1
|
Zhou J. An unusual case of ventral spontaneous thoracic epidural hematoma. Clin Case Rep 2024; 12:e9144. [PMID: 38962460 PMCID: PMC11220456 DOI: 10.1002/ccr3.9144] [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: 04/29/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) rarely occurs. Without early diagnosis, SSEH can lead to the acute onset of neurologic deficits. We report the case of a 65-year-old male with diabetes mellitus who was admitted to our emergency department with a chief complaint of sharp and severe pain in the left scapula and behind the sternum. He was misdiagnosed with cardiovascular disease until the onset of progressive bilateral paraplegia and lower limb numbness. Magnetic resonance imaging revealed a ventral thoracic SSEH. Surgical treatment to remove epidural hematoma and laminectomy for decompression were performed. Except for urine retention, bilateral lower limb paraplegia and numbness were alleviated postoperatively. Due to the high risk of poor neurological outcomes without treatment or with delayed intervention, timely surgical evacuation of the hematoma and hemostasis are recommended to ensure favorable neurological outcomes.
Collapse
Affiliation(s)
- Junge Zhou
- Department of NeurosurgeryWuhan Brain HospitalWuhanHubeiChina
| |
Collapse
|
2
|
Kissling C, Häni L, Schär RT, Goldberg J, Raabe A, Jesse CM. Clinical outcome after surgical management of spontaneous spinal epidural hematoma. Acta Neurochir (Wien) 2024; 166:277. [PMID: 38937326 PMCID: PMC11211104 DOI: 10.1007/s00701-024-06169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Spontaneous spinal epidural hematoma (SSEH) is a rare pathology characterized by a hemorrhage in the spinal epidural space without prior surgical or interventional procedure. Recent literature reported contradictory findings regarding the clinical, radiological and surgical factors determining the outcome, hence the objective of this retrospective analysis was to re-assess these outcome-determining factors. METHODS Patients surgically treated for SSEH at our institution from 2010 - 2022 were screened and retrospectively assessed regarding management including the time-to-treatment, the pre-and post-treatment clinical status, the radiological findings as well as other patient-specific parameters. The outcome was assessed using the modified McCormick Scale. Statistical analyses included binary logistic regression and Fisher's exact test. RESULTS In total, 26 patients (17 men [65%], 9 women [35%], median age 70 years [interquartile range 26.5]) were included for analysis. The SSEHs were located cervically in 31%, cervicothoracically in 42% and thoracically in 27%. Twenty-four patients (92%) improved after surgery. Fifteen patients (58%) had a postoperative modified McCormick Scale grade of I (no residual symptoms) and 8 patients (31%) had a grade of II (mild symptoms). Only 3 (12%) patients remained with a modified McCormick Scale grade of IV or V (severe motor deficits / paraplegic). Neither time-to-treatment, craniocaudal hematoma expansion, axial hematoma occupation of the spinal canal, anticoagulation or antiplatelet drugs, nor the preoperative clinical status were significantly associated with the patients' outcomes. CONCLUSION Early surgical evacuation of SSEH generally leads to favorable clinical outcomes. Surgical hematoma evacuation should be indicated in all patients with symptomatic SSEH.
Collapse
Affiliation(s)
- Cédric Kissling
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Levin Häni
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ralph T Schär
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christopher Marvin Jesse
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Nakao S, Hirata H, Yoshihara T, Kobayashi T, Tsukamoto M, Egashira Y, Mawatari M, Morimoto T. Conservative management of spontaneous spinal epidural hematoma: A case report with favorable prognosis. Clin Case Rep 2024; 12:e8760. [PMID: 38686020 PMCID: PMC11056786 DOI: 10.1002/ccr3.8760] [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: 01/28/2024] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 05/02/2024] Open
Abstract
Sudden spinal epidural hematoma (SSEH) is relatively rare. Sudden pain from the neck to the back and subsequent extremity paralysis necessitate immediate head and cervical magnetic resonance imaging or computed tomography, keeping SSEH in mind. Although surgery is recommended for progressive paralysis, conservative treatment is indicated for mildly symptomatic cases.
Collapse
Affiliation(s)
- Satoshi Nakao
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Hirohito Hirata
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Tomohito Yoshihara
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Takaomi Kobayashi
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Masatsugu Tsukamoto
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Yoshiaki Egashira
- Department of Radiology, Faculty of MedicineSaga UniversitySagaJapan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Tadatsugu Morimoto
- Department of Orthopedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| |
Collapse
|
4
|
Benzon HT, Nelson AM, Patel AG, Chiang S, Agarwal D, Benzon HA, Rozental J, McCarthy RJ. Literature review of spinal hematoma case reports: causes and outcomes in pediatric, obstetric, neuraxial and pain medicine cases. Reg Anesth Pain Med 2024:rapm-2023-105161. [PMID: 38267076 DOI: 10.1136/rapm-2023-105161] [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: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The risk of spinal epidural hematoma (SEH) has been described in the literature but the impact in various patient populations has not been assessed in the same study. We identified the risk factors for SEH and calculated the OR for recovery in the pediatric, adult and obstetric (OB) patients based on the degree of neurological deficit before surgery. METHODS Adult non-OB cases were categorized whether they were on anticoagulants or not; SEH was related to neuraxial or pain procedure; or whether there was adherence to the American Society of Regional Anesthesia (ASRA) guidelines. Eligible cases were identified through PubMed and Embase searches in the English literature from 1954 to July 2022. RESULTS A total of 940 cases were evaluated. In the pediatric cases, SEH was typically spontaneous, related to coagulopathy or athletic trauma. OB cases were spontaneous or related to neuraxial injections. Among adults on anticoagulant(s), SEH was mostly spontaneous with no related etiology or related to neuraxial procedure. SEH occurred despite adherence to the ASRA guidelines. Among non-OB adults not on anticoagulants, SEH was due to trauma, neuraxial injections, surgery or other causes. Neurological recovery was related to the degree of neurological deficit before surgery. CONCLUSIONS Our data show a preponderance of spontaneous SEH in all patient populations. SEH developed even though the ASRA guidelines were followed, especially in patients on multiple anticoagulants. Patients with less impairment prior to surgery had a higher likelihood of complete recovery, regardless of the interval between surgery and onset of symptoms.
Collapse
Affiliation(s)
- Honorio T Benzon
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ariana M Nelson
- Department of Anesthesiology, University of California Irvine, Irvine, California, USA
| | - Arpan G Patel
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Silvia Chiang
- Department of Anesthesiology, University of California Irvine, Irvine, California, USA
| | - Deepti Agarwal
- Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hubert A Benzon
- Department of Anesthesiology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jack Rozental
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert J McCarthy
- Department of Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA
| |
Collapse
|
5
|
Khandelwal A, Kakati A, Ali A. Cervical epidural hematoma masquerading as thrombosis of intracranial flow diverter in situ: A diagnostic and therapeutic conundrum. Med J Armed Forces India 2024; 80:98-101. [PMID: 38261807 PMCID: PMC10793230 DOI: 10.1016/j.mjafi.2022.12.015] [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: 10/11/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
Cervical epidural hematoma (EDH) is a rare but very serious cause of acute neurologic compression that needs early diagnosis and rapid intervention. Acute hemiparesis is an infrequent presentation of cervical EDH and often mimics cerebrovascular accident. In this case, we describe the management of a case of cervical EDH presenting as acute hemiparesis in an elderly female patient which mimicked as thrombosis of intracranial flow diverter in situ. The report emphasizes that cervical EDH should be considered as differential diagnosis in patients who present with acute hemiparesis especially, who are on antiplatelets or anticoagulants. Also, in a patient considered high-risk for surgery, conservative management can be considered under close supervision and intensive monitoring, especially, in non-expanding hematoma and non-progressive neurological deterioration.
Collapse
Affiliation(s)
- Ankur Khandelwal
- Associate Professor (Anaesthesiology, Critical Care & Pain Medicine), All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India
| | - Arindom Kakati
- Senior Neurosurgeon (Neurosciences), Hayat Superspeciality Hospital, Guwahati, Assam, India
| | - Asman Ali
- Associate Professor (Neurosurgery), Guwahati Medical College and Hospital (GMCH), Guwahati, Assam, India
| |
Collapse
|
6
|
Wu H, Huang X. Spontaneous spinal epidural hematoma (SSEH) after cesarean section under epidural anesthesia: A case report. Heliyon 2023; 9:e22855. [PMID: 38125522 PMCID: PMC10730741 DOI: 10.1016/j.heliyon.2023.e22855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is an uncommon condition that can lead to severe neurological injuries, often accompanied by back pain. Pregnancy is identified as a risk factor for SSEH. Early diagnosis of SSEH presents challenges due to its atypical manifestations and the use of intraspinal anesthesia and analgesic techniques. In this case, we present the instance of a 29-year-old woman who initially received epidural labor analgesia during the first stage of labor but subsequently required a cesarean section under epidural anesthesia according to amniotic fluid turbidity. Unfortunately, the anomalous recovery of neurological function in her left lower extremity was not given sufficient attention at an early stage, and paralysis in the non-puncture segment occurred 45.5 hours after the initial puncture. Interestingly, she did not experience any back pain during these procedures. MRI examination and consultation with neurosurgeons confirmed the diagnosis of SSEH, prompting the patient to undergo emergency decompression surgery. She made an incomplete recovery 17 months after the operation. This case emphasizes the importance of considering the possibility of SSEH in pregnant women undergoing epidural analgesia, highlighting the need for spinal imaging and early neurosurgical interventions to facilitate treatment.
