Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma

Spontaneous Spinal Subdural Hematoma Associated With Rivaroxaban and Aspirin Use: A Report of a Rare Case

A spontaneous spinal subdural hematoma (SSSH) is a rare but potentially deadly condition characterized by the presence of blood in the subdural space, commonly causing compression of the spinal cord and acute neurological deficits. Urgent surgical intervention with a decompressive laminectomy is warranted to avoid lasting deficits. The literature on this pathology is scarce, and the etiology is still poorly understood, although associations have been established with arteriovenous malformations, rupture of epidural vessels, and anticoagulant use, among others. This study presents the case of an 81-year-old Hispanic woman with a past medical history including an unspecified arrhythmia on treatment with oral anticoagulation who presented to the emergency room with sudden-onset, localized low back pain and an acute neurological deficit consisting of bilateral lower extremity paraplegia and areflexia. Magnetic resonance imaging (MRI) of the thoracic spine shows a 10-cm-long subdural hematoma causing compression from T5 to T10. At this time, the patient also developed an unstable atrial fibrillation with rapid ventricular response. After cardiac stabilization, a thoracic decompressive laminectomy with hematoma evacuation was performed. The degree of preoperative neural deficit and time to surgical intervention are prognostic factors for clinical recovery in these patients. Anticoagulant medication use is a risk factor for SSSH, and a high index of suspicion is needed for patients presenting with acute-onset back pain and neurological deficits, especially in the setting of known risk factors. MRI is the diagnostic tool of choice, and urgent surgical decompression is warranted to prevent further neurologic deterioration.

Surgical treatment of a spontaneous spinal epidural hematoma under antithrombotic treatment of a multisystem inflammatory syndrome in children associated with SARS-COV-2

Multisystem inflammatory syndrome in children (MIS-C) is a novel syndrome of multisystemic inflammation affecting children. This case report documents an exceptional and severe complication of an epidural hematoma in a 3-year-old boy under the treatment of MIS-C. During the course of the disease, the patient suffered from a hypocoagulable state and an extensive multisegmental epidural hematoma in the cervical spinal canal. This led to severe anterior spinal cord compression and tetraparesis. Extensive emergency surgery had to be carried out to reverse rapid clinical deterioration.

Spontaneous Spinal Epidural Hematoma in a 12-Year-Old Child

Spontaneous spinal epidural hematoma (SSEH) is uncommon, with an estimated incidence of one per million per year in the general population. Since SSEH was first described, only 29 cases have been reported in children. This condition is difficult to diagnose and needs immediate surgical intervention for hematoma evacuation and cord decompression to obtain optimal functional and neurological outcomes. The presentation in children might be atypical. We present a case that was managed surgically and yielded full recovery.

An unusual case of ventral spontaneous spinal epidural hematoma: Case report with review of literature

Spontaneous spinal epidural hematoma is a rare predominantly idiopathic entity which can prompt acute neurologic symptoms and if not managed in time can lead to devastating outcomes. High index of suspicion is required for early diagnosis on MRI for a prompt management of patients showing sudden neurologic deficits. Our patient was 42-year-old female who presented with sudden onset of numbness followed by weakness in both lower limbs and urinary retention without any comorbidity or any medication. MRI whole spine done within 14 hours of symptom onset showed ventral epidural hematoma without any vascular malformation. Immediate decompressive laminectomy with evacuation of hematoma improved power in both lower limbs with regaining bowel and bladder function. The key here is timely surgical decompression of the hematoma for a favorable neurosurgical outcome. Although there is a recent development towards non–surgical treatment, it needs to be well established yet and require such approach on case-to-case basis.

Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

Background:

First characterized in the 19^th century, spontaneous spinal epidural hematoma (SSEH) is known as the idiopathic accumulation of blood within the spinal canal’s epidural space, causing symptoms varying from general back pain to complete paraplegia. With varying etiologies, a broad spectrum of severity and symptoms, a time-dependent resolution period, and no documented diagnosis or treatment algorithm, SSEH is a commonly misunderstood condition associated with increasing morbidity. While SSEH can occur at any vertebrae level, 16% of all SSEH cases occur in the cervical spine, making it a region of interest to clinicians.

