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Spinal Epidural Hematoma

Though an extremely rare diagnosis, spinal epidural hematoma is very important to consider due to its potentially devastating effects, especially in elderly patients on anticoagulation who report sudden pain and neurological deficits...

Initially reported in the 17th century, this neurosurgical emergency is a rare condition – reported occurrence is 0.1 patients/100,000 people (i.e. 1 in a million). It is a difficult diagnosis to make and can be initially misdiagnosed as other serious conditions such as ischemic heart disease, stroke, or aortic dissection. Just over one-third of cases have an unknown etiology and slightly more than 25% are associated with coagulation disorders and…

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Articles of Interest

Acute spinal epidural hematoma

Typically, patients with SEH experience a sudden severe pain at the level of hemorrhage, which may radiate to the limbs. The radicular pain may precede the spinal pain. A rapid development of neurological symptoms follows because of compression of the spinal cord or the cauda equina. Motor and sensory deficits develop, and patients may have urinary retention. The symptoms are usually progressive and may result in permanent neurological disability or even death due to respiratory failure if emergent neurosurgical intervention is delayed.

Spinal Epidural Hematoma

Spinal epidural hematoma is a collection of blood in the potential space between the dura and the bone, along the spinal canal. Significant bleeding can lead to spinal cord damage, causing neurological injury and deficit. This is a neurosurgical emergency.

Spinal Hematomas: What a Radiologist Needs to Know

Spinal hematomas are a frequent indication for radiologic evaluation and can be a diagnostic dilemma for many radiologists and surgeons. There are four types of spinal hematomas: epidural, subdural, subarachnoid, and intramedullary (spinal cord) hematomas. Because they differ by their location in relationship to the meningeal membranes and spinal cord, unique radiologic appearances can be recognized to distinguish these types of spinal hemorrhage.

Spontaneous Epidural Hematoma

Spinal epidural hematomas are a rare clinical event in children. Only 33 cases had been reported in the literature as of 2006.1 Whereas epidural hematomas often follow major trauma in adults, the majority in children are spontaneous. However, minor trauma (eg, minor falls, minor automobile accidents, weight-lifting) often has been associated with epidural hematomas in children.

Spontaneous spinal epidural hematoma: a case report

Spinal epidural hematoma occurs most commonly after trauma, but, as our case shows, it may occur spontaneously. Its annual prevalence is ~ 1 per 1,000,000. Spinal epidural hematoma may develop after a lumbar puncture or epidural anesthesia. Other associated factors include thrombolysis, anticoagulation, thrombocytopenia, blood dyscrasias, neoplasms, coagulopathies, and vascular malformations...

Resources

Journal of the American Academy of Orthopaedic Surgeons

Spinal epidural hematoma is a rare condition that usually presents with acute, severe pain at the location of the hemorrhage, with radiation to the extremities. It can rapidly develop to include progressive and severe neurologic deficit. The pathophysiology often remains unclear. However, epidural hematoma in the lumbar spine is best described as the result of internal rupture of the Batson vertebral venous plexus. Clinical evaluation of pain control and neurologic deficit is the most important tool in early diagnosis. Currently, MRI is the diagnostic method of choice. Regardless of the setting, symptomatic spinal epidural hematoma is typically managed with urgent surgical decompression of the spinal canal.