Collapse
Affiliation(s)
- Hua Wu
- Department of Anesthesiology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Xuezhu Huang
- Department of Anesthesiology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| |
Collapse
|
7
|
Luo M, He M, Wu C. Prognosis and outcome of chronic pain after spontaneous spinal epidural hematoma. Acta Neurol Belg 2023; 123:1849-1854. [PMID: 36103086 DOI: 10.1007/s13760-022-02092-y] [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] [Received: 07/21/2022] [Accepted: 09/01/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Chronic pain is a common symptom experienced by patients after spontaneous epidural hematoma (SSEH), and it seriously affects their quality of life. The outcome and prognosis of chronic pain after SSEH are rarely reported. Thus, we conduct this study to present the outcomes and explore prognostic factors of chronic pain in patients with SSEH. METHODS We retrospectively reviewed patients diagnosed with SSEH and invited them to complete the American Spinal Injury Association (ASIA) and Neuropathic Pain Symptom Inventory (NPSI) scales. Pearson χ2 and binary logistic regression were used to explore prognostic factors related to chronic pain after SSEH. RESULTS A total of 55 patients were reviewed; 21 patients (38.2%) were lost to follow-up, 3 patients (5.4%) died, and 31 patients (56.4%) completed the scales, with a mean follow-up time of 20.6 ± 17.3 months. The ASIA and NPSI results showed significant improvement after surgery. Pearson χ2 showed that timely surgery (≤ 12 h) was related to better outcomes (p < 0.05, Fisher test), and binary logistic regression revealed that patients with a preoperative NPSI score of 11-20 were prone to achieving significant pain relief (OR 23.67, 95%CI 1.11-503.48, p = 0.04). CONCLUSION Chronic pain is a common symptom during follow-up after SSEH, and timely intervention is suggested to obtain satisfactory outcomes. Patients who receive emergent surgery within 12 h or who have a preoperative NPSI score of 11-20 may achieve significant relief of chronic pain.
Collapse
Affiliation(s)
- Mingtao Luo
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Cong Wu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
| |
Collapse
|
8
|
Kahraman MA, Senturk S. The Necessity of Extensive Decompression for Spinal Epidural Hematoma: A Case Report and Literature Review. Cureus 2023; 15:e44192. [PMID: 37641725 PMCID: PMC10460501 DOI: 10.7759/cureus.44192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 08/31/2023] Open
Abstract
Spinal epidural hematomas (SEHs)are space-occupying lesions that exert pressure on the spinal cord by rapidly accumulating blood between the dura and bone or ligament components. The annual incidence of spontaneous epidural hematoma is estimated to be one in one million. The predominant symptoms are back pain or neurological impairment, including sensory, motor, or autonomic dysfunction of the limbs below the hematoma level. Depending on the level and size of the hematoma and the affected cord, they cause neurological deficits. Neurological deficits are often reversible if diagnosed and treated early with surgical decompression. However, neurological deficits can become permanent if the patient is not operated on timely, and paraplegia or quadriplegia may occur. A 53-year-old man presented to our emergency department with acute-onset back pain and 36-hour-long, rapidly progressive paraparesis of both legs. On T1- and T2-weighted MRI scans, a hyperacute SEH was found as iso/hyperintense and hyperintense, respectively. Immediate decompressive laminectomy from T10 to L2 and hematoma evacuation were performed. It was challenging to remove the hematoma due to its firm consistency. Before performing a bilateral total laminectomy at five levels, the posterior spine was stabilized between T10 and L3 using transpedicular screws. Within 24 hours, the motor function of the lower limbs increased considerably. The patient could sit on a chair because of posterior stability. In addition to the importance of early diagnosis using imaging techniques, planning the extension of SEH surgery is crucial for the patient's postoperative neurological recovery.
Collapse
Affiliation(s)
- Mehmet Ali Kahraman
- Neurosurgery, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, TUR
| | | |
Collapse
|
9
|
Wang H, Yu H, Zhang N, Xiang L. Incidence, Risk Factors, and Management of Postoperative Hematoma Following Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases. Neurospine 2023; 20:525-535. [PMID: 37401070 PMCID: PMC10323355 DOI: 10.14245/ns.2245066.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Studies discussed few risk factors for specific patients, such as duration of disease; or surgical factors, such as duration and time of surgery; or C3 or C7 involvement, which could have led to the formation of hematomas (HTs). To investigate the incidence, risk factors especially the factors mentioned above, and management of postoperative HTs following anterior cervical decompression and fusion (ACF) for degenerative cervical diseases. METHODS Medical records of 1,150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019 were identified and reviewed. Patients were categorized into the HT group (HT group) or normal group (no-HT group). Demographic, surgical and radiographic data were recorded prospectively to identify risk factors for HT. RESULTS Postoperative HT was identified in 11 patients, with an incidence rate of 1.0% (11 of 1,150). HT occurred within 24 hours postoperatively in 5 patients (45.5%), while it occurred at an average of 4 days postoperatively in 6 patients (54.5%). Eight patients (72.7%) underwent HT evacuation; all patients were successfully treated and discharged. Smoking history (odds ratio [OR], 5.193; 95% confidence interval [CI], 1.058-25.493; p = 0.042), preoperative thrombin time (TT) value (OR, 1.643; 95% CI, 1.104-2.446; p = 0.014) and antiplatelet therapy (OR, 15.070; 95% CI, 2.663-85.274; p = 0.002) were independent risk factors for HT. Patients with postoperative HT had longer days of first-degree/intensive nursing (p < 0.001) and greater hospitalization costs (p = 0.038). CONCLUSION Smoking history, preoperative TT value and antiplatelet therapy were independent risk factors for postoperative HT following ACF. High-risk patients should be closely monitored through the perioperative period. Postoperative HT in ACF was associated with longer days of first-degree/intensive nursing and more hospitalization costs.
Collapse
Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Ning Zhang
- Department of Orthopedics, The Second Hospital of Chaoyang, Chaoyang, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| |
Collapse
|
10
|
Gnus J, Druszcz A, Miś M, Ślósarz L. Health-Related Quality of Life and Functional Status Following Intensive Neurorehabilitation in a Patient after Severe Head Injury with Spinal Epidural Hematoma: A Case Report. J Clin Med 2023; 12:jcm12082984. [PMID: 37109320 PMCID: PMC10147054 DOI: 10.3390/jcm12082984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Spinal epidural hematoma (SEH) is a very rare condition associated with trauma or occurring as a complication of lumbar puncture and can appear spontaneously. It manifests with acute pain and neurological deficits, leading to severe and permanent complications. This study aimed to assess changes in health-related quality of life and functional status following long-term intensive neurorehabilitation in a patient after severe sport-related head injury with a related SEH. The 60-year-old male patient experienced bilateral weakness of lower limbs, loss of sensation, and sphincter dysfunction. A laminectomy was performed, followed by a slight superficial and deep sensation improvement. The patient underwent intensive neurological rehabilitation treatment. The proprioceptive neuromuscular facilitation (PNF) method, PRAGMA device exercises, and water rehabilitation were provided. The study outcomes were assessed using the validated questionaries World Health Organization Quality-of-Life Scale (WHOQOL-BREF) and Health-Related Quality of Life (HRQOL-14) for health-related quality of life as well as the Functional Independence Measure (FIM) and Health Assessment Questionnaire (HAQ) for functional status. A beneficial clinical improvement was observed following the intensive rehabilitation using PNF techniques, training with a PRAGMA device, and water exercises in the case of SEH. The patient's physical condition significantly improved, with an increase in the FIM score from 66 to 122 pts. (by 56 pts.) and in the HAQ score from 43 to 16 pts. (by 27 pts.). Additionally, the QOL level increased after rehabilitation, with an increase in the WHOQOL-BREF from 37 to 74 pts. (by 37 pts.) and a decrease in unhealthy or limited days, as assessed using the HRQOL-14, from 210 to 168 (by 42 days). In conclusion, the improvement in QOL and functional level in the SEH patient were associated with high-intensity rehabilitation, simultaneous integration of three therapeutic modalities, and committed patient cooperation.
