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Sun P, Yu J, Liu Y, Zhou M, Liu Y, Du J, Zhi X, Zeng G. Treatment of spontaneous spinal epidural hematoma in children: analysis of 25 cases. Childs Nerv Syst 2022; 38:1557-1566. [PMID: 35635570 DOI: 10.1007/s00381-022-05459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare neurosurgical emergency, presenting as sudden onset of back pain and weakness of lower extremities. Many patients have no definite cause. Some cases of SSEH caused by vascular malformation have been reported. The treatment strategy remains controversial. This study aimed to analyze the causes of SSEH and proposed a treatment strategy according to clinical outcomes of patients at a single institution. METHODS A total of 25 cases of SSEH under 18 years of age treated between March 2004 and July 2021 were retrospectively analyzed. RESULTS The mean age of the first SSEH onset was 7.1 years. The most common location was cervicothorax. Nine patients suffered from multiple episodes. Twenty-three patients underwent spinal digital subtraction angiography (DSA), of which seven (30.4%) patients had positive findings: three cases had epidural artery venous fistula (AVF), two cases had epidural artery venous malformation (AVM), and two cases had abnormal concentration of contrast agent. Seventeen patients received surgery. Eleven patients (44%) were diagnosed as vascular malformation by either DSA or pathology. The follow-up rate was 80%, with 20 patients (80%) achieving satisfactory clinical outcome. Risk factors for poor clinical outcome included multiple episodes (p = 0.028) and higher Aminoff-Logue score (p = 0.005). CONCLUSION Spinal epidural vascular malformation is a significant cause of SSEH. Spinal DSA is necessary. Surgery should be recommended for patients with multiple episodes, positive findings on DSA, or severe neurological deficits. Conservation therapy can be considered for other patients, but long-time follow-up is necessary.
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Affiliation(s)
- Peng Sun
- Di Rocco Center of Pediatric Neurosurgery, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiaxing Yu
- Di Rocco Center of Pediatric Neurosurgery, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Di Rocco Center of Pediatric Neurosurgery, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mading Zhou
- Di Rocco Center of Pediatric Neurosurgery, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yutong Liu
- Di Rocco Center of Pediatric Neurosurgery, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianxin Du
- Di Rocco Center of Pediatric Neurosurgery, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xinglong Zhi
- Di Rocco Center of Pediatric Neurosurgery, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gao Zeng
- Di Rocco Center of Pediatric Neurosurgery, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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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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Niimi Y, Sato S, Ryu B, Inoue T, Shima S. Unusual pediatric epidural arteriovenous fistula with venous ectasia presented with spontaneous spinal epidural hematoma: Case report. Interv Neuroradiol 2021; 27:763-769. [PMID: 33847149 DOI: 10.1177/15910199211009121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is rare in children. Vascular malformation including arteriovenous fistulas and venous malformation is a rare cause of SSEH. CASE DESCRIPTION A 5-year-old girl presented with 2 episodes of SSEH at the upper thoracic spine and non-hemorrhagic episodes with spontaneous neurological recovery. Diagnostic study with MRI and spinal angiography demonstrated an unusual epidural arteriovenous fistula (AVF) with venous ectasia similar to venous malformation. She underwent embolization of the AVF with NBCA with mild transient neurological deterioration. Follow up angiography showed persistent occlusion of the embolized fistula and inconsistent visualization of another AVF to the patent venous ectasia. CONCLUSIONS This type of epidural AVF seems to be more common in children and tends to cause multiple neurologic episodes due to SSEH, venous expansion or thrombosis. Endovascular embolization with NBCA should be the first choice of treatment for this disease, unless emergent hematoma evacuation is necessary. Embolization should target at only the fistula site without significant penetration into the venous ectasia. Follow up is necessary for potential reappearance of AVF, even if AVF is occluded at the time of treatment. Time resolved MRI is useful to detect AVFs, thus for diagnosis and follow up of this disease.
