Hematomas espinales: la apoplejía espinal

Abstract

IntroductionSpinal haematomas (SH) are a rare pathology. They can produce a rapid and irreversible neurological deterioration. MethodIn this retrospective study, we review 8 cases of SH treated in our centre over the last five years. Data collected were: age, sex, predisposing factors, clinical status, radiological features, treatment and outcome. ResultsFive patients were female and three male. Age ranged between 13 and 81 years. Five patients were hypertensive. Four had a coagulation disorder. In three patients SH occurred after physical effort. One case appeared after a lumbar puncture and another was secondary to intramedullary cavernous angioma. All patients presented with pain followed by neurological symptoms. Four cases were epidural, two subdural and two were intramedullary. All epidural SH and one subdural SH, were located dorsal to medulla. Five patients were operated on due to progressive neurological deterioration. Only one of them showed neurological improvement. Patients who were not operated on, had a better neurological status and they improved spontaneously. Two of them were discharged without neurological symptoms. ConclusionsThere is controversy over the physiopathology of SH. The triggering mechanisms are unknown. The vessel (artery or vein) and the anatomical compartment in which SH arise are also unknown. Prompt diagnosis and urgent surgical treatment are needed when the patient has neurological symptoms. In these cases, the most important prognostic factor is the preoperative neurological status.