Collapse
Affiliation(s)
- Jan Gnus
- Department of Physiotherapy, Wroclaw Medical University, 50-368 Wroclaw, Poland
- Research and Development Center, Regional Specialist Hospital, 51-124 Wroclaw, Poland
| | - Adam Druszcz
- Department of Neurosurgery, Provincial Specialist Hospital in Legnica, 59-220 Legnica, Poland
| | - Maciej Miś
- Department of Neurosurgery, Health Clinic "Medic" in Walbrzych, 58-306 Walbrzych, Poland
| | - Luba Ślósarz
- Department of Humanities and Social Science, Wroclaw Medical University, 50-368 Wroclaw, Poland
| |
Collapse
|
11
|
Risavi BL, Reese EM, Knott M. An unusual presentation of spontaneous spinal epidural hematoma. J Am Coll Emerg Physicians Open 2023; 4:e12925. [PMID: 36936061 PMCID: PMC10015907 DOI: 10.1002/emp2.12925] [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: 01/14/2023] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023] Open
Abstract
We report a rare case of spontaneous spinal epidural hematoma. Various presentations may occur, most commonly including neck pain, interscapular pain, radicular pain, and paralysis. This condition is frequently associated with paralysis and long-term disability. This case is unique because it presented with right hand cyanosis, in addition to pain. A 69-year-old Caucasian female presented with cyanosis of the right hand, and severe right upper extremity pain which awakened her approximately 11 hours earlier. The pain was exacerbated on extending her head. The patient further reported bilateral shoulder pain and interscapular pain. She reported no motor weakness or paralysis. She denied any history of trauma. The patient was taking aspirin 81 mg/d for the past 2 months. Physical examination revealed cyanosis of the digits of the right hand as well as mildly diminished right biceps reflex and right grip strength. No edema or rashes were noted. Skin was warm and dry. Pulses were +2 in all extremities. Vital signs were within normal limits. The remainder of the physical examination was unremarkable. Magnetic resonance imaging of the cervical/thoracic spine revealed a right posterior-lateral epidural hematoma extending from the 3rd cervical level to the 1st thoracic level of the spinal cord. There was also evidence of cord compression at the 4th-5th and 5th-6th cervical levels. Given the potential for significant complications, clinicians should maintain a high index of suspicion for spinal epidural hematoma, particularly in those patients taking anticoagulation. Symptoms, including extremity cyanosis, pain, and paralysis all are suggestive of the diagnosis.
Collapse
Affiliation(s)
- Brian L. Risavi
- Department of Emergency MedicineLake Erie College of Osteopathic MedicineEriePennsylvaniaUSA
| | - Erin M. Reese
- Department of Emergency MedicineUPMC HamotEriePennsylvaniaUSA
| | - Mary Knott
- Department of Emergency MedicineLake Erie College of Osteopathic MedicineEriePennsylvaniaUSA
| |
Collapse
|
12
|
Jha VC, Alam S, Jha N. Spontaneous Cervicothoracic Extradural Hematoma with Rare Presentation in Pediatric Patient with Stroke-Like Features in Association with COVID-19, Presenting as Management Dillemma. Asian J Neurosurg 2023; 18:196-200. [PMID: 37056903 PMCID: PMC10089729 DOI: 10.1055/s-0043-1768249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
AbstractPresentation of cervico-thoracic extradural hematoma in pediatric age is rare with stroke-like features. Its association with COVID-19 in the active stage of the disease had not been reported and its management presents a management dilemma as COVID-19 with stroke-like features.A 14-year-old boy was referred to our institute with complaints of sudden-onset upper and middle back pain, associated with loss of sensation below the middle of the back, sudden progressive weakness of both lower limbs (power 0/5) and upper limbs (power grade-2/5), and incontinence of urine, following bouts of vomiting 12 days back. There was no history of trauma, bleeding diathesis, etc. Blood investigation was suggestive of leukocytosis, and RT-PCR test for COVID-19 was positive with raised D-dimer, serum ferritin, and C-reactive protein. MRI spine was suggestive of cervicothoracic extradural hematoma extending from C5-D3 level and compressing the spinal cord. The patient refused surgical decompression and was managed conservatively, following which he improved with power grade in limbs to 4/5.Surgical decompression is the treatment of choice but the patient can sometimes improve on medical management. Association of COVID-19 with spontaneous cervicothoracic extradural hematoma had not been reported earlier in the active stage, but its role in inducing vasculopathy and increased chances of bleeding at the uncommon site had been reported in the literature, and it may precipitate such cervical epidural hematoma.
Collapse
|
13
|
Nakamura S, Yoshida S, Matsuda H, Yahata T, Inokuchi K, Maru T, Ogihara S, Saita K, Oya S. Ultraearly Hematoma Evacuation (<12 Hours) Associated with Better Functional Outcome in Patients with Symptomatic Spontaneous Spinal Epidural Hematoma. World Neurosurg 2023; 171:e859-e863. [PMID: 36627018 DOI: 10.1016/j.wneu.2023.01.008] [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] [Received: 08/23/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early decompressive surgery within 24 hours improves the functional outcome of patients with traumatic spinal cord injury; however, little is known about the effect of early surgery for spontaneous spinal epidural hematoma (SSEH). In this study, we aimed to investigate the effectiveness of ultraearly hematoma evacuation (<12 hours) for SSEH. METHODS Patients with SSEH treated with surgical hematoma evacuation at our institution between January 2000 and July 2021 were retrospectively analyzed. Neurologic function was evaluated using the American Spinal Injury Association Impairment Scale (AIS). AIS grades A-C were defined as severe, and grades D and E as mild. AIS grades D and E at the final follow-up were considered favorable outcomes. Preoperative status and postoperative treatment results were compared between patients who had hematoma evacuation within 12 hours of onset and those who underwent surgery after 12 hours. RESULTS Twenty-five consecutive patients were included in the analysis. Preoperatively, 23 patients (92.0%) had severe AIS. Fourteen (56.0%) patients underwent early surgery. At the final follow-up, 21 patients (84.0%) achieved favorable outcomes. Patients treated with ultraearly surgery had significantly better outcomes (100% vs. 63.6%, P = 0.03). Additionally, the time from onset to surgery was significantly shorter in patients with AIS improvement by 2 or more grades than that in patients with AIS improvement of 1 or less (median 8 hours vs. 14 hours, P = 0.0001). CONCLUSIONS Ultraearly surgery within 12 hours for SSEH was associated with better functional outcomes.
Collapse
Affiliation(s)
- Sho Nakamura
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiromi Matsuda
- Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tadashi Yahata
- Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Koichi Inokuchi
- Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takanori Maru
- Orthopedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Ogihara
- Orthopedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazuo Saita
- Orthopedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
| |
Collapse
|
14
|
Abu-Abaa M, Jumaah O, Mousa A, Al-Qaysi G. A Spontaneous Spinal Epidural Hematoma Secondary to Long-Term Low-Dose Aspirin and Clopidogrel Use: A Case Report. Cureus 2023; 15:e34537. [PMID: 36879714 PMCID: PMC9985069 DOI: 10.7759/cureus.34537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
The association between antiplatelet agents such as aspirin, clopidogrel, and ticlopidine and spontaneous spinal epidural hematoma is based on multiple case reports in the literature. Here, we present the case of a 76-year-old male patient who presented with acute low back pain associated with sudden-onset paralysis of the lower extremities. His past medical history was remarkable for coronary artery disease with a stent placement history on dual antiplatelet therapy including low-dose aspirin and clopidogrel. An extensive posterior thoracolumbar epidural hematoma was seen on the imaging test, and rapid clinical improvement was evident early during his presentation. This prompted a conservative approach that led to complete neurological recovery. This case is in line with limited English-language literature evidence that suggests a possible association between spontaneous spinal epidural hematoma and antiplatelet agents. We aim to enhance clinicians' awareness of this clinical entity, association, presentation, and management.
Collapse
Affiliation(s)
- Mohammad Abu-Abaa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Omar Jumaah
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Ghassan Al-Qaysi
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| |
Collapse
|
15
|
Emergency surgical decompression for spontaneous spinal epidural hematoma in octogenarians: risk factors, clinical outcomes, and complications. Acta Neurochir (Wien) 2022; 165:905-913. [PMID: 36571626 PMCID: PMC10068654 DOI: 10.1007/s00701-022-05457-7] [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: 10/16/2022] [Accepted: 12/10/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Spontaneous spinal epidural hematoma (SSEH) is a rare but disabling disease. Although several cases have been reported in the literature, their treatment remains unclear, especially in patients with advanced age. We, therefore, aimed to describe the clinical outcomes of cervical SSEH in octogenarians with an acute onset of neurological illness undergoing laminectomy. METHODS Electronic medical records from a single institution between September 2005 and December 2020 were retrieved. Data on patient demographics, neurological conditions, functional status, surgical characteristics, complications, hospital course, and 90-day mortality were also collected. RESULTS Twenty-two patients aged ≥ 80 years with SSEH undergoing laminectomy were enrolled in this study. The mean Charlson comorbidity index was 9.1 ± 2.0, indicating a poor baseline reserve. Ten individuals (45.5%) were taking anticoagulant agents with a pathologic partial thromboplastin time (PTT) of 46.5 ± 3.4 s. Progressive neurological decline, as defined by the motor score (MS), was observed on admission (63.8 ± 14.0). The in-hospital and 90-day mortality were 4.5% and 9.1%, respectively. Notably, the MS (93.6 ± 8.3) improved significantly after surgery (p < 0.05). Revision surgery was necessary in 5 cases due to recurrent hematoma. Anticoagulant agents and pathological PTT are significant risk factors for its occurrence. Motor weakness and comorbidities were unique risk factors for loss of ambulation. CONCLUSIONS Laminectomy and evacuation of the hematoma in octogenarians with progressive neurological decline induce clinical benefits. Emergent surgery seems to be the "state of the art" treatment for SSEH. However, potential complications associated with adverse prognostic factors, such as the use of anticoagulants, should be considered.