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Affiliation(s)
- Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Bikei Ryu
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Shogo Shima
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
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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: 0.5] [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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Spontaneous spinal epidural hematoma in 2 cases with excellent outcome. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100642] [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] Open
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Zhang S, Geng F, Wang J, Zhang Z, Du C. Rapid Recovery of Spontaneous Spinal Epidural Hematoma without Surgical Treatment: Case Report and Literature Review. World Neurosurg 2018; 115:216-219. [PMID: 29709757 DOI: 10.1016/j.wneu.2018.04.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a relatively uncommon yet potentially disabling neurologic emergency. The classical presentation includes a severe acute attack, sometimes radiating pain at the back, interscapular, or neck areas, followed by neurologic deficits. The main treatment is surgical, and self-healing cases are rare. CASE DESCRIPTION A 17-year-old female was admitted to the neurosurgery department with neck pain, myasthenia of the limbs, and difficulty moving. Mild neck pain had developed 1 week prior with no obvious predisposing causes. The patient had suddenly suffered severe neck pain during normal walking and developed rapid paralysis of her limbs. There was no recent history of trauma, infection, or drug administration. Magnetic resonance imaging performed 1 hour after the onset of limb paralysis demonstrated a large spinal epidural hematoma that extended from C4 to C6. However, 9 hours after the initial onset of severe neck pain, her symptoms completely ceased. Magnetic resonance imaging demonstrated that the SSEH had nearly dissipated. CONCLUSIONS Most cases of SSEH with spontaneous resolution are located on the upper thoracic and cervical spine. Surgery is the standard of care for these patients but can occasionally be deferred if the patient demonstrates significant rapid improvement.
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Affiliation(s)
- Shubao Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Fengyang Geng
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Zhiti Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Chigang Du
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China.
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Wang M, Zhou P, Jiang S. Clinical Features, Management, and Prognostic Factors of Spontaneous Epidural Spinal Hematoma: Analysis of 24 Cases. World Neurosurg 2017; 102:360-369. [PMID: 28288922 DOI: 10.1016/j.wneu.2017.02.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a rare neurosurgical emergency. It presents as acute spinal cord compression and usually requires surgical decompression. The patients who will benefit most from decompression surgery are unknown, and the factors associated with prognosis remain controversial. The purpose of our study was to identify the clinical features, treatments, and main factors related to the prognosis of SSEH. METHODS We reviewed the records of 24 patients treated for SSEH from September 2010 to January 2016 at West China Hospital. Clinical features, radiologic images, treatment methods, and clinical outcomes were reviewed retrospectively. To ascertain which factors were related to outcomes, statistical analysis was performed. RESULTS Among 24 patients, 19 presented with severe initial neurologic deficits (American Spinal Injury Association grade A-C) underwent decompressive surgery, and the remaining patients (initial American Spinal Injury Association grade D or E) received conservative treatment. Among the 19 patients in the operation group, seven (36.8%) had good outcomes, whereas 12 (63.2%) had poor outcomes. All patients in the conservative group had good outcomes. CONCLUSIONS SSEH is a rare but serious illness. It is more likely that SSEH arises from a ruptured internal vertebral venous plexus. The initial neurologic status is the determining factor influencing the treatment method and clinical outcome. The number of involved segments cannot be used to decide the treatment method or predict prognosis. Patients with shorter operative intervals appear to have better neurologic recovery.
