1
|
Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
Collapse
Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
| |
Collapse
|
2
|
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
|
3
|
Liu Y, George R, Tan GYH. Spontaneous spinal epidural hematoma leading to acute paraplegia: a case report. J Med Case Rep 2023; 17:545. [PMID: 38093265 PMCID: PMC10720198 DOI: 10.1186/s13256-023-04297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Spontaneous spinal epidural hematoma is an infrequent yet potentially debilitating condition characterized by blood accumulation in the epidural space, with only 300 documented cases globally. Although the exact etiology of spontaneous spinal epidural hematoma remains poorly understood, theories suggest arteriovenous malformations, rupture of epidural vessels, or epidural veins as possible causes. CASE PRESENTATION This study presents a 58-year-old Malay woman patient from Singapore with well-controlled hypertension, hyperlipidemia, type II diabetes mellitus, and microscopic hematuria. Despite a prior cystoscopy revealing no abnormalities, she presented to the emergency department with sudden-onset back pain, weakness, and numbness in both lower limbs. Rapidly progressing symptoms prompted imaging, leading to the diagnosis of a spinal epidural hematoma from thoracic (T) 9 to lumbar (L) 1. Prompt decompressive surgery was performed, and the patient is currently undergoing postoperative rehabilitation for paralysis. CONCLUSION This case emphasizes the severity and life-altering consequences of spontaneous spinal epidural hematomas. Despite various proposed causative factors, a definitive consensus remains elusive in current literature. Consequently, maintaining a low threshold of suspicion for patients with similar presentations is crucial. The findings underscore the urgent need for swift evaluation and surgical intervention in cases of acute paraplegia.
Collapse
Affiliation(s)
- Yu Liu
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore.
| | - Rajeesh George
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Gamaliel Yu Heng Tan
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| |
Collapse
|
4
|
Ogawa K, Akimoto T, Hara M, Fujishiro M, Uei H, Nakajima H. Two Patients with Spontaneous Spinal Epidural Hematoma Carrying a Good Prognosis without Surgical Operations. Neurol Int 2023; 15:362-370. [PMID: 36976667 PMCID: PMC10051280 DOI: 10.3390/neurolint15010024] [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: 01/28/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
(1) Introduction: Spontaneous spinal epidural hematoma (SSEH) points to hematoma within the epidural space of the spinal cord without traumatic or iatrogenic causes. (2) Case Reports: One patient showed paraplegia, numbness of both legs with acute onset, acute myelopathic signs, subsequent to back pain. Magnetic resonance imaging (MRI) showed hematoma in the posterior part of the thoracic spinal cord. Another patient showed acute numbness in the shoulder, upper part of the back, and the upper extremity on the right side after pain in the back, shoulder, and neck on the right side. Sagittal computed tomography (CT) images of the cervical bone showed a high-density area behind the spinal cord between C4 and C7. MRI analysis showed hematoma in the right diagonally posterior part of the cervical spinal cord. These 2 patients lacked traumatic or iatrogenic events, and their symptoms abated without surgical operation. (3) Conclusions: The location of hematoma correlated with symptoms in each patient. SSEH is rare but should be taken into account in patients with myelopathy or radiculopathy with acute onset subsequent to back pain. The usefulness of emergent CT scans of the spinal cord prior to MRI analysis was shown in the diagnosis of SSEH.
Collapse
Affiliation(s)
- Katsuhiko Ogawa
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
- Department of Neurology, Akabane Central General Hospital, Tokyo 115-0044, Japan
| | - Takayoshi Akimoto
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Midori Fujishiro
- Division of Diabetes and Metabolic Diseases, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| |
Collapse
|
5
|
Muacevic A, Adler JR, Bairwa A, Pundir A. A Rare Life-Threatening Presentation of Shoulder Pain: Cervical Epidural Hematoma. Cureus 2023; 15:e33510. [PMID: 36779100 PMCID: PMC9904511 DOI: 10.7759/cureus.33510] [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: 01/08/2023] [Indexed: 01/09/2023] Open
Abstract
Shoulder pain is a common complaint of patients presenting to emergency department. Various conditions, intrinsic and extrinsic to the shoulder, can result in shoulder pain. Some of these extrinsic conditions can pose a threat to life. We present a case of a young, previously healthy male who initially had bilateral shoulder pain, later developed quadriparesis, and was ultimately diagnosed with a spontaneous cervical epidural hematoma. He underwent an emergency C7-T1 laminectomy with hematoma evacuation and had a full recovery. Cervical epidural hematoma is a rare surgical emergency where timely diagnosis and treatment are crucial.
Collapse
|
6
|
Al-Dwairy S, Al-Mousa A, Fataftah J. Spontaneous cervical epidural hematoma presenting as quadriparesis: A case report in compliance with the SCARE guidelines. Ann Med Surg (Lond) 2022; 80:104133. [PMID: 36045788 PMCID: PMC9422073 DOI: 10.1016/j.amsu.2022.104133] [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] [Received: 05/08/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Spinal epidural hematoma (SEH) is a rare disease. Several pathologies have been described as a cause, including trauma, arteriovenous malformations, coagulopathies, and iatrogenic causes. Spontaneous spinal epidural hematomas (SSEH) are blood in the spinal extradural space without a known cause. The incidence of SSEH has been estimated as 0.1 per 100,000 per year. Herein, we report a case of spontaneous spinal epidural hematoma in the cervical spine. We report a 57-year-old male patient who presented with sudden axial neck pain associated with upper and lower extremities weakness. Symptoms were precipitated by coughing. MRI of the cervical spine revealed an extradural lesion compressing the dorsal aspect of the spinal cord from C4 – C7. He underwent urgent decompressive laminectomy and evacuation of the hematoma. We report a rare case of spontaneous cervical extradural hematoma. Patient presented with sudden neck pain and quadriparesis. MRI findings were not easy to interpret and to give a final diagnosis. Other causes were excluded. Urgent decompression was done. Patient improved postoperatively.