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
Fukui H, Kamei N, Fujiwara Y, Hamasaki T, Hiramatsu T, Fujimoto Y, Nakanishi K, Nakamae T, Nishida K, Yamamoto R, Sasaki M, Adachi N. Prognostic factors for spontaneous spinal epidural hematoma: a multicenter case-control study. Acta Neurochir (Wien) 2022; 164:1493-1499. [PMID: 35124747 DOI: 10.1007/s00701-022-05130-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the optimal treatment for spontaneous spinal epidural hematoma (SSEH). The aim of this study was to identify factors associated with SSEH. METHODS In 62 patients with SSEH, several patient-related parameters were analyzed as candidate factors associated with Frankel grade before treatment or at the last follow-up. These parameters were compared between patients with and without surgery. In addition, multivariate ordinal logistic regression analysis was used to identify factors significantly associated with Frankel's grade before treatment or at the last follow-up. RESULTS There were significant differences in age, location of the hematoma, and Frankel grade before treatment and at the last follow-up between surgical and nonsurgical cases in all patients, but there were no significant differences in any of these parameters when comparing patients with pre-treatment Frankel grade C. The location of the hematoma was significantly associated with the severity of paralysis before treatment. In surgical cases, the time from onset to surgery and the location of the hematoma was significantly associated with the prognosis. When the time from onset to surgery was evaluated using the criteria of 12, 24, and 48 h, 24 and 48 h had a significant impact on the prognosis. In the analysis of nonsurgical cases, only the vertical size of the hematoma was significantly associated with prognosis. CONCLUSION The time from onset to surgery and the location of the hematoma were prognostic factors in surgical cases, while the vertical size of the hematoma was a prognostic factor in nonsurgical cases.
Collapse
Affiliation(s)
- Hiroki Fukui
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Orthopaedic Surgery, JA Yoshida General Hospital, Akitakata, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Yasushi Fujiwara
- Orthopedics and Micro-Surgical Spine Center, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Takahiko Hamasaki
- Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Kure, Japan
| | - Takeshi Hiramatsu
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Yoshinori Fujimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | | | - Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Koji Nishida
- Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Risako Yamamoto
- Department of Orthopaedic Surgery, JA Yoshida General Hospital, Akitakata, Japan
| | - Masanobu Sasaki
- Department of Orthopaedic Surgery, JR Hiroshima Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
18
|
Boukebous B, Maillot C, Hachache BE, Rousseau MA. Tiny but risky: the reasons why the Caspar pin distractor causes suffocating cervical hematoma - two cases and a literature review. Neurochirurgie 2022; 68:518-524. [DOI: 10.1016/j.neuchi.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/26/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
|
19
|
Iida A, Miura M, Maki S, Furuya T, Ohtori S. Bladder and Bowel Dysfunction due to a Spontaneous Spinal Epidural Hematoma Without Paraplegia: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00049. [PMID: 35696718 DOI: 10.2106/jbjs.cc.22.00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 44-year-old man developed urinary retention due to a spontaneous spinal epidural hematoma (SSEH) at the cervicothoracic junction, without paraplegia. Symptoms improved with surgical treatment. CONCLUSION SSEH is rare and causes acute neck or back pain and progressive paralysis. Patients with advanced myelopathy due to spinal cord compression lesion including SSEH often present with bladder and bowel disorders after exacerbation of quadriplegia. However, SSEH can cause predominant bladder and bowel disorders without paraplegia or quadriplegia. Physicians should consider that there can be a manifestation of myelopathy with bladder and bowel dysfunction without quadriplegia.
Collapse
Affiliation(s)
- Akihiro Iida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | | | | | | |
Collapse
|
20
|
Kwasnicki A, Calandriello A, Nikas D. Spontaneous spinal epidural hematoma in an infant presenting with Horner syndrome. Childs Nerv Syst 2022; 38:827-830. [PMID: 34228175 DOI: 10.1007/s00381-021-05252-2] [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: 02/19/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic entity, especially in infants, that develops in the absence of underlying coagulopathy, bleeding diathesis, infection, vascular malformation, trauma, iatrogenic, or other identifiable cause. In contrast to adults, diagnosis is frequently delayed or missed in infants due to non-specific symptoms and limited clinical examination. CASE ILLUSTRATION An 11-month-old female demonstrated symptoms of irritability, intermittent diarrhea, lethargy, decreased oral intake, and difficulties crawling before presenting to the emergency room. At time of presentation, she was noted to have minimal spontaneous movement of the lower extremities and anisocoria with ptosis of the right eye. Given her clinical presentation, a magnetic resonance image (MRI) of the spine was obtained which revealed an epidural hematoma with compression extending from C7-T3. She underwent C7-T3 laminoplasty and hematoma evacuation. Following surgical intervention, she demonstrated significant improvements in her lower extremity strength and resolution of Horner syndrome. CONCLUSION SSEH in infants is a rare neurologic condition, with diagnosis often delayed due to nonspecific symptomatology. Prompt diagnosis and intervention are essential in the treatment of SSEH to prevent permanent neurologic dysfunction. Physicians should have a high index of suspicion for SSEH in these instances, and investigation with spinal MRI imaging is recommended.
Collapse
Affiliation(s)
- Amanda Kwasnicki
- Department of Neurological Surgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA.
| | - Amy Calandriello
- Department of Pediatric Neurological Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Dimitrios Nikas
- Department of Neurological Surgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA.,Department of Pediatric Neurological Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA
| |
Collapse
|
21
|
Barwar N, Kumar N, Sharma A, Bharti A, Kumar R. A Rare Presentation of Spontaneous Spinal Epidural Hematoma as Spinal Cord Compression and Complete Paraplegia: A Case Report and Review of the Literature. Cureus 2022; 14:e22199. [PMID: 35308734 PMCID: PMC8925991 DOI: 10.7759/cureus.22199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/05/2022] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is a serious but infrequent cause of profound neurological compromise of acute onset. It is often an atraumatic occurrence, and in around half of the cases, no etiology is identified. However, several causes such as arteriovenous malformation in the spine, use of anticoagulants in various cardiovascular diseases, and spinal trauma have been incriminated for its development. Here we encountered a case of SSEH following unregulated use of anticoagulants after a mitral valve replacement surgery. The patient had complete paraplegia with bowel and bladder involvement. The case was treated with decompressive laminectomy with regularization of her coagulation profile. Although she presented late to the healthcare center for the treatment, she showed a remarkable neurological improvement with gaining power worth near independent ambulation after one year of follow-up.
Collapse
|
22
|
Zübeyde Ö, Adem K, Samet D. A case of spontaneous thoracolumbar epidural hematoma in Covid-19 pneumonia. Int J Surg Case Rep 2022; 90:106719. [PMID: 34961838 PMCID: PMC8695519 DOI: 10.1016/j.ijscr.2021.106719] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance Covid-19 is an important disease that still occupies our agenda, and as time passes, we have been observing its extrapulmonary manifestations. In this study, we presented a case of spontaneous thoracolumbar epidural hematoma, which we could not attribute to any cause other than Covid-19. Case presentation We presented a 55-year-old female patient whose etiology could not be found to be compatible with the literature. In the formation of this disease, we did not have any positive findings except for Covid-19, which she had 20 days ago. The patient had no history of anticoagulant or antiaggregant drug use. He had no history of trauma and no signs. Hematological tests were normal. We evacuated the hematoma in the T12-L1 vertebral canal after laminectomy and the pathology result was compatible with hematoma. Clinical discussion Although spontaneous spinal epidural hematoma is rare, many factors are blamed for its etiology. Many extrapulmonary complications of Covid-19 stand out in the literature. The fact that the patient had Covid-19 did not affect the neurosurgical approach, but we think that it is useful to examine the complaints of patients with Covid-19 more systematically. Conclusion Spontaneous spinal epidural hematomas are rare. Making the correct diagnosis often takes time and is difficult. Decompression surgery is at the forefront as a treatment option. However, conservative treatment can be performed in suitable patients. As we saw in this case, we should consider Covid-19 among the etiological causes. The etiology of spontaneous spinal epidural hematoma is multifactorial. Covid-19 is one of these etiological factors. Etiological cause does not change the approach to spontaneous spinal hematoma.
Collapse
|
23
|
El-azrak M, Noumairi M, Oulalite MA, El Mir S, Kachmar S, Bkiyar H, El Ouafi N, El Oumri AA, Bazid Z, Housni B. Spontaneous spinal epidural hematoma in a patient on acenocoumarol for valvular atrial fibrillation: A rare case report. Ann Med Surg (Lond) 2021; 72:103076. [PMID: 34876979 PMCID: PMC8632830 DOI: 10.1016/j.amsu.2021.103076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare finding, but one with serious clinical implications. Oral anticoagulant drugs are known to be associated with the SSEH onset, particularly when combined with drugs increasing the bleeding risk. CASE PRESENTATION We present the case of a 62-year-old female on acencoumarol for her atrial fibrillation complicating severe mitral stenosis with a history of Ketoprofen use for the onset of her first symptoms. She presented to our emergency room with paraplegia and sphincter disturbance. Spinal magnetic resonance imaging (MRI) revealed a posterior SSEH extended from T10 to T12 requiring an urgent decompression of the spinal cord by laminectomy performed within 48 hours from the symptom's onset. After 3 months of rehabilitation, the patient improves partially her muscular strength with mostly unchanged sensitive and sphincteric levels. CLINICAL DISCUSSION Vitamin K antagonists (VKA) use appears to be a high suspicion index for SSEH diagnosis resulting in earlier surgery and improving neurological outcome. Also, it is important to pay attention to the concomitant use of VKA and non-steroidal anti-inflammatory drugs which increase the risk of bleeding and may worsen the neurological outcome. CONCLUSION SSEH is a rare and serious finding which should be especially searched when a history of oral anticoagulation is reported in presence of neurological symptoms. A prompt and suitable management may improve the patient outcomes.