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Affiliation(s)
- Mengmeng Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Peizhi Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shu Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Yu JX, Liu J, He C, Sun LY, Xiang SS, Ma YJ, Bian LS, Hong T, Ren J, Tao PY, Li JW, Li GL, Ling F, Zhang HQ. Spontaneous Spinal Epidural Hematoma: A Study of 55 Cases Focused on the Etiology and Treatment Strategy. World Neurosurg 2016; 98:546-554. [PMID: 27890764 DOI: 10.1016/j.wneu.2016.11.077] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic emergency of the spinal cord. Its cause and treatment strategy remain controversial. This study aimed to evaluate a significant cause of SSEH and to discuss the treatment strategy according to the clinical outcomes of patients in 2 institutions. METHODS Fifty-five cases of SSEH treated at our institutions between February 2002 and February 2016 were retrospectively analyzed. RESULTS The mean age of the first SSEH onset was 31.8 years. The follow-up rate was 72.7%, with 28 patients (70%) showing satisfactory clinical outcomes. Forty patients received preoperative spinal digital subtraction angiography. Spinal epidural (extradural) arteriovenous fistula was detected in 6 patients (15%), 5 of whom showed 1 type of special slow-flow shunt. Nineteen patients (34.5%) suffered from multiple episodes until they underwent invasive treatments or last follow-up. Rebleeding was confirmed in 8 patients. None of the patients had a subsequent episode or rebleeding after invasive treatment. The risk factors for poor clinical outcome included advanced age at initial onset (P = 0.020), a short progression interval (P = 0.030), no symptom relief after admission (P = 0.011), hypesthesia (P = 0.017), complete spinal cord injury (P = 0.001), and hematoma below the T4 level (P = 0.014). CONCLUSIONS Spinal epidural (extradural) arteriovenous fistula is a significant cause of SSEH. Standard spinal digital subtraction angiography is necessary for patients with SSEH. Conservative treatment could not prevent occurrence of multiple episodes or rebleeding in patients. Microsurgery should be recommended as the preferred treatment strategy for SSEH. Endovascular embolization is also recommended if applicable.
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Affiliation(s)
- Jia-Xing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiang Liu
- Department of Neurosurgery, Beijing Haidian section of Peking University Third Hospital, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Li-Yong Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Si-Shi Xiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Yong-Jie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Li-Song Bian
- Department of Neurosurgery, Beijing Haidian section of Peking University Third Hospital, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng-Yu Tao
- Department of Neurosurgery, Beijing Haidian section of Peking University Third Hospital, Beijing, China
| | - Jing-Wei Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Gui-Lin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China.
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The classification of recurrent spinal epidural hematoma: a review of the literature and a comparison with the cases. 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 2016; 25 Suppl 1:224-9. [PMID: 27002614 DOI: 10.1007/s00586-016-4506-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 12/30/2022]
Abstract
Symptomatic postoperative spinal epidural hematoma (SEH) and spontaneous spinal epidural hematoma (SSEH) are both rare conditions, and recurrent SEH occurs even less frequently. Therefore, we describe a case of symptomatic postoperative SEH after surgical evacuation of SSEH, which was diagnosed using magnetic resonance imaging (MRI) and managed with negative pressure wound therapy (NPWT). The authors classified the reported recurrent SEHs into two types based on the cause of their previous hematoma, which can be classified as spontaneous or postoperative. The characteristics, diagnosis, managements, and results of recurrent SEHs were analyzed. The authors suggest that the postoperative SEH in the Type II will be treated with NPWT, and the new classification will be helpful for prognosis, diagnosis, and management of the recurrent SEHs.
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Iwatsuki K, Deguchi M, Hirata H, Kanamono T. Spontaneously Resolved Recurrent Cervical Epidural Hematoma in a 37-Week Primigravida. Global Spine J 2015; 5:e44-7. [PMID: 26430600 PMCID: PMC4577326 DOI: 10.1055/s-0034-1398489] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 12/01/2014] [Indexed: 11/11/2022] Open
Abstract
Study Design Case report. Objective To describe a patient with a recurrent spontaneous spinal epidural hematoma (SSEH) during pregnancy that had spontaneous remission. Methods A 27-year-old primigravida at 37 weeks' gestation suddenly felt a strong left shoulder pain without any trauma. She had a history of fenestration for a spontaneous cervical hematoma when she was 18 years old. An emergency magnetic resonance imaging revealed a recurrence of the cervical epidural hematoma at the C4-T1 level, but she had no paralysis. Results The patient subsequently underwent a cesarean section and delivered a healthy male infant. Her spinal epidural hematoma disappeared. Multislice computed tomography showed no evidence for a vascular malformation or tumor. Three years after the initial cesarean section, she underwent a second one and delivered another male infant. Conclusions We report on a rare case of recurrent SSEH during pregnancy with no neurologic deficits that was treated nonoperatively with close observation and resulted in spontaneous resolution. In such patients with no neurologic deficits, nonoperative management with close observation may be a reasonable alternative.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan,Address for correspondence Katsuyuki Iwatsuki, MD, PhD Department of Hand Surgery, Nagoya University Graduate School of Medicine65 Tsurumai-cho, Showa-ku, Nagoya 466-8550Japan