Collapse
|
7
|
Huang D, Iken S, Elbadri S, Falgiani M, Ganti L. Spontaneous Spinal Epidural Hematoma: A Case of a Benign Presentation and Emergency Department Management. Cureus 2022; 14:e23532. [PMID: 35494915 PMCID: PMC9040688 DOI: 10.7759/cureus.23532] [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: 03/23/2022] [Indexed: 11/27/2022] Open
Abstract
Spontaneous spinal epidural hematomas (SSEHs) are neurological emergencies complicated by a wide array of presentations. In this study, we report a case of a patient who presented with neck pain and was diagnosed with an SSEH with computed tomography (CT) angiography with subsequent confirmation by magnetic resonance imaging (MRI). The high-risk location and size of the lesion guided management and surgical intervention. In a stable patient presenting to the emergency department without focal neurological deficits, clinical suspicion and assessment of risk factors are integral in the evaluation of patient risk and subsequent imaging and intervention.
Collapse
|
8
|
Jiang W, Tan XY, Li JA, Dong M. Spontaneous Spinal Epidural Hematoma Complicated by Pulmonary Embolism During Pregnancy: A Case Report. Front Med (Lausanne) 2022; 9:832693. [PMID: 35402434 PMCID: PMC8990125 DOI: 10.3389/fmed.2022.832693] [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] [Received: 12/10/2021] [Accepted: 02/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Spontaneous spinal epidural hematoma, without discernable underlying conditions, is considered a neurological emergency, and is rare during pregnancy. Case Presentation We report the case of a 24-year-old patient at 37 weeks of gestation. She had back pain that progressed to paraplegia of both lower limbs within 2 days. Thoracic magnetic resonance imaging revealed a lesion behind the spinal cord at the T5–T6 level, suggestive of spontaneous spinal epidural hematoma. Due to the rapid recovery of muscle strength in her lower limbs after an emergency cesarean section, we used methylprednisolone therapy to reduce spinal edema rather than decompression of the spinal canal. We incidentally found that the patient’s left pulmonary artery was occluded. In consideration of spontaneous spinal epidural hematoma as relative contraindication to anticoagulation, and in the absence of pulmonary embolism symptoms, including good partial oxygen pressure, we did not administer anticoagulant therapy. The patient’s condition improved rapidly in the following week. Conclusion Spontaneous spinal epidural hematoma concomitant with pulmonary artery embolism is an extremely rare manifestation during pregnancy. As exemplified by our case, desirable treatment outcomes are possible under such cases.
Collapse
Affiliation(s)
- Wei Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Xuan-Yu Tan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jia-Ai Li
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Ming Dong
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Ming Dong,
| |
Collapse
|
9
|
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
|
10
|
Bhardwaj S, Chaurasiya M, Shah S. Spontaneous cervicothoracic epidural misinterpreted as transient ischemic attack (TIA). Surg Neurol Int 2022; 13:19. [PMID: 35127219 PMCID: PMC8813617 DOI: 10.25259/sni_1224_2021] [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] [Received: 12/09/2021] [Accepted: 01/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The acute onset of a spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of spinal cord compression. Early diagnosis and treatment are critical to avoid significant residual postoperative neurological deficits. Case Description: A 15-year-old male presented with the sudden onset of a hemiparesis which recovered (4/5 weakness). The brain MR was negative, but spinal MRI revealed a dorsolateral extradural lesion extending from C7 to D1. At surgery, this proved to be a hematoma that we readily removed. Conclusion: Spontaneous epidural hematomas are rare. They should be diagnosed promptly with MR, and typically warrant urgent/emergent surgical excision. Further, cases of SSEH resulting in hemiparesis may occasionally be misdiagnosed as attributed to a stroke or transient ischemic attack.
Collapse
Affiliation(s)
- Sandeep Bhardwaj
- Department of Neurosurgery, Advanced Neurology and Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Manish Chaurasiya
- Department of Neurosurgery, Shri Balaji Superspeciality Hospital, Raipur, Chhattisgarh, India
| | - Sunit Shah
- Department of Neurosurgery, Advanced Neurology and Superspeciality Hospital, Jaipur, Rajasthan, India
| |
Collapse
|
11
|
Bathini A, Dubey A, Mehta SH, Mohammad Kassem A, Sulaiman M, Hakma Z. Spontaneous spinal epidural hematoma in the setting of uncontrolled hypertension and hypertensive emergency. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
12
|
Koo JM, Hwang SH, Yoon J, Yoon SH, Cho BK. Recurrent Cervical Spontaneous Spinal Epidural Hematoma with Conservative Management: A Case Report. Korean J Neurotrauma 2021; 17:186-191. [PMID: 34760832 PMCID: PMC8558013 DOI: 10.13004/kjnt.2021.17.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/03/2022] Open
Abstract
Cervical spontaneous spinal epidural hematoma (CSSEH) is a rare condition that can be potentially fatal if not properly diagnosed and managed. While prompt surgical decompression and evacuation of the hematoma are generally considered as the first line of treatment, mild cases that were managed through observation and conservative treatment have been reported. Our patient was a 24-year-old man who experienced two CSSEH events 8 months apart, both of which were managed conservatively. This was a rare case of recurrent CSSEH in which recovery was achieved without surgical intervention. We believe conservative treatment with close observation may be effective in CSSEH patients presenting with mild neurologic symptoms who have a tendency towards spontaneous neurologic improvement.
Collapse
Affiliation(s)
- Jung Myung Koo
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sung Hwan Hwang
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Joonho Yoon
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang Hoon Yoon
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Byung-Kyu Cho
- Department of neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
| |
Collapse
|
13
|
Abstract
Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.
