A case report of Spontaneous Spinal Epidural Hematoma in Elderly Patient with Surgical Decompression

Abstract

Spontaneous spinal epidural hematoma (SSEH), uncommon disorder with potentially devastating consequences as high morbidity. Incidence around 0.1 in 100,000 per/year, male- female ratio is approximately 1.4:1, most cases in 4th-5th decades. The etiology was associated with lumbar puncture and myelography, arteriovenous malformations, bleeding disorders, pregnancy, spinal manipulation. Anticoagulation is also a risk factor for spontaneous spinal epidural hematomas, warfarin is the most common related with SSEH. SSEH present clinically as a cord compression syndrome, acute onset pain and neurological deficit such as progressive motor or sensory symptoms, sphincter dysfunction, ultimately leads to complete/incomplete motor deficit caused by spinal cord/nerve root compression or cauda equina. The symptoms depending on the location of the hematoma. The worst prognostic factors are thoracic location, anticoagulation, severe neurologic deficits on admission, sphincter dysfunction, rapid progression. Magnetic resonance imaging (MRI) is the gold standard technique to diagnose SSEH. Once the diagnosis is established with clinical and imaging results, early surgical intervention should be considered. Currently, appropriate management is emergence decompression laminectomy and hematoma evacuation. We present the case of 87-year-old female, on warfarin for atrial fibrillation. Without recent trauma events. Presented sudden thoracic and lumbar pain, paresthesias with irradiation to legs. Progression with sudden paraplegic and anesthesia in lower extremities. Thoracolumbar MRI revealed a posterior SSEH extended from T9-T12. Was released a laminectomy and SSEH aspiration within 6 hours from the symptom’s onset. The patient was discharged one week after the surgery, symptoms improved during the follow-up.