| | - Masao Deguchi
- Department of Orthopaedic Surgery, Nagano Red Cross Hospital, Nagano, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Toshihisa Kanamono
- Department of Orthopaedic Surgery, Nagano Red Cross Hospital, Nagano, Japan
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Abstract
STUDY DESIGN A case report. OBJECTIVE We report a case of spontaneous spinal epidural hematoma with 3 bleeding episodes and discuss the surgical management of recurrent spontaneous spinal epidural hematoma. SUMMARY OF BACKGROUND DATA Spontaneous spinal epidural hematoma is a rare condition that causes spinal cord compression and neurological deficits. However, the cause of bleeding remains unclear and recurrent bleeding is very seldom reported. METHODS A 39-year-old female patient was referred to Kyoto University hospital with sudden back and right upper extremity pain. She was also treated conservatively at the local hospital 19 and 4 months previously because of same episodes. Magnetic resonance images demonstrated right spinal epidural hematoma at the C6-T1 level. In the first 2 episodes, magnetic resonance images revealed spinal epidural hematomas at exactly the same level. RESULTS In the third episode, the patient's neurological condition was not worse than it had been in the first 2 episodes, and we initially managed her conservatively. To identify the cause of the hematoma, surgery was performed 15 days after the third onset. Microscopic examination revealed the development of a venous plexus around the old hematoma in the dorsal epidural space. The patient was discharged without any further neurological deficits, and recurrent bleeding has not occurred for 6 months after surgery. CONCLUSION This is the first report of operative and histological observation of recurrent spontaneous spinal epidural hematoma caused by a posterior venous plexus. In a case of recurrent spontaneous spinal epidural hematoma, surgery might be necessary to prevent further hematomas. LEVEL OF EVIDENCE N/A.
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12
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Sivakumaran R, King A, Bodi I, Chandler CL, Walsh DC. Spontaneous epidural spinal haematoma in children caused by vascular malformations. 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 2014; 25:614-8. [PMID: 25301573 DOI: 10.1007/s00586-014-3616-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 10/05/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The occurrence of spinal epidural haematoma of 'spontaneous' origin in adults is a well-documented entity, though it is rare in children. In the literature to date, there are few cases of this kind of spontaneous haematoma proven to be due to an underlying vascular abnormality. METHOD Retrospective review of two cases of children under 15 years of age with spontaneous epidural spinal haematoma. RESULTS Underlying arteriovenous malformations were identified in both cases. Intra-operative photographs and histological sections of these anomalies are presented. CONCLUSION These are the first two such cases described with clinico-pathological correlation.
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Affiliation(s)
- Ramanan Sivakumaran
- Department of Neurosurgery, King's College Hospital, London, UK. .,Academic Neurosurgery Unit, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Andrew King
- Department of Neuropathology, King's College Hospital, London, UK
| | - Istvan Bodi
- Department of Neuropathology, King's College Hospital, London, UK
| | | | - Daniel C Walsh
- Department of Neurosurgery, King's College Hospital, London, UK.,Institute of Psychiatry, King's College University, London, UK
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Recurrent spontaneous spinal epidural hematoma leading to compressive myelopathy. Am J Emerg Med 2014; 32:818.e1-2. [PMID: 24534194 DOI: 10.1016/j.ajem.2013.12.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 12/31/2013] [Indexed: 11/22/2022] Open
Abstract
Spontaneous spinal epidural hematoma accounts for most cases of spinal epidural hematoma, but very few cases of recurrent spontaneous spinal epidural hematoma have been published to date. We herein report a case of a 20-year-old man who presented with 10-day history of pain in the interscapular region, followed by paraparesis and sensory loss below umbilicus along with urinary retention. The patient gave history of 2 similar episodes in the last 3 months, with complete spontaneous recovery. His magnetic resonance imaging of dorsal spine was suggestive of subacute spinal epidural hematoma. On reviewing previous 2 magnetic resonance images of dorsal spine, it was apparent that the patient had recurrent hematoma at the same site. Thus, a provisional diagnosis of recurrent spontaneous spinal hematoma at the level of upper dorsal spine was kept and was managed accordingly. Patient with recurrent spontaneous spinal epidural hematoma should be educated about the nature of the disease and advised to consult a neurosurgeon as early as possible in case of a relapse, so that they can undergo surgical management preferably within 8 hours and not later than 36 hours.
