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Spontaneous resolution and complete recovery of spontaneous cervical epidural hematoma: Report of two cases and literature review. Neurochirurgie 2019; 65:27-31. [PMID: 30635115 DOI: 10.1016/j.neuchi.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/08/2018] [Accepted: 10/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present the natural course and treatment modalities of spontaneous cervical epidural hematoma (SCEH), by reporting two rare cases with spontaneous resolution in both clinical and radiologic findings without surgery. MATERIAL AND METHODS One patient presenting with acute right side hemiparesis and another showing pure cervical radiculopathy were diagnosed with SCEH on magnetic resonance imaging (MRI). Both were both treated non-operatively. We also conducted a literature review of 19 cases of spontaneous spinal epidural hematoma (SSEH). RESULTS These two patients achieved complete resolution in terms of both neurologic function and radiologic findings within 21 days after onset. In the literature review, 63.2% of cases experienced neurologic improvement in the first 24h, 78.9% achieved complete neurologic recovery within 1 month, and radiological images showed complete resolution of hematoma in the first month for 73.7% of patients. CONCLUSIONS Atypical cervical SSEH can mimic cerebral stroke or a ruptured cervical disc. A high index of clinical suspicion followed by MRI examination is critical for diagnosis. Prompt surgical decompression and evacuation of the hematoma is generally regarded as first-line treatment. However, for patients without or with only slight neurologic symptoms, or showing early and sustained neurologic improvement, non-surgical therapy with close observation is a viable alternative. Both neurologic and radiologic resolution can be expected within the first month following onset in most cases of spontaneous resolution of SSEH.
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Ohba T, Ebata S, Haro H. Influence of Postoperative Hypertension on the Development of Spinal Epidural Hematoma. Orthop Surg 2018; 9:386-390. [PMID: 29178307 DOI: 10.1111/os.12352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022] Open
Abstract
Spinal epidural hematoma (SEH) is a rare postoperative complication but can result in catastrophic neurological deficits requiring immediate surgical evacuation of the hematoma. Knowing the risk factors for postoperative SEH can help surgeons stratify patients. Therefore, to identify possible risk factors for postoperative SEH, we reviewed 6 clinical cases and examined the relation between postoperative hypertension and the risk of developing SEH. A retrospective review was conducted of 1282 consecutive patients who underwent spinal surgery at a single institution between 2010 and 2015. Of this cohort, 6 patients developed symptomatic SEH and underwent emergency hematoma evacuation. The 6 SEH patients were evaluated for previously described risk factors of postoperative hematoma formation. In particular, postoperative blood pressure measurements were reviewed. The incidence of postoperative symptomatic SEH was 0.468%. Two patients developed SEH secondary to a nonfunctional surgical drain in the early postoperative period (5 or 12 h post-surgery). Preoperative and postoperative hypertension was observed in 4 patients who developed SEH at greater than or equal to 48 h following surgery. Our findings suggest that rigorous postoperative blood pressure control may decrease the risk of SEH.
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Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Shigeto Ebata
- Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Yamanashi, Japan
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Fang M, Zhou J, Yang D, He Y, Xu Y, Liu X, Zeng Y. Management and outcomes of spinal epidural hematoma during vertebroplasty: Case series. Medicine (Baltimore) 2018; 97:e10732. [PMID: 29794750 PMCID: PMC6393141 DOI: 10.1097/md.0000000000010732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Spinal cord injury (SCI) is one of the common complications of spinal surgery. There is no definite treatment and time of decompression for spinal cord induced by epidural hematoma during vertebroplasty. PATIENT CONCERNS A total of 6 patients with SCI during vertebroplasty were included in our research. All of them occurred sensory disturbance and motor dysfunction due to a lower or same level operative vertebral body lesion in vertebroplasty. DIAGNOSES Neurological manifestations during vertebroplasty, postoperative magnetic resonance imaging and computed tomography. INTERVENTIONS Once SCI occurred in vertebroplasty, four patients were underwent spinal cord decompression immediately, and two patients were done after 14 and 22 hours, respectively. OUTCOMES Before decompression operation, one patient was Frankel A, three were Frankel B, and two were Frankel C. One day after evacuation of the SEH, three patients recovered to normal neurological function (Frankel E), one to Frankel C, and one to Frankel D, but the other one did not recover. At the last follow-up, five patients had recovered to Frankel E and one patient to Frankel D. LESSONS According to our experience, when SCI occurs during vertebroplasty, neurological deficits are always secondary to acute SEH. Timely decompression, particularly transfer surgery, can shorten recovery time.