Collapse
Affiliation(s)
- Foram B Gala
- Lifescan Imaging Centre, Mumbai, Maharashtra, India; Department of Neuroradiology, University Hospital of Zurich/Children's Hospital of Zurich, Zurich, Switzerland
| | - Yashant Aswani
- Department of Radiology, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
14
|
Gandhi D, Chowdhary A, Kichloo A, Singh J, Patel L, Shah J. An unusual case of ventral spontaneous spinal epidural hematoma: Case report with review of literature. Radiol Case Rep 2021; 16:2207-2210. [PMID: 34178193 PMCID: PMC8213979 DOI: 10.1016/j.radcr.2021.05.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Darshan Gandhi
- Department of Diagnostic Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611, USA
| | - Anisa Chowdhary
- Department of Medicine, Maulana Azad Medical College 2, Bahadur Shah Zafar Marg, New Delhi, Delhi 110002, India
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University School of Medicine, 1280 East Campus Dr, Mt Pleasant, MI 48858, USA
| | - Jagmeet Singh
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA 18510, USA
| | - Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, 800 E 28th Street, Minneapolis, MN 55407, USA
| | - Jayun Shah
- Department of Neurosurgery, Sterling Hospitals, Memnagar, Ahmedabad, Gujarat 380052, India
| |
Collapse
|
15
|
Bond JD, Zhang M. Clinical Anatomy of the Extradural Neural Axis Compartment: A Literature Review. World Neurosurg 2020; 142:425-433. [PMID: 32711147 PMCID: PMC7375305 DOI: 10.1016/j.wneu.2020.07.095] [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: 05/26/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The extradural neural axis compartment (EDNAC) is an adipovenous zone located between the meningeal and endosteal layers of the dura and has been minimally investigated. It runs along the neuraxis from the orbits down to the coccyx and contains fat, valveless veins, arteries, and nerves. In the present review, we have outlined the current knowledge regarding the structural and functional significance of the EDNAC. METHODS We performed a narrative review of the reported EDNAC data. RESULTS The EDNAC can be organized into 4 regional enlargements along its length: the orbital, lateral sellar, clival, and spinal segments, with a lateral sellar orbital junction linking the orbital and lateral sellar segments. The orbital EDNAC facilitates the movement of the eyeball and elsewhere allows limited motility for the meningeal dura. The major nerves and vessels are cushioned and supported by the EDNAC. Increased intra-abdominal pressure will also be conveyed along the spinal EDNAC, causing increased venous pressure in the spine and cranium. From a pathological perspective, the EDNAC functions as a low-resistance, extradural passageway that might facilitate tumor encroachment and expansion. CONCLUSIONS Clinicians should be aware of the extent and significance of the EDNAC, which could affect skull base and spine surgery, and have an understanding of the tumor spread pathways and growth patterns. Comparatively little research has focused on the EDNAC since its initial description. Therefore, future investigations are required to provide more information on this underappreciated component of neuraxial anatomy.
Collapse
Affiliation(s)
- Jacob D Bond
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Dundin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Anatomy, Anhui Medical University, Hefei, China.
| |
Collapse
|
16
|
Counselman FL, Tondt JM, Lustig H. A Case Report: The Challenging Diagnosis of Spontaneous Cervical Epidural Hematoma. Clin Pract Cases Emerg Med 2020; 4:428-431. [PMID: 32926704 PMCID: PMC7434283 DOI: 10.5811/cpcem.2020.5.47107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 01/30/2023] Open
Abstract
Introduction We present the case of a patient with a spontaneous cervical epidural hematoma that presented with neck pain and mild, left arm parasthesia. Case Report A 59-year old man presented with sudden onset of severe neck pain, without history of injury or trauma. The patient also complained of associated left arm parasthesias that progressed to left arm and leg weakness while in the emergency department. Multiple diagnoses were considered and worked up; eventually the correct diagnosis was made with magnetic resonance imaging of the cervical spine. Conclusion Spontaneous cervical epidural hematoma typically presents with neck pain, and variable neurologic complaints. This case illustrates the challenge in making this uncommon but serious diagnosis.
Collapse
Affiliation(s)
- Francis L Counselman
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia.,Emergency Physicians of Tidewater, Norfolk, Virginia
| | - Julie M Tondt
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - Harry Lustig
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia.,Emergency Physicians of Tidewater, Norfolk, Virginia
| |
Collapse
|
17
|
Shah JA, Patel NN, Michael KW. Spontaneous Spinal Epidural Hematoma: An Atypical Clinical Presentation and Discussion of Management. Int J Spine Surg 2020; 14:158-161. [PMID: 32355620 DOI: 10.14444/7030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Spontaneous spinal epidural hematoma (SSEH) is a rare but potentially devastating condition if not appropriately identified and managed. A few case series exist regarding SSEH and certain risk factors have been described; however, much continues to be unknown regarding the pathophysiology and optimal management. Case Presentation We present the case of SSEH in a healthy 33-year-old African American woman with no identifiable risk factors who initially presented with significant neurologic compromise. This case reports discusses pertinent clinical presentation, imaging findings, and surgical management. The patient demonstrated near-complete neurologic recovery, highlighting the need for prompt identification and intervention. Conclusions We believe this case adds to the limited literature surrounding the topic, particularly in regard to diagnosis and surgical management. It is essential for clinicians to be cognizant of SSEH for timely diagnosis and treatment, even in patients without obvious risk factors.
Collapse
Affiliation(s)
- Jason A Shah
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Nick N Patel
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Keith W Michael
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
18
|
Muhammad Safian MS, Ngu PH, Rashidah Ismail Ohnmar HTWE RIOHTWE, Sridharan R, Naicker AS. Spontaneous Spinal Epidural Hematoma due to Anticoagulant Therapy: A Case Report and Literature Review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Lobo R, Sawatsky AP. 82-Year-Old Woman With Acute-Onset Left-Sided Weakness. Mayo Clin Proc 2020; 95:164-168. [PMID: 31902412 DOI: 10.1016/j.mayocp.2019.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/18/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
MESH Headings
- Aged, 80 and over
- Cervical Vertebrae/diagnostic imaging
- Conservative Treatment/methods
- Diagnosis, Differential
- Female
- Hematoma, Epidural, Spinal/complications
- Hematoma, Epidural, Spinal/diagnosis
- Hematoma, Epidural, Spinal/physiopathology
- Hematoma, Epidural, Spinal/therapy
- Humans
- Magnetic Resonance Imaging/methods
- Neck Pain/diagnosis
- Neck Pain/physiopathology
- Neurologic Examination/methods
- Paresis/diagnosis
- Paresis/etiology
- Paresis/therapy
- Shoulder Pain/diagnosis
- Shoulder Pain/physiopathology
- Tomography, X-Ray Computed/methods
Collapse
Affiliation(s)
- Ronstan Lobo
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Adam P Sawatsky
- Advisor to resident and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
20
|
Douraiswami B, Subramani S, Varman M. Unprecedented clinical presentation of fungal spondylodiscitis as an extradural mass in an immunocompetent individual. J Clin Orthop Trauma 2020; 11:942-946. [PMID: 32904184 PMCID: PMC7452353 DOI: 10.1016/j.jcot.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Balaji Douraiswami
- Department of Orthopaedics, Hairmyres Hospital, NHS Lanarkshire, Glasgow, G75 8RG, United Kingdom
- Corresponding author.