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Schoonjans AS, De Dooy J, Kenis S, Menovsky T, Verhulst S, Hellinckx J, Van Ingelghem I, Parizel PM, Jorens PG, Ceulemans B. Spontaneous spinal epidural hematoma in infancy: review of the literature and the "seventh" case report. Eur J Paediatr Neurol 2013; 17:537-42. [PMID: 23786707 DOI: 10.1016/j.ejpn.2013.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/14/2013] [Accepted: 05/25/2013] [Indexed: 12/19/2022]
Abstract
Spontaneous spinal epidural hematomas (SSEH) are a rare cause of spinal cord compression in childhood and especially in infancy. We reviewed the literature and describe a case of an 8-month-old boy with a large spontaneous cervico-thoracic epidural hematoma. With this review we want to detail the importance of early investigation, diagnosis and treatment in infants with SSEH. In our case the infant presented with irritability and crying and an ascending paralysis within four days. Magnetic resonance imaging (MRI) of the spine demonstrated an extensive epidural hematoma between C5 and L1, serious medullar compression and secondary cervical and thoracic medullar edema and hydromyelia. An emergency laminectomy was performed with evacuation of a well organized hematoma. There was a partial recuperation of the neurologic symptoms. Based on the scarce literature which only concerns seven case reports, SSEH is a rare cause of spinal compression in infancy. The presentation is often not specific and neurological symptoms are often lacking in the beginning. However early diagnosis with MRI and prompt neurosurgical intervention are important to improve outcome.
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Affiliation(s)
- An-Sofie Schoonjans
- Department of Neurology-Pediatric Neurology, Antwerp University Hospital (UZA), University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium; Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Belgium
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Spontaneous spinal epidural hematoma secondary to extradural arteriovenous malformation in a child: a case-based update. Childs Nerv Syst 2013; 29:1985-91. [PMID: 23812629 DOI: 10.1007/s00381-013-2214-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/18/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this study was to report a rare pediatric case of spontaneous spinal epidural hematoma (SSEH) mimicking Guillain-Barré syndrome (GBS), secondary to an epidural arteriovenous malformation (AVM). Furthermore, a case-based update and insight into the entity is attempted. METHODS An 8-year-old male presented with progressing severe lower limb weakness and no traumatic history. Presentation was mimicking GBS with ascending symptoms. Magnetic resonance (MR) scan revealed a dorsal epidural mass, extending from C6-C7 to T2, compressing the spinal cord. Emergency laminoplasties and surgical evacuation of the hematoma were performed. An up-to-date review of reported SSEH cases in children was conducted, with emphasis on underlying vascular malformations (epidural AVMs in particular). Pathogenesis, predisposing factors, imaging, diagnosis, treatment and outcome are discussed. RESULTS The hematoma was successfully evacuated. A vascular membrane on the dura was peeled off and sent for histopathology. There was no evidence of intradural vascular penetration. The patient improved postoperatively and was able to walk with support 7 months later. Histology revealed closely packed thin-walled angiomatous structures with wide lumens (filled with red blood cells) with walls composed of collagen and smooth muscle fibers, findings consistent with AVM. CONCLUSIONS Non-traumatic SSEH is rare in the pediatric population. Although vascular malformations are suspected, they are extremely rarely identified histopathologically. This case represents one of the very few reports of pediatric SSEH caused by a histologically proven, purely epidural AVM. High index of clinical suspicion and low threshold for MR can lead to timely diagnosis and prompt treatment with good functional outcome.
