Evaluation of clinical and MR findings for the prognosis of spinal epidural haematomas

Abstract

The potential of MR and clinical findings of spinal epidural haematomas (SEHs), particularly the early MR findings, to help minimize delays in diagnosis, to aid prognosis and as a reference for conservative treatment, are evaluated. Retrospectively 20 patients with SEHs (14 men and 6 women) were examined to record their neurological deficit, MR findings, management, clinical outcome, and interval between symptom onset and MRI or surgery. Two-tailed Fisher's exact test was used for these analyses. Of 8 patients with severe neurological deficit at the onset of symptoms, none had obvious clinical improvement after either surgical or conservative management. Of 12 patients with mild to moderate deficits, 11 (92%) showed improvement or recovery of clinical symptoms. T2-weighted images revealed myelopathy or infarction of the compressed spinal cord in 9 patients, 7 (78%) of whom had no improvement in neurological deficit with either conservative or surgical management. Images in 6 patients showed contrast enhancement in the haematomas. Poor clinical outcomes were observed mainly in those with severe neurological deficit and hyperintensity on T2-weighted images of the involved spinal cord. Surgery did not appear to improve outcome in many of these patients. In acute SEHs, MRI showed characteristic findings, such as contrast enhancement, which should not be confused with signs of inflammatory or neoplastic epidural disease.