Spinal Epidural Hemorrhage Three Cases Report and Literature Review

Abstract

Spinal epidure hemorrhage is rare. It is often misdiagnosed and mistreated, and may result in severe paraplegia or death. Abort half of the cases reported in the literature had identifiable causes. Among these, trauma and anticoagulant therapy were most frequently encountered. The others were known as spontaneous spinal epidural hemorrhage. We report here 3 cases treated in NTUH. Their symptoms included sudden onset of severe localized back pain and flaccid paralysis of lower extremities which progressed within minutes to days. In case 1, early spinal decompression minimized the possible neurological sequelae. In case 2, hematoma occurred in the lower thoracic spine. Pain in the early stage was not differenciated carefully from acute abdomen. Diagnosis was made in case 3 when flaccid paralysis developed completely. Unlike that occurs in the skull, epidural hemorrhage in the spine is always a surgical emergency. It is important to differentiate from other causes of spinal cord injury, and to make early diagnosis and management.