra- dural hematoma following thoracic spine surgery and resulting in paraplegia: a case report. 2008. http://www.jmedicalcasereports.com/content/2/1/141
7)
Iliescu BF, Chiriţă BC, Poeată I. The pitfalls of differential diagnosis of lumbar spine epidural lesions–exemplification with two particular cases and a review of the literature. Rev Med Chir Soc Med Nat Iasi. 2013 Oct-Dec;117(4):947-53. Review. PubMed PMID: 24502074.
8)
Silber SH. Complete Nonsurgical Resolution of a Spontaneous Spinal Epidural Hematoma. Am J Emergency Med. 1996; 14:391–393
9)
Harik SI, Raichle ME, Reis DJ. Spontaneous Remitting Spinal Epidural Hematoma in a Patient on Anticoagulants. N Engl J Med. 1971; 284:1355– 1357
10)
Rebello MD, Dastur HM. Spinal Epidural Hemorrhage: A Review of Case Reports. Neurol India. 1966; 14:135–145
11)
Porter RW, Detwiler PW, Lawton MT, et al. Postoperative Spinal Epidural Hematomas: Longitudinal Review of 12,000 Spinal Operations. BNI Quarterly. 2000; 16:10–17
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