| | - Suresh Subramani
- Department of Orthopaedics, SRM Medical College & Research Centre, Chennai, 603 203, India
| | - Mahendhira Varman
- Department of Orthopaedics, Tagore Medical College, Chennai, 600127, India
| |
Collapse
|
21
|
Taha MM, Elsharkawy AM, Al Menshawy HA, AlBakry A. Spontaneous cervical epidural hematoma: A case report and review of literature. Surg Neurol Int 2019; 10:247. [PMID: 31893148 PMCID: PMC6935966 DOI: 10.25259/sni_543_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not diagnosed early can lead to catastrophic consequences. Case Description: Here, we report a 41-year-old male, diagnosed with SCEH, with a presenting chief complaint of cervical pain followed by progressive quadriparesis and urgency of micturition who was managed surgically, along with the review of literature. Conclusion: SCEH is a rare pathologic entity. Due to the high risk of poor neurological outcome without treatment, SCEH should be a diagnostic possibility when the presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma and hemostasis leads to a favorable neurological outcome, whereas delay in treatment can be disastrous.
Collapse
Affiliation(s)
| | | | | | - Amr AlBakry
- Department of Neurosurgery, Zagazig University, Zagazig
| |
Collapse
|
22
|
Unnithan AKA. A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0046-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
23
|
Gomes PA, Cernadas E, Sá J, Brito H, Costa R. Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review. Eur J Case Rep Intern Med 2018; 5:000887. [PMID: 30755993 PMCID: PMC6346978 DOI: 10.12890/2018_000887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/09/2018] [Indexed: 01/30/2023] Open
Abstract
Spinal cord haematoma, or haematomyelia, is a rare condition caused by several unusual disease processes. Traumatic events, such as spinal cord injury and surgery or procedures involving the spinal cord, are the most important causes of spinal cord haematoma. Rarely, it is associated with anticoagulation therapy. Irrespective of cause, spinal cord haematoma is considered a neurosurgical emergency and must be treated promptly in order to prevent neurological sequelae. The authors describe the case of a 69-year-old patient taking warfarin in the therapeutic range for a mechanic mitral valve, who developed chest pain with cervical and dorsal radiation, and experienced sudden paraparesis of the limbs. A CT of the spine confirmed haematomyelia. A high index of suspicion, prompt recognition and immediate intervention are essential to prevent major morbidity and mortality from intraspinal haemorrhage. LEARNING POINTS This article reports an unusual presentation of spontaneous spinal haematoma, imposing the careful elaboration of differential diagnoses, which is very important in internal medicine.The description of this low-incidence case allows the scientific community to assist in approaching patients with similar symptoms.The lack of studies about the etiology and treatment of spontaneous spinal haematoma underlines the need for further studies and research in the area in order to increase the scientific evidence on the approach of these patients.
Collapse
Affiliation(s)
- Patrícia A Gomes
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Eduardo Cernadas
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Juliana Sá
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Helena Brito
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Ricardo Costa
- Emergency Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal
| |
Collapse
|
24
|
Nonsurgical Intervention in a Preeclamptic Patient with Spontaneous Spinal Epidural Hematoma. Case Rep Obstet Gynecol 2018; 2018:5879481. [PMID: 30524763 PMCID: PMC6247676 DOI: 10.1155/2018/5879481] [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] [Received: 08/25/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background Spontaneous epidural hematoma (SEH) is a rare finding in pregnancy, especially since most pregnant women do not have risk factors for developing SEH. The presence of epidural anesthesia can delay the diagnosis of SEH in pregnant patients. Immediate surgical decompression is the current standard of care for treating SEH. Case Presentation We present the case of a 37-year-old pregnant woman with preeclampsia with severe features who developed neurological deficits that were initially attributed to her epidural anesthesia. She was eventually found to have SEH with spinal stenosis at T5-T6 on MRI. Oral antihypertensives were used to keep the patient's blood pressures within normal limits, and she subsequently had complete resolution of her neurological symptoms and her SEH on imaging. Conclusion Preeclampsia may contribute to the development of SEH in pregnancy, and strict blood pressure control may potentially provide a safe and effective alternative to neurosurgery for these patients.
Collapse
|
25
|
Abstract
RATIONALE Epidural hematoma is a possible complication after neuraxial procedures. Recently, caudal epidural pulsed radiofrequency (PRF) stimulation was reported as an effective method for controlling several types of chronic pain. Herein, we report on a patient who developed a lumbar epidural hematoma after receiving caudal epidural PRF stimulation. PATIENT CONCERNS A 75-year-old woman, who was taking oral warfarin (2 mg/d), received caudal epidural PRF stimulation for symmetrical neuropathic pain in both legs due to chronic idiopathic axonal polyneuropathy. She did not discontinue warfarin use before undergoing the procedure. Three days and 12 hours after the procedure, motor weakness suddenly manifested in the right leg (manual muscle testing [MMT] = 2-3). DIAGNOSES Lumbar magnetic resonance imaging (MRI) performed 7 days after the PRF procedure showed a spinal epidural hematoma at the L1 to L5 levels, compressing the thecal sac. The international normalized ratio was 6.1 at the time of the MRI. INTERVENTIONS Decompressive laminectomy from L1 to L5 with evacuation of the hematoma was performed. OUTCOMES Three months postoperatively, the motor weakness in the patient's right leg improved to MMT = 4 to 5. LESSONS This case suggests that clinicians should carefully check if patients are taking an anticoagulant medication and ensure that it is discontinued for an appropriate length of time before a caudal epidural PRF procedure is performed.