Case Description:

Herein, the authors present two case examples describing the clinical presentation of SSEH, while also reviewing the literature to provide a comprehensive overview of its presentation, pathology, and treatment. The first case is a patient with nontraumatic sudden onset neck pain with rapidly progressing weakness. The second case is a patient with painless weakness that developed while taking 325 mg of aspirin daily.

Conclusion:

Clinicians should keep SSEH in their differential diagnosis when seeing patients with nontraumatic sources of weakness in their extremities. The appropriate steps should be followed to diagnose and treat this condition with magnetic resonance imaging and surgical decompression if there are progressive neurological deficits. There is a continued need for more extensive database-driven studies to understand better SSEHs clinical presentation, etiology, and ultimate treatment.

Spontaneous spinal epidural hemorrhage following disseminated intravascular coagulation resulting in paraplegia: a case report

CONTEXT

Spontaneous spinal epidural hemorrhage (SSEH) mostly presents as low back pain with or without a radiculopathy, and rarely with paraplegia or tetraplegia depending on the site and severity of spinal cord compression. We present here a case who had anemia and developed paraplegia following disseminated intravascular coagulation (DIC) due to a transfusion reaction.

FINDINGS

A 65-year-old lady presented with sudden onset chest pain radiating to nape of the neck followed by loss of sensations and power in legs few hours after a blood transfusion. Her past history was negative for diabetes mellitus, hypertension, coronary artery disease, or a bleeding disorder. Her blood pressure was 90/57 mmHg and she had a normal pulse, respiratory rate, and temperature. On neurological examination, she had no motor power and unevokable muscle stretch reflexes in the lower limbs. The sensations were intact till T₃ dermatome. The laboratory evaluation was suggestive of DIC. The magnetic resonance imaging showed a non-enhancing abnormal signal intensity area in the posterior epidural space, extending from CV₄ to LV₄ causing cervico-dorsal cord compression associated with cord edema. Following diagnosis, urgent decompressive surgery was carried out due to deteriorating neurological status. The patient was transfused with five bags of red cell concentrate, two bags of platelets, and four bags of fresh frozen plasma during the operation. The patient regained consciousness following operation, however, the neurological status did not improve. She, unfortunately, died on the third post-op day due to cardiac arrest.

CONCLUSION

SSEH is a rare cause of paraplegia. Early radiological diagnosis is crucial for timely neurosurgical management and saving patient from permanent neurological deficit or a fatal outcome.

Spontaneous Spinal Epidural Hematoma from Rivaroxaban

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.

Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome

RATIONALE

Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but potentially disabling disease, and the classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression.

PATIENT CONCERNS

Here, we report a 26-year-old female patient presented with weakness in bilateral lower extremities, progressing to intense paraplegia and anesthesia without recent medical history of trauma, infection, surgery, or drug use.

DIAGNOSIS

A magnetic resonance imaging (MRI) scan of spinal cord was planned and a posterior epidural hematoma of the thoracic spine was observed.

INTERVENTIONS

A posterior decompression and hematoma evacuation was performed after diagnosis immediately. Early rehabilitation program of the specific kind spinal cord injury was formulated and implemented.

OUTCOMES

The patient finally can handle basic living activities, such as completing wheelchair locomotion, transferring from bed to wheelchair independently after 3 months of rehabilitation.

LESSONS

SSEH is a rarely occurring case in emergency. Acute chest pain and paraplegia could be the initial presentation of acute spinal epidural hemorrhage, but the diagnosis of patient without classical manifestations is still a challenge for doctors. Early diagnosis, prompt decompression, and individualized rehabilitation program can improve the prognosis and outcome.