Collapse
Affiliation(s)
- Mohammed El-azrak
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Mohammed Noumairi
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Mohammed Amine Oulalite
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Siham El Mir
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Safaa Kachmar
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Houssam Bkiyar
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Ahmed Amine El Oumri
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Brahim Housni
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| |
Collapse
|
24
|
Lee BJ. Letter to the Editor: Commentary on Recurrent Cervical Spontaneous Spinal Epidural Hematoma with Conservative Management: A Case Report ( Korean J Neurotrauma 2021;17:186-191). Korean J Neurotrauma 2021; 17:192. [PMID: 34760833 PMCID: PMC8558011 DOI: 10.13004/kjnt.2021.17.e32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, Goyang, Korea
| |
Collapse
|
25
|
An unusual acute onset hard and small volume epidural blood clotting after anterior cervical discectomy with tetraparetic neurological findings. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.1013491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
26
|
Singh S, Raheja A, Mahapatra AK. Successful Nonoperative Management of Acute Spontaneous Idiopathic Spinal Epidural Hematoma Presenting as Cauda Equina Syndrome. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1735428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Simranjeet Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ashok K. Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| |
Collapse
|
27
|
Cervical Epidural Hematoma With Hemiparesis: An Unusual But Important Stroke Mimic. Am J Phys Med Rehabil 2021; 100:e133. [PMID: 33252473 DOI: 10.1097/phm.0000000000001655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Chia KJ, Lin LH, Sung MT, Su TM, Huang JF, Lee HL, Sung WW, Lee TH. Acute spontaneous thoracic epidural hematoma associated with intraspinal lymphangioma: A case report. World J Clin Cases 2021; 9:3411-3417. [PMID: 34002152 PMCID: PMC8107886 DOI: 10.12998/wjcc.v9.i14.3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/24/2021] [Accepted: 03/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spontaneous spinal epidural hematoma is a rare neurosurgical emergency.
CASE SUMMARY A 53-year-old healthy woman suffered from complete paraplegia in both legs and loss of all sensation below the xiphoid process. She was diagnosed as acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma. The primary lab survey showed all within normal limits. Presence of a posteriorly epidural space-occupying lesion at the T4-T8 level of the spinal canal was confirmed on magnetic resonance imaging. A decompressive laminectomy was performed from the T4 to T7 levels at the sixth hour following abrupt onset of complete paraplegia. The lesion was confirmed as lymphangioma. This patient recovered well within one month.
CONCLUSION This study reports a case of acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma with well recovery after surgical intervention.
Collapse
Affiliation(s)
- Kai-Jay Chia
- Division of Neurosurgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Li-Han Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Ming-Tse Sung
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Tsung-Ming Su
- Division of Neurosurgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Jin-Fu Huang
- Division of Neurosurgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Hsiang-Lin Lee
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Wen-Wei Sung
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Tsung-Han Lee
- Division of Neurosurgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| |
Collapse
|
29
|
Musha Y, Kinjo S, Ishimine Y, Takesue Y, Sakamoto T, Ito K. Therapeutic strategy for acute spinal cord paralysis by epidural hematoma derived from the application of non-operative observation and the optimal timing to convert to surgical intervention. J Clin Neurosci 2021; 86:242-246. [PMID: 33775335 DOI: 10.1016/j.jocn.2021.01.029] [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: 05/21/2020] [Revised: 11/30/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Some cases of acute spinal cord paralysis by epidural hematoma have made complete recovery through natural progression. This group cannot be ignored in choosing a therapy. We have considered the applications of non-operative observation and the optimal timing to convert to surgical intervention. Of the 454 cases reported, cases that were of trauma/post-operative, undergone epidural block, lumbosacral level, paralysis-free, were excluded. 10 clinical items were identified as factors related to the outcome of therapy, and a total of 142 cases (73 surgical and 69 non-surgical/observation cases) which included all items in its record, were extracted for this study. 104 cases that made complete recovery from spinal paralysis (CR) includes 65 cases without surgical intervention (NOP-CR). Using "paralysis recovery start time (PRST)", ROC analysis was conducted to show the diagnostic time needed to detect the cases of CR and NOP-CR. Clinical characteristics of CR and NOP-CR were identified using multiple logistics regression analysis. CR probability were higher at PRST < 15 h from the onset and NOP-CR was even higher at < 11 h. Three clinical items: incomplete motor paralysis, no use of anti-coagulant therapy, and PRST within 15 h were found to be the characteristics of CR and NOP-CR. The case with all 3 items; especially PRST within 11 h from onset, is applicable to non-operative observation. Immediate surgical intervention at 6-hours is recommended in cases that presented with unchanged complete motor paralysis. Observation treatment is discontinued and converted to surgery if motor usefulness is not regained at 15-hours.
Collapse
Affiliation(s)
- Yoshiro Musha
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
| | - Sumito Kinjo
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| | - Youhei Ishimine
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| | - Yuya Takesue
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| | - Tetsuo Sakamoto
- Department of Orthopaedic Surgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| | - Keisuke Ito
- Department of Neurosurgery, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan
| |
Collapse
|
30
|
A spontaneous cervical spinal epidural hematoma in a male patient receiving treatment for acute coronary syndrome: A case report. Turk J Phys Med Rehabil 2020; 66:360-363. [PMID: 33089093 PMCID: PMC7557616 DOI: 10.5606/tftrd.2020.3971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/12/2019] [Indexed: 12/29/2022] Open
Abstract
Although spontaneous spinal epidural hematoma is a rare entity with an unknown origin, it may occur secondary to the use of anticoagulant and/or antiplatelet agents, which are particularly used for the treatment of cardiovascular and cerebrovascular diseases. Since it occurs rarely and its initial symptoms are usually non-specific, early and accurate diagnosis can be challenging which affects survival rate and the quality of life. Herein, we present a 65-year-old male case who developed acute severe neck pain and headache on the third day of acute coronary syndrome treatment, followed by neurological deficits in bilateral upper and lower extremities.
Collapse
|
31
|
Abstract
A spontaneous spinal epidural hematoma is a collection of blood in the spinal epidural space that occurs in the absence of trauma. They most commonly present in the fourth to fifth decade in life with acute onset neck or back pain with delayed neurologic deficit. However, this presentation is often complicated in children because of the limitations in the pediatric neurologic exam. Magnetic resonance imaging is the imaging modality of choice for diagnosis. Here is a rare case of an infant spontaneous spinal epidural hematoma whose diagnosis was delayed because of a recent history of fever and viral pharyngitis before his development of neurologic deficits. Spontaneous spinal epidural hematomas are a rare phenomenon, which often present with nonspecific symptoms in the pediatric population. This diagnosis should be considered to initiate treatment in a timely manner. The treatment typically is emergent surgical decompression to minimize the risk of permanent neurologic deficit.
Collapse
|
32
|
Zheng HX, Eric Nyam TT, Liu CA, Lee YL, Kuo JR, Sung KC. Spontaneous Spinal Epidural Hematoma After Normal Spontaneous Delivery with Epidural Analgesia: Case Report and Literature Review. World Neurosurg 2020; 137:214-217. [PMID: 32058108 DOI: 10.1016/j.wneu.2020.01.240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pregnancy is a known risk factor for spontaneous spinal epidural hematoma. During cesarean section or vaginal delivery, the unstable hemodynamic status that may occur owing to fluctuation of intra-abdominal pressure increases the possibility of spontaneous spinal epidural hematoma. During labor and the postpartum period, neurologic symptoms may be masked by labor pain or anesthesia block, which makes early diagnosis difficult, especially in the obstetric clinic without a neurologist or neurosurgeon. CASE DESCRIPTION A 28-year-old woman who had a normal spontaneous delivery under epidural anesthesia developed bilateral lower limb flaccid paralysis and loss of sensation 12.5 hours after delivery. Magnetic resonance imaging showed a 5.2 × 0.9 × 2 cm spinal epidural hematoma with severe spinal cord stenosis at the T2-T5 level with no evidence of a vascular anomaly. After emergent evacuation of the spinal epidural hematoma, lower limb muscle power improved from 0/5 to 1/5, and sensation gradually returned to bilateral lower limbs 22 days postoperatively. Deep vein thrombosis developed at 35 days postoperatively, and an inferior vena cava filter was implanted with urokinase infusion for thrombolytic therapy. She was discharged on day 52 after admission, and lower limb muscle power returned to normal after 3 months. CONCLUSIONS Clinicians should observe postpartum women for signs of myelopathy or back tenderness and closely monitor neurologic function until anesthesia has run its course. A prompt diagnosis can enable prompt intervention.