Collapse
Affiliation(s)
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Spine Center, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| |
Collapse
|
26
|
Ismail R, Zaghrini E, Hitti E. Spontaneous Spinal Epidural Hematoma in a Patient on Rivaroxaban: Case Report and Literature Review. J Emerg Med 2018; 53:536-539. [PMID: 29079069 DOI: 10.1016/j.jemermed.2017.06.005] [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] [Received: 02/12/2017] [Revised: 05/30/2017] [Accepted: 06/03/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Spinal hematomas (SHs) are rare yet potentially debilitating causes of acute back pain. Although spontaneous SHs have been described in the setting of anticoagulation with warfarin or enoxaparin, few cases of spontaneous SH on direct oral anticoagulants (DOACs) have been reported. CASE REPORT We report a case of spontaneous spinal epidural hematoma in a patient on rivaroxaban. A 72-year-old man on rivaroxaban and aspirin presented with a 4-day history of nontraumatic back pain. In the emergency department he developed lower-extremity weakness and numbness, followed by urinary incontinence. Magnetic resonance imaging revealed spinal epidural hematoma at T11-L2. The patient underwent emergent decompression and hematoma evacuation and was discharged home 8 days later with complete resolution of symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early recognition and surgical intervention for SHs with neurologic compromise is key to favorable outcome. Optimal timing of surgery in patients on DOACs requires an assessment of the risk of intraoperative or postoperative bleeding, an assessment of the patient's symptom progression, as well as an understanding of the pharmacokinetics of the DOAC used and possible reversal options available. We also review all published cases of spontaneous SHs in patients on DOACs and report on their management and outcomes.
Collapse
Affiliation(s)
- Raed Ismail
- American University of Beirut, Beirut, Lebanon
| | | | | |
Collapse
|
27
|
Yang X, Richard SA, Liu J, Huang S. Systemic lupus erythematosus flare up as acute spinal subarachnoid hemorrhage with bilateral lower limb paralysis. Clin Pract 2018; 8:1069. [PMID: 30069301 PMCID: PMC6047477 DOI: 10.4081/cp.2018.1069] [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: 02/08/2018] [Accepted: 04/03/2018] [Indexed: 02/05/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) is an uncommon complication of systemic lupus erythematosus (SLE). Solitary association of fatal spinal SAH as a complication of SLE, has not been encountered much in literature although coexisting acute cerebral and spinal SAH have been associated with SLE. We present a 39-year old female with initial diagnosis of SLE eight years ago who suddenly developed a productive cough, acute abdomen and paralysis of the lower limbs. Magnetic resonance imaging of the spine revealed thoracic spinal SAH with varying degrees of thoracic spinal cord compression. The hemorrhage was total evacuated via surgery. She regained normal function of her lower limbers after the operation with no further neurological complications. One of the rare but fatal complications of SLE is solitary spinal SAH without cranial involvement. The best and most appropriate management of this kind of presentation is surgical decompression of the hematoma with total hemostasis. The cause of hemorrhage should be identified intra-operatively and treated appropriately.
Collapse
Affiliation(s)
- Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, P.R China
| | - Seidu A Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, P.R China.,Department of Immunology, Jiangsu University, Jiangsu, P.R. China.,Department of Surgery, Volta Regional Hospital, Ho, Ghana, West Africa
| | - Jiagang Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, P.R China
| | - Siqing Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, P.R China
| |
Collapse
|
28
|
Salehpour F, Mirzaei F, Kazemzadeh M, Alavi SAN. Spontaneous Epidural Hematoma of Cervical Spine. Int J Spine Surg 2018; 12:26-29. [PMID: 30280079 PMCID: PMC6162037 DOI: 10.14444/5005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Spontaneous cervical epidural hematoma is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not recognized early can have catastrophic consequences. Acute cervical epidural hematoma is definitely a condition of neurologic emergency. Although it is a rare condition, it must be considered in nontraumatic patients with sudden onset of neurologic deficits. Patients with spontaneous spinal epidural hematoma typically present with acute onset of severe back pain, and they rapidly develop signs of compression of the spinal cord or cauda equina. Here, we present a case of a 31-year-old man who presented with acute onset of neck pain with radicular component with progressive neurologic deficit. Emergent magnetic resonance imaging revealed cervical extradural hematoma with cord compression that was promptly evacuated. Functional recovery was achieved within 48 hours. The level of preoperative neurologic deficit and its severity, as well as operative interval, are important factors significantly affecting the postoperative outcome.
Collapse
Affiliation(s)
- Firooz Salehpour
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Mirzaei
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Kazemzadeh
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ahmad Naseri Alavi
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
29
|
Yardan T, Baydin A, Genc S, Cokluk C, Acar E, Aydin K. A Case of Spontaneous Spinal Epidural Haematoma in the Emergency Department Associated with Warfarin Therapy. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a neurosurgical emergency that requires early diagnosis and treatment. An 88-year-old man presented to the emergency department with complaints of weakness in the legs, walking deficit, incontinence and back pain for the last two days. He had been on warfarin therapy for 5 years for atrial fibrillation. There was no antecedent trauma. The neurological examination revealed hypoesthesia below the T6 level, anaesthesia below the T10 level and complete paraplegia of both lower extremities. The INR level was 7.81 on admission. Magnetic resonance imaging revealed a posterolateral epidural haematoma extending from T2 to L5. He was given fresh frozen plasma and vitamin K in the emergency department. Emergency thoracic and lumbar laminectomy was performed by neurosurgeons. The probability of SSEH should be investigated in any patient under anticoagulation therapy who presents with signs of spinal compression in the emergency department.