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Recurrent spinal epidural hematoma: Case report. Neurochirurgie 2013; 59:105-7. [DOI: 10.1016/j.neuchi.2012.10.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 12/23/2022]
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Fedor M, Kim ES, Ding K, Muizelaar JP, Kim KD. Spontaneous Spinal Epidural Hematoma: A Retrospective Study on Prognostic Factors and Review of the Literature. KOREAN JOURNAL OF SPINE 2011; 8:272-82. [PMID: 26064145 PMCID: PMC4461739 DOI: 10.14245/kjs.2011.8.4.272] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 12/20/2011] [Accepted: 01/05/2012] [Indexed: 12/26/2022]
Abstract
Objectives The spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Patients typically present with sudden onset back pain followed by neurological deficits. Methods Diagnosis of SSEH is usually made with MRI and standard treatment is surgical evacuation. In 1996, Groen published the most comprehensive review on the SSEH in which he analyzed 333 cases. We review 104 cases of SSEH presented in the English literature since the last major review and add three of our own cases, for a total of 107 cases. Results Our patients presented with back pain and neurologic deficits. Two made excellent functional recovery with prompt surgical decompression while one continued to have significant deficits despite evacuation. Better postoperative outcome was associated with less initial neurological dysfunction, shorter time to operation from symptom onset and male patients. Conclusion We discuss the etiology of SSEH and report current trends in diagnosis, treatment, and outcome.
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Affiliation(s)
- Mark Fedor
- Department of Neurological Surgery, University of California, Davis Medical Center, USA
| | - Eric S Kim
- Department of Neurological Surgery, University of California, Davis Medical Center, USA
| | - Kai Ding
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, USA
| | - J Paul Muizelaar
- Department of Neurological Surgery, University of California, Davis Medical Center, USA
| | - Kee D Kim
- Department of Neurological Surgery, University of California, Davis Medical Center, USA
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Spontaneous spinal epidural hematoma. J Clin Neurosci 2011; 18:1490-4. [DOI: 10.1016/j.jocn.2011.02.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 02/11/2011] [Accepted: 02/14/2011] [Indexed: 01/30/2023]
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Lehman AAR, McKenna ME, Wisneski R, Hess WF. Delayed presentation of a traumatic spinal epidural hematoma in a preadolescent: a case report. J Bone Joint Surg Am 2011; 93:e28. [PMID: 21471408 DOI: 10.2106/jbjs.j.00537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Two cases of acute spinal cord injury resulting from spontaneous spinal epidural hematoma are reported, both of which had a cavernous vascular malformation origin. Both spontaneous spinal epidural hematoma and intramedullary cavernous malformation are rare in children. In the pediatric emergency setting, spontaneous epidural hematoma should be considered as part of the differential diagnosis for acute extremity weakness and paresthesia. Immediate magnetic resonance imaging of the brain and spine as well as prompt neurosurgical consult is recommended for the best chance of improved outcome.
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Kitagawa RS, Mawad ME, Whitehead WE, Curry DJ, Luersen TG, Jea A. Paraspinal arteriovenous malformations in children. J Neurosurg Pediatr 2009; 3:425-8. [PMID: 19409023 DOI: 10.3171/2009.2.peds08427] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arteriovenous malformations (AVMs) within the spinal canal and in the paraspinal region are unusual. Spinal cord and dural AVMs or arteriovenous fistulas have been the subject of numerous reports, but paraspinal malformations causing venous congestion or hemorrhage in the spinal canal are rare and present special diagnosis and management challenges. The authors review previously published reports on 16 children with paraspinal AVMs. They also describe the 17th case of a child with a paraspinal AVM who presented with a spontaneous spinal epidural hematoma. To the best of the authors' knowledge, there has been no other case of a spinal epidural hematoma associated with a paraspinal AVM. In each of the 17 cases, the vascular lesion was successfully obliterated using endovascular therapy. Embolization with permanent occlusive agents is an effective treatment for these rare but potentially debilitating lesions.
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Affiliation(s)
- Ryan S Kitagawa
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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