Collapse
Affiliation(s)
- Hong-Xiang Zheng
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | | | - Che-An Liu
- Jin-Sin Women and Children's Hospital, Tainan, Taiwan
| | - Yao-Lin Lee
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kuan-Chin Sung
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
| |
Collapse
|
33
|
Liao Y, Tian Y, Ye R, Tang C, Tang Q, Ma F, Yang S, He H, Zhong D. Risk and treatment of symptomatic epidural hematoma after anterior cervical spine surgery: A retrospective clinical study. Medicine (Baltimore) 2020; 99:e18711. [PMID: 31914081 PMCID: PMC6959927 DOI: 10.1097/md.0000000000018711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Symptomatic epidural hematoma (SEH) after anterior cervical spine surgery is very rare, but it has disastrous consequences for the patients. Timely diagnosis and evaluation can effectively reduce the sequelae of neurological deficit in SEH. The purpose of this study was to retrospectively analyze a subset of clinical data of SEH after anterior cervical spine surgery, and to investigate the risk factors and treatment experience of this serious complication.Neurological deterioration after anterior cervical spine surgery was detected in six patients. Epidural hematoma was confirmed by emergency cervical magnetic resonance imaging (MRI). The patients included five males and one female, with an average age of 56.7 ± 13.1 years (range 42-76 years). Three patients had a history of drinking and/or smoking. All of the patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively, but without anticoagulant drugs or pre-spinal surgery. The coagulation function was normal in all patients. Except for one patient, who had lower blood pressure (BP) during the operation and higher BP after the operation, the other patients had a normal level of BP during the pre-, intra-, and post-operation periods. The average time was 9.9 ± 6.7 hours (range, 2-19 hours) from the postoperative period to the initial neurological deficit and 6.3 ± 6.0 hours (range, 1.8-16.7 hours) from the initial deterioration to evacuation. Five patients underwent emergency evacuation, and one patient underwent conservative treatment. Four patients who underwent evacuation and one patient who received conservative treatment achieved neurological function recovery with an American Spinal Injury Association (ASIA) grade 2.4 ± 0.9 (range, 2-4 score) score at the last follow-up. One patient with confirmed arterial epidural hemorrhage during the evaluation showed no neurological function recovery at the last follow-up.Wide exposure of the epidural space and BP level during the perioperative period play an important role in the formation of SEH after anterior cervical spine surgery. Arterial epidural hematoma has serious consequences; therefore, early diagnosis and evaluation play an important role in the recovery from paralysis.
Collapse
Affiliation(s)
| | | | - Rupei Ye
- Department of Pathology, The affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | | | | | - Fei Ma
- Department of Spinal Surgery
| | | | | | | |
Collapse
|
34
|
Eto F, Tatsumura M, Iwabuchi S, Ogawa T, Mammoto T, Hirano A. Clinical features of spontaneous spinal epidural hematoma. J Rural Med 2019; 14:206-210. [PMID: 31788143 PMCID: PMC6877928 DOI: 10.2185/jrm.3005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/31/2019] [Indexed: 11/27/2022] Open
Abstract
Objective: Spontaneous spinal epidural hematoma is rare and therefore
difficult to diagnose. This study evaluated the clinical features of this condition in
patients admitted to our hospital. Patients and Methods: We evaluated 12 patients with spontaneous spinal
epidural hematoma who were treated at our hospital. We investigated the following
variables in these patients: underlying diseases, medications used, initial symptoms,
spinal level affected, whether transported to the hospital by ambulance, department where
first evaluated, mass lesion on computed tomography with soft tissue window settings, time
interval between symptom onset and diagnosis, treatment received, and Frankel
classification on arrival and when last observed. Results: Five patients reported the use of antiplatelet or anticoagulant
drugs. All patients in this study reported acute onset of severe pain as the initial
symptom, and 10 patients reported some degree of paralysis accompanying the pain. With
respect to the morbidity level, the cervical region was the most common site of
involvement (n=7). Ten patients were transported to the hospital at night via ambulance.
Five patients first visited the Department of Internal Medicine. Seven patients presented
with a mass lesion on computed tomography with soft tissue window settings. The time
interval between symptom onset and diagnosis ranged from 2 hours to 6 days. Three and 9
patients received conservative and surgical treatments, respectively. No patient showed
worsening of Frankel classification. Conclusion: Acute onset of severe pain was the most characteristic clinical
symptom. Spontaneous spinal epidural hematoma should be included in the differential
diagnosis. Computed tomography with soft tissue window settings may rule out
cerebrovascular disease and cardiovascular disease, and specifically detect a hematoma.
Subsequent magnetic resonance imaging can diagnose a spontaneous spinal epidural hematoma
at an early stage.
Collapse
Affiliation(s)
- Fumihiko Eto
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education andTraining Center, Mito Kyodo General Hospital, Japan
| | - Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education andTraining Center, Mito Kyodo General Hospital, Japan
| | - Sho Iwabuchi
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education andTraining Center, Mito Kyodo General Hospital, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education andTraining Center, Mito Kyodo General Hospital, Japan
| | - Takeo Mammoto
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education andTraining Center, Mito Kyodo General Hospital, Japan
| | - Atsushi Hirano
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education andTraining Center, Mito Kyodo General Hospital, Japan
| |
Collapse
|
35
|
Emamhadi M, Ghadarjani S, Alijani B, Yousefzadeh-Chabok S, Behzadnia H, Naseri A, Andalib S. Spontaneous Cervical Epidural Hematoma with Stroke Manifestations. Asian J Neurosurg 2019; 14:286-288. [PMID: 30937056 PMCID: PMC6417315 DOI: 10.4103/ajns.ajns_333_17] [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] [Indexed: 01/30/2023] Open
Abstract
Spontaneous cervical epidural hematoma (SCEH), which is a rare disease, is manifested as by a sudden quadriplegia or paraplegia and other neurological deficits. SCEH can compress the spinal cord resulting in its clinical manifestations. The reported etiological risk factors are anticoagulants, coagulopathies, vascular malformations, infections, and herniated discs. Here, we report a 77-year-old woman with a presenting chief complaint of left hemiparesis and a history of hypertension. The medical drugs in use were aspirin and antihypertensives. The initiating presentations were hemiparesis, in favor of ischemic stroke, so the patient admitted to neurology ward and received anticoagulant therapy with the initial diagnosis of stroke. Although clinical manifestations and examinations are important in these patients due to mimicking stroke picture, imaging evaluation is paramount for a definite diagnosis, which in our case showed a SCEH, who was suspected to have an ischemic stroke during the initial assessment because its initial demonstration mimicked ischemic stroke. This patient underwent laminectomy after 3 days and showed a clinical recovery the day after. Her muscle strength improved gradually, and neurological symptoms were diminished after physiotherapy.
Collapse
Affiliation(s)
- Mohammadreza Emamhadi
- Brachial Plexus and Peripheral Nerve Injury Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Shervin Ghadarjani
- Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Babak Alijani
- Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Shahrokh Yousefzadeh-Chabok
- Neuroscience Research Center, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Behzadnia
- Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amin Naseri
- Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sasan Andalib
- Neuroscience Research Center, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
36
|
Kondo A, Yamaguchi H, Ishida Y, Toyoshima D, Azumi M, Akutsu N, Koyama J, Kurosawa H, Kawamura A, Maruyama A. Spontaneous spinal epidural hematoma mimicking Guillain-Barre Syndrome. Brain Dev 2019; 41:392-395. [PMID: 30471873 DOI: 10.1016/j.braindev.2018.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/23/2018] [Accepted: 11/06/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS. CASE REPORT A previously healthy 6-year-old girl presented with a 2-day history of progressive pain in the lower extremities and an inability to walk. On initial evaluation, she was completely paraparetic in the lower extremities. Deep tendon reflexes were absent in the lower extremities, and Babinski reflexes were positive on both sides. She exhibited reduced response to light touch and pinprick with a sensory level below T10, and experienced difficulty during urination. However, the strength, sensation and flexion of upper extremities were normal. Because her presentation and examinations were consistent with GBS, we initiated intravenous immunoglobulin therapy. The next day, she also developed pain and muscle weakness of the right upper extremity. Three days after admission, respiratory depression progressed rapidly. Spinal MRI showed a mass extending from the level of C7-T3, with spinal cord compression. The patient underwent an emergency laminectomy with evacuation of hematoma, and was diagnosed with SSEH. Sixty days after admission, she was transferred to the rehabilitation hospital with severe neurologic sequelae of paralysis in both legs. CONCLUSION SSEH might have severe consequences, including neurologic deficits and risk of death. This case report serves to raise the awareness of SSEH that mimics the initial presentation of GBS.