Collapse
Affiliation(s)
| | | | | | - C Cokluk
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurosurgery, Samsun, Turkey
| | | | - K Aydin
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurosurgery, Samsun, Turkey
| |
Collapse
|
30
|
Mukherjee P, Chawla A, Swarup S. Film Quiz: Sudden Onset Acute Neck Pain with Hemiparesis - Pearls and Pitfalls. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- P Mukherjee
- Khoo Teck Puat Hospital, Department of Diagnostic Radiology, 90 Yishun Central, Singapore 768828
| | - A Chawla
- Khoo Teck Puat Hospital, Department of Diagnostic Radiology, 90 Yishun Central, Singapore 768828
| | - S Swarup
- Khoo Teck Puat Hospital, Department of Accident and Emergency, 90 Yishun Central, Singapore 768828
| |
Collapse
|
31
|
Raasck K, Habis AA, Aoude A, Simões L, Barros F, Reindl R, Jarzem P. Spontaneous spinal epidural hematoma management: a case series and literature review. Spinal Cord Ser Cases 2017; 3:16043. [PMID: 28382214 PMCID: PMC5289268 DOI: 10.1038/scsandc.2016.43] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/11/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord and leading to acute neurological deficits. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Sub-optimal therapeutic principles contribute to SSEH's 5.7% mortality-which patient will benefit from surgery remains unclear. This study aims to investigate parameters that affect SSEH's progression, outlining a best-practice therapeutic approach. MATERIALS AND METHODS Literature review yielded 65 cases from 12 studies. Furthermore, 6 cases were presented from our institution. All data were analyzed under American Spinal Injury Association (ASIA) score guidelines. RESULTS Fifty percent of SSEH patients do not fully recover. In all, 30% of patients who presented with an ASIA score of A did not improve with surgery, although every SSEH patient who presented at C or D improved. Spontaneous recovery is rare-only 23% of patients were treated conservatively. Seventy-three percent of those made a full recovery, as opposed to the 48% improvement in patients managed surgically. Thirty-three percent of patients managed conservatively had an initial score of A or B, all improving to a score of D or E without surgery. Regardless, conservative management tends toward low-risk presentations. Patients managed conservatively were three times as likely to have an initial score of D than their surgically managed counterparts. DISCUSSION The degree of pre-operative neural deficit is a major prognostic factor. Conservative management has proven effective, although feasible only if spontaneous recovery is manifested. Decompressive laminectomy should continue to remain readily available, given the inverse correlation between operative interval and recovery.
Collapse
Affiliation(s)
- Kyle Raasck
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Ahmed A Habis
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Ahmed Aoude
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Leonardo Simões
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Fernando Barros
- Instituto de Ortopedia e Traumatologia, Oeste D'Or Hospital , Campo Grande, Rio de Janeiro, Brazil
| | - Rudy Reindl
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Peter Jarzem
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| |
Collapse
|
32
|
Lumbar Epidural Hematoma Following Interlaminar Fluoroscopically Guided Epidural Steroid Injection. Reg Anesth Pain Med 2016; 41:402-4. [DOI: 10.1097/aap.0000000000000387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
33
|
Lee HH, Park SC, Kim Y, Ha YS. Spontaneous Spinal Epidural Hematoma on the Ventral Portion of Whole Spinal Canal: A Case Report. KOREAN JOURNAL OF SPINE 2015; 12:173-6. [PMID: 26512277 PMCID: PMC4623177 DOI: 10.14245/kjs.2015.12.3.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/14/2015] [Accepted: 07/22/2015] [Indexed: 12/28/2022]
Abstract
Spontaneous spinal epidural hematoma is an uncommon but disabling disease. This paper reports a case of spontaneous spinal epidural hematoma and treatment by surgical management. A 32-year-old male presented with a 30-minute history of sudden headache, back pain, chest pain, and progressive quadriplegia. Whole-spinal sagittal magnetic resonance imaging (MRI) revealed spinal epidural hematoma on the ventral portion of the spinal canal. Total laminectomy from T5 to T7 was performed, and hematoma located at the ventral portion of the spinal cord was evacuated. Epidural drainages were inserted in the upper and lower epidural spaces. The patient improved sufficiently to ambulate, and paresthesia was fully recovered. Spontaneous spinal epidural hematoma should be considered when patients present symptoms of spinal cord compression after sudden back pain or chest pain. To prevent permanent neurologic deficits, early and correct diagnosis with timely surgical management is necessary.
Collapse
Affiliation(s)
- Hyun-Ho Lee
- Department of Neurosurgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Sung-Choon Park
- Department of Neurosurgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Young Kim
- Department of Neurosurgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Young-Soo Ha
- Department of Neurosurgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| |
Collapse
|
34
|
Moore JM, Jithoo R, Hwang P. Idiopathic Spinal Subarachnoid Hemorrhage: A Case Report and Review of the Literature. Global Spine J 2015; 5:e59-64. [PMID: 26430603 PMCID: PMC4577320 DOI: 10.1055/s-0035-1546416] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 12/31/2014] [Indexed: 10/26/2022] Open
Abstract
Study Design Case report. Objective Spinal subarachnoid hemorrhage (SSAH) makes up less than 1.5% of all the cases of subarachnoid hemorrhage. Most cases of spontaneous SSAH occur in association with coagulopathy, lumbar punctures, or minor trauma. Idiopathic SSAH is extremely rare with only 17 cases published. Idiopathic SSAH presents a diagnostic dilemma, and the appropriate investigations and treatment remain a matter of controversy. We report a case of idiopathic SSAH and a review of the literature regarding its clinical presentation, diagnosis, and treatment. Methods A 73-year-old woman presented to the emergency department after spontaneously developing severe right leg and lower back pain while bending over to vomit. After a review of the patient's history and examination, the magnetic resonance imaging (MRI) of the thoracolumbar spine revealed T1 hyperintensity and T2 hypointensity, a diffusion-restricted collection at the T11-T12 level, and a posterior collection from L3 to S1 producing a mild displacement of the thecal sac. Results The patient was taken for an L5 laminectomy. Intraoperatively, rust-colored, xanthochromic fluid was drained from the subarachnoid space, confirming SSAH. The thecal sac was decompressed. The cultures and Gram stains were negative. Computer tomography (CT) and CT angiography of the brain were normal. She recovered postoperatively with resolution of the pain and no further episodes of hemorrhage after 2 years of follow-up. Repeat thoracolumbar MRI, selective spinal angiogram, and six-vessel cerebral angiogram did not reveal pathology. Conclusion We suggest a clinical algorithm to aid in the diagnosis and management of such patients.
