A rare case of chronic idiopathic spinal epidural haematoma

Abstract

Spinal epidural haematoma (SEH) though rare is the most frequent cause of spinal haemorrhage. It is an important cause of compressive myelopathy, frequently presents as an emergency and requires prompt diagnosis and management. SEH can be classified as secondary (e.g., secondary to coagulopathies or anticoagulant therapy), spontaneous (absence of any definite cause but associated with risk factors like minor trauma) and idiopathic (no attributable risk factors identified) or acute and chronic.1 The spontaneous and idiopathic groups comprise about 50% of cases.2 The chronic form is the rarest and its most frequent location is the lumbar spine. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosis. Irrespective of the aetiology, the mainstay of treatment is urgent surgical decompression and evacuation of the haematoma. There are only a few reports of successful conservative treatment in this condition where symptoms and signs have resolved without surgery.3,4 Here we present an unusual case of chronic idiopathic spinal epidural haematoma where the patient was only symptomatic with chronic low backache. This article aims to discuss the pathogenesis, clinical and radiological features, and differential diagnosis in this condition.