Collapse
Affiliation(s)
- Aya Kondo
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Yamaguchi
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Daisaku Toyoshima
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Mai Azumi
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Nobuyuki Akutsu
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Junji Koyama
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Kurosawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Atushi Kawamura
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| |
Collapse
|
37
|
Baeesa S, Jarzem P, Mansi M, Bokhari R, Bassi M. Spontaneous Spinal Epidural Hematoma: Correlation of Timing of Surgical Decompression and MRI Findings with Functional Neurological Outcome. World Neurosurg 2019; 122:e241-e247. [DOI: 10.1016/j.wneu.2018.09.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/28/2022]
|
38
|
Uei H, Tokuhashi Y, Maseda M, Nakahashi M, Sawada H, Miyakata H. Delayed-onset paralysis induced by spontaneous spinal epidural hematoma communicated with hematoma in the paraspinal muscle in a 6-month-old girl: a case report. Childs Nerv Syst 2019; 35:379-383. [PMID: 30196393 DOI: 10.1007/s00381-018-3971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/04/2018] [Indexed: 11/25/2022]
Abstract
Spontaneous spinal epidural hematoma (SSEH) very rarely develops in infants younger than 1 year old. To our knowledge, no previous case of delayed-onset paralysis induced by SSEH communicated with hematoma in the paraspinal muscle has been reported in the literature. The authors present the case of a 6-month-old girl with a tumor mass on her back who developed a paresis of her bilateral lower limbs. On spinal magnetic resonance imaging, the epidural mass appeared to be a dumbbell type and communicated with the mass in the paraspinal muscle through T12/L1 intervertebral foramen at the right side. After excision of the mass in the paraspinal muscle, hemi-laminectomy of T10-L3 was performed. No solid lesion was also present in the spinal canal and it was found to be an epidural hematoma. No malignancy was observed on pathological examination, and vascular and nerve system tumors were negative. When a tumor mass suddenly develops on the back of an infant and motor impairment of the lower limbs develops as the mass gradually enlarges, differential diagnosis should be performed taking SSEH into consideration.
Collapse
Affiliation(s)
- Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masafumi Maseda
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiro Nakahashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hiroyuki Miyakata
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| |
Collapse
|
39
|
Consecutive images of conservatively treated cervical spontaneous spinal epidural hematoma. J Clin Neurosci 2018; 59:270-275. [PMID: 30392835 DOI: 10.1016/j.jocn.2018.10.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/29/2018] [Accepted: 10/24/2018] [Indexed: 11/22/2022]
Abstract
Spontaneous spinal epidural hematoma (SSEH) in the cervical spine is rare, and it remains unclear how this condition resolves. We aimed to elucidate the underlying pathology of SSEH conservatively treated using magnetic resonance imaging (MRI) analysis. We reviewed the clinical records of patients with SSEH treated conservatively between January 2011 and November 2016 and analyzed the patients' medical history, medication, spinal cord compression on MRI, and neurological status. Patients underwent the first MRI on admission and the second MRI at average 10.8 days (range, 3-24 days) after the first MRI. Ten patients were enrolled (five men and five women), and the average age on admission was 73 years. In all patients, the neurological status improved within 24 h and the spinal cord area had increased on the second MRI. Four patients were diagnosed with hematoma regression and six with hematoma persistence by 14 orthopedic surgeons, who were blinded to the patients' data. Hematoma regression was associated with the difference of MRI interval (hematoma regression four patients 16.3 days vs. hematoma persistence six patients 7.2 days, p = 0.01). In conclusion, our report is the largest case series of SSEH with consecutive MRI; we found that SSEH in the cervical spine required approximately 10 days for absorption on the spot, without spreading longitudinally. This information could be useful for deciding when to alter the rehabilitation program.
Collapse
|
40
|
Kim EJ, Ahn J, Kim SJ. Spontaneous spinal epidural hematoma of the thoracic spine after herbal medicine: a case report. Altern Ther Health Med 2018; 18:291. [PMID: 30373581 PMCID: PMC6206678 DOI: 10.1186/s12906-018-2354-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/17/2018] [Indexed: 12/24/2022]
Abstract
Background Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease, but it can lead to acute cord compression with disabling consequences. Identifiable reasons for spontaneous hemorrhage are vascular malformations and bleeding disorders. However, SSEH after taking herbal medicines has not been described yet. Case presentation A 60-year-old female experienced sudden back pain combined with numbness and weakness in the lower limbs for several hours with no trauma, drug use, family history or any disease history. Her deep tendon reflexes were normoactive, and Babinski was negative. An emergent MRI showed a spinal epidural hematoma extending from T3 to T5. She was taken to surgery after immediate clinical and laboratory evaluations had been completed. Emergency decompression with laminectomy was performed and the patient recovered immediately after the surgery. Additional history taken from the patient at outpatient clinic after discharge revealed that she had been continuously taking herbal medicine containing black garlic for 8 weeks. Conclusion To our knowledge, no report has been previously issued on SSEH after taking herbal medicines. Although contradictory evidence is present on bleeding risks with herbal uses, we believe that it’s reasonable to ascertain if patients with SSEP are taking herbal medication before or during spinal surgery.
Collapse
|
41
|
Arévalo A, Navas M, Pulido P, García de Sola R. Spontaneous acute epidural haematoma of the cervical spine with an atypical onset resembling ictal symptom. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
42
|
Treatment of hematomas after anterior cervical spine surgery: A retrospective study of 15 cases. Neurochirurgie 2018; 64:166-170. [PMID: 29735379 DOI: 10.1016/j.neuchi.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Postoperative hematoma is a rare and dangerous complication of cervical spine surgery. The aim of this study was to investigate the incidence and related factors of postoperative hematoma, and to report on 15 cases at our institution over a 6-year period. METHODS Fifteen cases of postoperative hematoma were retrospectively identified. We investigated their neurological outcomes, characteristics, and surgical data, and identified risk factors associated with postoperative (PO) hematoma. Patients with hematoma were compared to those with no hematoma, in order to identify risk factors. RESULTS Retropharyngeal hematomas developed in seven cases and epidural hematomas in eight. The total incidence of postoperative hematoma was 1.2%: 0.5% retropharyngeal hematomas and 0.6% spinal epidural hematomas. At time of onset, the severity of paralysis was assessed as grade B in one case, grade C in six cases, and grade D in eight cases. Risk factors for PO hematoma were: (1) presence of ossification of the posterior longitudinal ligament (OPLL) (P<0.001); (2) longer operative duration (P=0.048); (3) greater number of surgical levels (P=0.02); and (4) higher body mass index (BMI; P=0.035). There was no significant difference in modified Japan Orthopedic Association scores between the hematoma group and non-hematoma group (P>0.05). CONCLUSION Precise preoperative preparation and systematic evaluation are central to successful management of PO hematoma after anterior cervical surgery. Risk factors for PO hematoma include multilevel decompression, OPLL, higher BMI, and longer operation time.
Collapse
|
43
|
Goldfine C, Glazer C, Ratzan RM. Spontaneous Spinal Epidural Hematoma from Rivaroxaban. Clin Pract Cases Emerg Med 2018; 2:151-154. [PMID: 29849242 PMCID: PMC5965116 DOI: 10.5811/cpcem.2018.2.37096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 12/20/2022] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is a rare diagnosis. One known risk factor is anti-coagulation medication. We present a case of SSEH in a 74-year-old male on rivaroxaban therapy who clinically presented with an intermittently resolving and then worsening neurological exam. Due to the extremely high morbidity and mortality associated with this diagnosis, it is important to be aware of the various presentations and adverse effects related to novel anticoagulation.
Collapse
Affiliation(s)
- Charlotte Goldfine
- University of Connecticut School of Medicine, Hartford Hospital, Department of Emergency Medicine, Hartford, Connecticut
| | - Catherine Glazer
- University of Connecticut School of Medicine, Hartford Hospital, Department of Emergency Medicine, Hartford, Connecticut
| | - Richard M Ratzan
- University of Connecticut School of Medicine, Hartford Hospital, Department of Emergency Medicine, Hartford, Connecticut
| |
Collapse
|
44
|
Bos E, Haumann J, de Quelerij M, Vandertop W, Kalkman C, Hollmann M, Lirk P. Haematoma and abscess after neuraxial anaesthesia: a review of 647 cases. Br J Anaesth 2018; 120:693-704. [DOI: 10.1016/j.bja.2017.11.105] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/19/2017] [Accepted: 11/30/2017] [Indexed: 01/30/2023] Open
|
45
|
Patel R, Kumar A, Nishizawa K, Kumar N. Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator. BMJ Case Rep 2018; 2018:bcr-2017-222686. [PMID: 29374642 DOI: 10.1136/bcr-2017-222686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare condition that requires urgent surgical intervention in order to prevent permanent neurological deficit. SSEH commonly presents as a paraparesis or tetraparesis. SSEH presenting as a hemiparesis is less common and in such situations, it can be mistaken for a cerebrovascular accident (CVA). Thrombolytic or anticoagulant treatment for CVA can potentially worsen the neurological deficit. We report one such case of SSEH misdiagnosed as a CVA. Treatment with tissue plasminogen activator led to worsening of his condition. On a subsequent cervical spine MRI, an epidural haematoma extending from C3 to C5 was detected and treated with laminectomy and evacuation. Surgical intervention led to significant improvement from American Spinal Injury Association Scale (ASIA) B to ASIA E. Presence of clinical features such as Horner's syndrome, Brown-Sequard syndrome and the absence of cranial nerve palsies in acute hemiparesis are indicative of SSEH rather than CVA.