Collapse
Affiliation(s)
- Justin M. Moore
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia,Address for correspondence Justin M. Moore, MD, PhD Department of Neurosurgery, 1st floorOld Baker Building, The Alfred Hospital, MelbourneVictoria, Australia 3004
| | - Rondhir Jithoo
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Hwang
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
35
|
Muñoz González A, Cuello J, Rodríguez Cruz P, Iglesias Mohedano A, Domínguez Rubio R, Romero Delgado F, García Pastor A, Guzmán de Villoria Lebiedziejswki J, Fernández García P, Romero Martínez J, Ezpeleta Echevarri D, Díaz Otero F, Vázquez Alen P, Villanueva Osorio J, Gil Núñez A. Spontaneous spinal epidural haematoma: A retrospective study of a series of 13 cases. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2014.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
|
36
|
Sen D, Satija L, Girdhar S. A rare case of chronic idiopathic spinal epidural haematoma. Med J Armed Forces India 2015; 71:S32-5. [PMID: 26265864 PMCID: PMC4529506 DOI: 10.1016/j.mjafi.2012.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Debraj Sen
- Graded Specialist (Radiodiagnosis), Command Hospital (CC), Lucknow 226002, India
| | - Lovleen Satija
- Consultant (Radiodiagnosis), Command Hospital (CC), Lucknow 226002, India
| | - Sachin Girdhar
- Resident (Radiodiagnosis), Command Hospital (CC), Lucknow 226002, India
| |
Collapse
|
37
|
Muñoz González A, Cuello JP, Rodríguez Cruz PM, Iglesias Mohedano AM, Domínguez Rubio R, Romero Delgado F, García Pastor A, Guzmán de Villoria Lebiedziejswki J, Fernández García P, Romero Martínez J, Ezpeleta Echevarri D, Díaz Otero F, Vázquez Alen P, Villanueva Osorio JA, Gil Núñez A. Spontaneous spinal epidural haematoma: a retrospective study of a series of 13 cases. Neurologia 2014; 30:393-400. [PMID: 24839904 DOI: 10.1016/j.nrl.2014.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/26/2014] [Accepted: 03/10/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset. OBJECTIVE To describe a sample of patients with SSEH and analyse variables related to its functional prognosis. PATIENTS AND METHODS Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital. RESULTS We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset. CONCLUSIONS Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option.
Collapse
Affiliation(s)
- A Muñoz González
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - J P Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P M Rodríguez Cruz
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A M Iglesias Mohedano
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Domínguez Rubio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Romero Delgado
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A García Pastor
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - P Fernández García
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Romero Martínez
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - F Díaz Otero
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Vázquez Alen
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J A Villanueva Osorio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Gil Núñez
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| |
Collapse
|
38
|
Cha KH, Cho TG, Kim CH, Lee HK, Moon JG. Spinal epidural hematoma related to intracranial hypotension. KOREAN JOURNAL OF SPINE 2014; 10:203-5. [PMID: 24757490 PMCID: PMC3941751 DOI: 10.14245/kjs.2013.10.3.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 09/14/2013] [Accepted: 09/16/2013] [Indexed: 01/29/2023]
Abstract
A 45-year-old female patient visited the hospital complaining of severe sudden headache and posterior neck pain. The patient did not have any traumatic history or abnormal neurologic finding. The patient had sudden quadriplegia and sensory loss. Cervical spine MRI scan was taken, and the compatible findings to acute epidural hematoma were shown. The emergency operation was performed. After the operation, the patient recovered all motor and senses. As there was CSF leakage in the postoperative wound, this was confirmed by cervical spinal computed tomography (CT). Then lumbar drainage was thus performed. The opening pressure upon lumbar puncture was not measured as it was very low. As a result of continous CSF leakage, dural repair was performed. After the operation, the patient had been discharged without neurologic deficits. In this case, it is sensible to suspect intracranial hypotension as a possible cause of spinal EDH.
Collapse
Affiliation(s)
- Kyung Han Cha
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Tack Geun Cho
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Chang Hyun Kim
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ho Kook Lee
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jae Gon Moon
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| |
Collapse
|
39
|
Ito H, Takai K, Taniguchi M. Spontaneous cervical epidural hematomas with acute hemiparesis should be considered a contraindication for intravenous thrombolysis: a case report with a literature review of 50 cases. Intern Med 2014; 53:57-62. [PMID: 24390530 DOI: 10.2169/internalmedicine.53.1274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We herein report the case of a 63-year-old woman with an acute spontaneous cervical epidural hematoma who presented with acute hemiparesis and was successfully managed with surgery. Based on a literature review of 50 cases of spontaneous cervical epidural hematomas, we concluded that the relatively high frequency of hemiparesis (12 of 50 cases, 24%) is the result of the fact that epidural hematomas are predominantly distributed dorsolaterally in the region of the mid and lower cervical spine, leading to unilateral cervical cord compression. Clinicians should keep in mind that acute hemiparesis can be caused by spontaneous cervical epidural hematomas for which intravenous thrombolysis is contraindicated.
Collapse
Affiliation(s)
- Hirotaka Ito
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Japan
| | | | | |
Collapse
|
40
|
Abstract
Spontaneous spinal epidural hematoma (SSEH) is a rare condition, often causing significant neurologic morbidity owing to its insidious nature and difficulty in diagnosis. Initial nonspecific clinical findings make the timely diagnosis challenging. A variety of underlying etiologies predispose patients to SSEH such as anticoagulation therapy, bleeding diatheses, vascular malformations, tumors, as well as spontaneous and idiopathic cases. Early diagnosis and intervention are critical for optimal patient outcomes. Here, we present a case of SSEH where coagulopathy was originating from underlying cholestasis. This, to our knowledge, represents the first case reported in the literature where a primary cholestatic disease is the underlying etiology.