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Affiliation(s)
- Miao Fang
- Department of Orthopedics, Second People's Hospital of Chengdu
| | - Jiaojiao Zhou
- Division of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Dongjun Yang
- Department of Orthopedics, Second People's Hospital of Chengdu
| | - Yu He
- Department of Orthopedics, Second People's Hospital of Chengdu
| | - Yong Xu
- Department of Orthopedics, Second People's Hospital of Chengdu
| | - Xin Liu
- Department of Orthopedics, Second People's Hospital of Chengdu
| | - Yong Zeng
- Department of Orthopedics, Second People's Hospital of Chengdu
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Zhao W, Shu LF, Cai S, Zhang F. Acute Cervical and Thoracic Ventral Side Spontaneous Spinal Epidural Hematoma Causing High Paraplegia: A Case Report. Anesth Pain Med 2017; 7:e14041. [PMID: 29696120 PMCID: PMC5903384 DOI: 10.5812/aapm.14041] [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: 04/20/2017] [Revised: 05/24/2017] [Accepted: 10/10/2017] [Indexed: 01/30/2023] Open
Abstract
Introduction Spontaneous spinal epidural hematoma (SSEH) is a rare condition that can potentially cause paraplegia. SSEH has an increasing incidence rate and its cause remains unclear. Magnetic resonance imaging (MRI) results shows that SSEH presents a spinal epidural space-occupying lesion; therefore, emergency surgical treatment is required in some cases. MRI results of most SSEH cases showed that hematoma occurs in the dorsal or lateral side. By contrast, hematoma in the ventral side is very rarely shown. Case Presentation A 42-year-old healthy woman developed a sudden onset of severe neck pain with mild limb weakness, gradual breathing difficulty, and high paraplegia. MRI results revealed that an SSEH was compressing her spinal cord in the ventral epidural space from C2 to T3. Upon admission, she received emergency decompressive laminectomy in a posterior approach from C3 to T1, and the epidural hematoma was evacuated through full incision of the dorsal side dural, release of cerebrospinal fluid, and intermittent incision of the ventral side dural. The symptoms of limb paralysis and breathing distress gradually improved after recover rehabilitation, and the patient was discharged with life self-care after 2 months. Conclusions Performing early decompressive laminectomy and evacuation of hematoma on severe SSEH patients improves neurological outcomes. For patients with ventral side SSEH, the cerebrospinal fluid should be released after the incision on the dorsal side dural, and the ventral side dural should be gradually as well as intermittently clipped to evacuate the hematoma. The patient would also receive a good prognosis after the total release of the spinal cord compression.