Collapse
Affiliation(s)
- Ravish Patel
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Aravind Kumar
- Orthopaedic Surgery, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Kazuya Nishizawa
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Naresh Kumar
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| |
Collapse
|
46
|
Li C, He R, Li X, Zhong Y, Ling L, Li F. Spontaneous spinal epidural hematoma mimicking transient ischemic attack: A case report. Medicine (Baltimore) 2017; 96:e9007. [PMID: 29245281 PMCID: PMC5728896 DOI: 10.1097/md.0000000000009007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Spontaneous spinal epidural hematoma (SSEH) is a rare but highly disabling neurological emergency. The initial presentations are variable. Most patients of SSEH present with paraplegia or tetraplegia clinically, but recurrent hemiparesis with complete spontaneous recovery, mimicking transient ischemic attack (TIA), is a very rare initial presentation of SSEH. PATIENT CONCERNS A 71-year-old female presented to the emergency department with 2 episodes of transient right hemiparesis in 5 hours. Two days later, above symptom reappeared and progressed to quadriplegia, dyspnea, and uroschesis quickly. The neurological examination showed tetraplegia and hypalgesia below the C2 level, but neither facial palsy nor aphasia was found. DIAGNOSIS The patient was initially misdiagnosed as TIA and treated with antiplatelet therapy. But during the hospital day, the cervical magnetic resonance imaging showed a dorsal epidural hematoma extending from C2 to C6 level and she was diagnosed as SSEH. INTERVENTIONS She underwent surgical decompression and hematoma removal 1 week later. OUTCOMES One week after operation, the sensory deficit above C6 level improved, but there was no improvement in her muscle strength and dyspnea. Unfortunately, she died 1 month later. LESSONS Our case highlights recurrent hemiparesis with complete spontaneous recovery mimicking TIA is a rare initial presentation of SSEH. It is important to perform careful clinical assessments and neuroimaging investigations for correct diagnosis. Neck pain and hemiparesis sparing cranial nerve are important signs for distinction of SSEH from acute ischemic cerebrovascular diseases.
Collapse
Affiliation(s)
- Chuqiao Li
- Department of Neurology, The Affiliated Guangzhou Red Cross Hospital, Jinan University, Guangzhou
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Rui He
- Department of Neurology, The Affiliated Guangzhou Red Cross Hospital, Jinan University, Guangzhou
| | - Xiaoqiang Li
- Department of Neurology, Xiaolan Hospital of Southern Medical University, Zhongshan
| | - Yulan Zhong
- Department of Neurology, The Affiliated Guangzhou Red Cross Hospital, Jinan University, Guangzhou
| | - Li Ling
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Fangming Li
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| |
Collapse
|
47
|
Hongo T, Iseda K, Tsuchiya M, Inaba M, Nozaki S, Takahashi K, Nakajima M, Fujiwara T. Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men. Acute Med Surg 2017; 5:181-184. [PMID: 29657732 PMCID: PMC5891113 DOI: 10.1002/ams2.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/18/2017] [Indexed: 12/26/2022] Open
Abstract
Cases Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease. Most SSEH cases involve back and/or neck pain. We report the cases of two men who experienced SSEH with dysstasia but without back or neck pain. Outcomes This study presents two cases involving elderly Japanese men who visited an emergency department because of sudden dysstasia without back or neck pain. The results of the neurological examinations revealed ataxic gait. Cervical spinal epidural hematomas were observed by computed tomography and magnetic resonance imaging. One patient underwent hematoma removal and decompression by corpectomy, whereas the other patient received conservative treatment and observation. The patients were discharged without sequelae. Conclusion Spinal epidural hematomas are difficult to diagnose, and a delayed diagnosis can adversely affect the patient's quality of life. These hematomas should be considered in the differential diagnosis of cerebrovascular diseases.
Collapse
Affiliation(s)
- Takashi Hongo
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Kenichi Iseda
- Department of Neurosurgery Okayama Saiseikai General Hospital Okayama Japan
| | - Midori Tsuchiya
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Mototaka Inaba
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Satoshi Nozaki
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Kenji Takahashi
- Department of Neurosurgery Okayama Saiseikai General Hospital Okayama Japan
| | - Masaaki Nakajima
- Department of Neurosurgery Okayama Saiseikai General Hospital Okayama Japan
| | | |
Collapse
|
48
|
Domenicucci M, Mancarella C, Santoro G, Dugoni DE, Ramieri A, Arezzo MF, Missori P. Spinal epidural hematomas: personal experience and literature review of more than 1000 cases. J Neurosurg Spine 2017; 27:198-208. [PMID: 28574329 DOI: 10.3171/2016.12.spine15475] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The goal of this study was to identify factors that contribute to the formation of acute spinal epidural hematoma (SEH) by correlating etiology, age, site, clinical status, and treatment with immediate results and long-term outcomes. METHODS The authors reviewed their series of 15 patients who had been treated for SEH between 1996 and 2012. In addition, the authors reviewed the relevant international literature from 1869 (when SEH was first described) to 2012, collecting a total of 1010 cases. Statistical analysis was performed in 959 (95%) cases that were considered valid for assessing the incidence of age, sex, site, and clinical status at admission, correlating each of these parameters with the treatment results. Statistical analysis was also performed in 720 (71.3%) cases to study the incidence of etiological factors that favor SEH formation: coagulopathy, trauma, spinal puncture, pregnancy, and multifactorial disorders. The clinical status at admission and long-term outcome were studied for each group. Clinical status was assessed using the Neuro-Grade (NG) scale. RESULTS The mean patient age was 47.97 years (range 0-91 years), and a significant proportion of patients were male (60%, p < 0.001). A bimodal distribution has been reported for age at onset with peaks in the 2nd and 6th decades of life. The cause of the SEH was not reported in 42% of cases. The etiology concerned mainly iatrogenic factors (18%), such as coagulopathy or spinal puncture, rather than noniatrogenic factors (29%), such as genetic or metabolic coagulopathy, trauma, and pregnancy. The etiology was multifactorial in 11.1% of cases. The most common sites for SEH were C-6 (n = 293, 31%) and T-12 (n = 208, 22%), with maximum extension of 6 vertebral bodies in 720 cases (75%). At admission, 806 (84%) cases had moderate neurological impairment (NG 2 or 3), and only lumbar hematoma was associated with a good initial clinical neurological status (NG 0 or 1). Surgery was performed in 767 (80%) cases. Mortality was greater in patients older than 40 years of age (9%; p < 0.01). Sex did not influence any of these data (p > 0.05). CONCLUSIONS Factors that contribute to the formation of acute SEH are iatrogenic, not iatrogenic, or multifactorial. The treatment of choice is surgery, and the results of treatment are influenced by the patient's clinical and neurological status at admission, age, and the craniocaudal site.
Collapse
Affiliation(s)
| | | | | | | | | | - Maria Felice Arezzo
- Department of Methods and Models for Economics, Territory and Finance, "Sapienza" University of Rome; and
| | - Paolo Missori
- Department of Neurology and Psychiatry, Neurosurgery, and
| |
Collapse
|
49
|
Tang SC, Wang Y, Wang Y, Yang L, Chen J. Spontaneous cervical epidural hematomas in mild cervical spondylotic myelopathy patients: An analysis of 8 cases. ACTA ACUST UNITED AC 2017; 37:248-252. [PMID: 28397048 DOI: 10.1007/s11596-017-1723-y] [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: 08/20/2016] [Revised: 12/26/2016] [Indexed: 10/18/2022]
Abstract
Spontaneous cervical epidural hematoms (SCEH) complicated with mild cervical spondylotic myelopathy (CSM) is a rare but emerging condition. Early diagnosis and treatment are important for good outcomes. This study aimed to investigate the clinical characteristics of this condition and to discuss the optimal treatment. The clinical data from 8 patients with SCEH plus CSM who were divided into two groups by treatment methods were retrospectively analyzed. The neurological function of the patients was assessed by Japanese Orthopedic Association (JOA) score before and after the surgical operations. Other factors were reviewed with medical records. Among them, 4 out of the 8 patients underwent emergency surgery, and the rest 3 patients experienced an initial conservative treatment and ultimately received a laminectomy. We found that the Frankel Scale scores in most of the surgical patients were increased after surgery (6/7, 85.7%). However, the JOA scores at the 6th month after onset were even lower than those before onset in 3 of the operative cases, and those in the patients who were given conservative treatment showed no significant change. It was concluded that some patients with SCEH and CSM treated with a timely operation may obtain relief from their previous CSM symptoms. However, the final neurological deficits of these patients were closely related to the progressive interval which refers to the hours between the initial onset and the occurrence of new neurological deficits or mild CSM deterioration, no matter whether they accept the operation. We found the crucial progressive interval may be in 9 h. Early MRI and prompt neurosurgical intervention are also important to improve the neurological deficits.
Collapse
Affiliation(s)
- Si-Cheng Tang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Lei Yang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| |
Collapse
|
50
|
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.
Collapse
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.
| |
Collapse
|