Collapse
|
41
|
Kim T, Lee CH, Hyun SJ, Yoon SH, Kim KJ, Kim HJ. Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment. J Korean Neurosurg Soc 2012; 52:523-7. [PMID: 23346323 PMCID: PMC3550419 DOI: 10.3340/jkns.2012.52.6.523] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/07/2012] [Accepted: 12/18/2012] [Indexed: 12/17/2022] Open
Abstract
Objective The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. Methods We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. Results Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. Conclusion For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.
Collapse
Affiliation(s)
- Tackeun Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | | | | | | | | | | |
Collapse
|
42
|
Yoon BH, Park KS, Jung SS, Park MS, Kim SM, Chung SY, Chung JC, Kim HK. Spontaneous cervical epidural hematoma causing brown-sequard syndrome. KOREAN JOURNAL OF SPINE 2012; 9:297-9. [PMID: 25983837 PMCID: PMC4431024 DOI: 10.14245/kjs.2012.9.3.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 09/04/2012] [Accepted: 09/25/2012] [Indexed: 12/13/2022]
Abstract
Spontaneous cervical epidural hematoma (SCEH) is a rare clinical entity and has a varied etiology. Urgent surgical decompression should be done to prevent serious permanent neurologic deficits. We describe a 59-year-old female who presented with Brown-Sequard syndrome due to spontaneous cervical epidural hematoma. Initially, she was misdiagnosed as cerebrovascular accident. Cervical magnetic resonance imaging revealed epidural hematoma to the right of the spinal cord extending from C3 to C6. She later underwent surgical evacuation and had complete restoration of neurologic function. The outcome in SCEH is essentially determined by the time taken from onset of the symptom to operation. Therefore, early and precise diagnosis such as careful history taking and MRI evaluation is mandatory.
Collapse
Affiliation(s)
- Byul Hee Yoon
- Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea
| | - Ki Seok Park
- Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea
| | - Sung Sam Jung
- Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea
| | - Mun Sun Park
- Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea
| | - Seong-Min Kim
- Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea
| | - Seung-Young Chung
- Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea
| | - Jong-Chul Chung
- Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea
| | - Han-Kyu Kim
- Department of Neurosurgery, Eulji University College of Medicine, Daejeon, Korea
| |
Collapse
|
43
|
Fedor M, Kim ES, Ding K, Muizelaar JP, Kim KD. Spontaneous Spinal Epidural Hematoma: A Retrospective Study on Prognostic Factors and Review of the Literature. KOREAN JOURNAL OF SPINE 2011; 8:272-82. [PMID: 26064145 PMCID: PMC4461739 DOI: 10.14245/kjs.2011.8.4.272] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 12/20/2011] [Accepted: 01/05/2012] [Indexed: 12/26/2022]
Abstract
Objectives The spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Patients typically present with sudden onset back pain followed by neurological deficits. Methods Diagnosis of SSEH is usually made with MRI and standard treatment is surgical evacuation. In 1996, Groen published the most comprehensive review on the SSEH in which he analyzed 333 cases. We review 104 cases of SSEH presented in the English literature since the last major review and add three of our own cases, for a total of 107 cases. Results Our patients presented with back pain and neurologic deficits. Two made excellent functional recovery with prompt surgical decompression while one continued to have significant deficits despite evacuation. Better postoperative outcome was associated with less initial neurological dysfunction, shorter time to operation from symptom onset and male patients. Conclusion We discuss the etiology of SSEH and report current trends in diagnosis, treatment, and outcome.
Collapse
Affiliation(s)
- Mark Fedor
- Department of Neurological Surgery, University of California, Davis Medical Center, USA
| | - Eric S Kim
- Department of Neurological Surgery, University of California, Davis Medical Center, USA
| | - Kai Ding
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, USA
| | - J Paul Muizelaar
- Department of Neurological Surgery, University of California, Davis Medical Center, USA
| | - Kee D Kim
- Department of Neurological Surgery, University of California, Davis Medical Center, USA
| |
Collapse
|
44
|
Kim HS, Lee SK, Kim SW, Shin H. Chronic Spinal Epidural Hematoma Related to Kummell's Disease. J Korean Neurosurg Soc 2011; 49:231-3. [PMID: 21607183 DOI: 10.3340/jkns.2011.49.4.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/26/2010] [Accepted: 03/23/2011] [Indexed: 12/15/2022] Open
Abstract
Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.
Collapse
Affiliation(s)
- Heyun Sung Kim
- Department of Neurosurguery, Heori Sarang Hospital, Daejeon, Korea
| | | | | | | |
Collapse
|
45
|
Nam KH, Choi CH, Yang MS, Kang DW. Spinal epidural hematoma after pain control procedure. J Korean Neurosurg Soc 2010; 48:281-4. [PMID: 21082060 DOI: 10.3340/jkns.2010.48.3.281] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/04/2010] [Accepted: 09/09/2010] [Indexed: 12/20/2022] Open
Abstract
Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.
Collapse
Affiliation(s)
- Kyoung Hyup Nam
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | | | | | | |
Collapse
|
46
|
Ahn SS, Song YJ. Clinical experience and management of cervico-thoracic epidural hematoma. J Korean Neurosurg Soc 2010; 47:381-4. [PMID: 20539799 DOI: 10.3340/jkns.2010.47.5.381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 02/05/2010] [Accepted: 02/08/2010] [Indexed: 12/31/2022] Open
Abstract
Spinal epidural hematoma (SEH) causing acute myelopathy is rare. The usual clinical presentation of a SEH is sudden severe neck or back pain that progresses toward paraparesis or quadriparesis, depending on the level of the lesion. Recent studies have shown that early decompressive surgery is very important for patient's recovery. We experienced five patients of cervico-thoracic epidural hematomas associated with neurologic deficits that were treated successfully with surgical intervention.
Collapse
Affiliation(s)
- Sang-Soak Ahn
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| | | |
Collapse
|