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Affiliation(s)
- Wei Zhao
- Department of Neurospinal and Neurotrauma, Craniocerebal Injury Cure Center of PLA, the No.101 Hospital of PLA, Wuxi, Jiangsu 214044, China
| | - Long-Fei Shu
- Department of Neurospinal and Neurotrauma, Craniocerebal Injury Cure Center of PLA, the No.101 Hospital of PLA, Wuxi, Jiangsu 214044, China
| | - Sang Cai
- Department of Neurospinal and Neurotrauma, Craniocerebal Injury Cure Center of PLA, the No.101 Hospital of PLA, Wuxi, Jiangsu 214044, China
- Corresponding author: Sang Cai, Department of Neurospinal and Neurotrauma, Craniocerebal Injury Cure Center of PLA, the No.101 Hospital of PLA, Wuxi, Jiangsu 214044, China. Tel: +82-18921150098, E-mail:
| | - Feng Zhang
- Department of Neurospinal and Neurotrauma, Craniocerebal Injury Cure Center of PLA, the No.101 Hospital of PLA, Wuxi, Jiangsu 214044, China
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Wang M, Zhou P, Jiang S. Clinical Features, Management, and Prognostic Factors of Spontaneous Epidural Spinal Hematoma: Analysis of 24 Cases. World Neurosurg 2017; 102:360-369. [PMID: 28288922 DOI: 10.1016/j.wneu.2017.02.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a rare neurosurgical emergency. It presents as acute spinal cord compression and usually requires surgical decompression. The patients who will benefit most from decompression surgery are unknown, and the factors associated with prognosis remain controversial. The purpose of our study was to identify the clinical features, treatments, and main factors related to the prognosis of SSEH. METHODS We reviewed the records of 24 patients treated for SSEH from September 2010 to January 2016 at West China Hospital. Clinical features, radiologic images, treatment methods, and clinical outcomes were reviewed retrospectively. To ascertain which factors were related to outcomes, statistical analysis was performed. RESULTS Among 24 patients, 19 presented with severe initial neurologic deficits (American Spinal Injury Association grade A-C) underwent decompressive surgery, and the remaining patients (initial American Spinal Injury Association grade D or E) received conservative treatment. Among the 19 patients in the operation group, seven (36.8%) had good outcomes, whereas 12 (63.2%) had poor outcomes. All patients in the conservative group had good outcomes. CONCLUSIONS SSEH is a rare but serious illness. It is more likely that SSEH arises from a ruptured internal vertebral venous plexus. The initial neurologic status is the determining factor influencing the treatment method and clinical outcome. The number of involved segments cannot be used to decide the treatment method or predict prognosis. Patients with shorter operative intervals appear to have better neurologic recovery.
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Affiliation(s)
- Mengmeng Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Peizhi Zhou
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shu Jiang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Rajz G, Cohen JE, Harnof S, Knoller N, Goren O, Shoshan Y, Fraifeld S, Kaplan L, Itshayek E. Spontaneous spinal epidural hematoma: The importance of preoperative neurological status and rapid intervention. J Clin Neurosci 2015; 22:123-8. [DOI: 10.1016/j.jocn.2014.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/05/2014] [Indexed: 12/17/2022]
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Sathirapanya P, Setthawatcharawanich S, Limapichat K, Phabphal K. Thunderclap headache as a presentation of spontaneous spinal epidural hematoma with spontaneous recovery. J Spinal Cord Med 2013; 36:707-10. [PMID: 24090118 PMCID: PMC3831335 DOI: 10.1179/2045772313y.0000000104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a rare spinal cord compression disorder. Thunderclap headache mimicking subarachnoid hemorrhage as an initial manifestation of this disorder has been scarcely reported. Moreover, the neurological outcome of conservative treatment is satisfactory only in some clinical settings. The unusual presentation and mechanisms for spontaneous recovery of SSEH are discussed. OBJECTIVE To report a case of SSEH that presented with acute severe headache that mimicked subarachnoid hemorrhage. After a period of neurological deficit, spontaneous improvement was seen, which progressed to full recovery without neurosurgical intervention. FINDINGS A 62-year-old man presented with acute occipital headache and neck stiffness for which subarachnoid hemorrhage was initially suspected. An emergency computed tomographic brain scan and cerebrospinal fluid analysis excluded subarachnoid hemorrhage. Later, he developed acute paraparesis, hypoesthesia up to the fourth thoracic dermatomal level (T4) as well as bowel and bladder dysfunction. The magnetic resonance imaging eventually revealed spinal epidural hematoma, located anterior to C7 through T4 spinal level. He had no previous history of spinal injury, systemic, and hematological disorders. The neurological recovery began 20 hours after the onset and continued until complete recovery, 4 months after the onset without neurosurgical intervention. CONCLUSION SSEH could sometimes imitate subarachnoid hemorrhages when it located in the cervical region. Spontaneous recovery of SSEH without surgical intervention might be possible in cases with continuing neurological recovery, although the recovery began much later in the clinical course.
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Affiliation(s)
- Pornchai Sathirapanya
- Correspondence to: Pornchai Sathirapanya, Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Wang L, Liu G, Subramaniam S, Wong TAKW, Kumar N. Spontaneous spinal epidural haematoma after antiplatelet treatment: a report of two cases. J Orthop Surg (Hong Kong) 2012; 20:386-90. [PMID: 23255653 DOI: 10.1177/230949901202000326] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report 2 cases of spontaneous spinal epidural haematoma after antiplatelet treatment. One patient was on ticlodipine therapy and the other was on aspirin and clopidogrel. Both diagnoses were made using magnetic resonance imaging. One patient underwent multilevel laminectomies and posterior spinal fusion within 24 hours of symptom onset and achieved complete neurological recovery. The other underwent unilateral hemilaminectomies 40 hours after symptom onset and did not show neurological improvement. A high index of suspicion is needed for patients presenting with severe lower back pain and rapid neurological deterioration, especially in those on antiplatelet therapy. Urgent spinal cord decompression and epidural haematoma cord evacuation may provide more favourable outcome.
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Affiliation(s)
- Lushun Wang
- Department of Orthopaedics, National University Hospital, Singapore
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Martindale JL, Hwang JQ, Nadel ES, Brown DFM. Acute atraumatic quadriplegia. J Emerg Med 2012; 43:335-8. [PMID: 22494603 DOI: 10.1016/j.jemermed.2012.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
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Spontaneous spinal epidural hematoma. J Clin Neurosci 2011; 18:1490-4. [DOI: 10.1016/j.jocn.2011.02.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 02/11/2011] [Accepted: 02/14/2011] [Indexed: 01/30/2023]
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Nakanishi K, Nakano N, Uchiyama T, Kato A. Hemiparesis caused by cervical spontaneous spinal epidural hematoma: a report of 3 cases. Adv Orthop 2011; 2011:516382. [PMID: 21991415 PMCID: PMC3170783 DOI: 10.4061/2011/516382] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/06/2011] [Accepted: 06/08/2011] [Indexed: 01/15/2023] Open
Abstract
We report three cases of spontaneous spinal epidural hematoma (SSEH) with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.
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Affiliation(s)
- Kinya Nakanishi
- Department of Neurosurgery, Kinki University School of Medicine, 377-2 Onohigashi, Osakasayama-shi, Osaka 589-8511, Japan
| | - Naoki Nakano
- Department of Neurosurgery, Kinki University School of Medicine, 377-2 Onohigashi, Osakasayama-shi, Osaka 589-8511, Japan
| | - Takuya Uchiyama
- Department of Neurosurgery, Kinki University School of Medicine, 377-2 Onohigashi, Osakasayama-shi, Osaka 589-8511, Japan
| | - Amami Kato
- Department of Neurosurgery, Kinki University School of Medicine, 377-2 Onohigashi, Osakasayama-shi, Osaka 589-8511, Japan
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Spontaneous spinal epidural hematoma: An urgent complication of adding clopidogrel to aspirin therapy. J Neurol Sci 2009; 285:254-6. [DOI: 10.1016/j.jns.2009.06.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 11/20/2022]
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Woon CYL, Peng BCW, Chen JLT. Spontaneous spinal epidural haematomas and the prognostic implications of interval to surgical decompression: a report of two cases. J Orthop Surg (Hong Kong) 2009; 17:216-9. [PMID: 19721156 DOI: 10.1177/230949900901700220] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Spontaneous spinal epidural haematomas (SSEHs) are rare causes of spinal cord compression. We present 2 cases of thoracic SSEHs with similar magnetic resonance imaging (MRI) features. Patient 1 was on long-term oral anticoagulants and patient 2 had uncontrolled hypertension. Patient 1 presented with a dense motor deficit, whereas patient 2 developed progressive lower limb weakness. Decompression laminectomy and haematoma evacuation was performed 51 hours later for patient 1 and 14 hours later for patient 2. Both had recovered their lower limb power, but neurological recovery was greater for patient 2. In patients with bleeding diatheses or uncontrolled hypertension, acute SSEHs must be suspected when they present with atraumatic back pain and signs of spinal cord compression. The interval to surgical decompression greatly influences the prognosis for neurological recovery.
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Affiliation(s)
- Colin Yi-Loong Woon
- Spine Service, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169608.
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