Spontaneous spinal epidural hematoma: early recognition and clinical evaluation

Abstract

To investigate early recognition and clinical evaluation of spontaneous spinal epidural hematoma (SSEH) and to analyze the factors related to prognosis. Nine patients with SSEH were include in current study. There were 7 men and 2 women with a mean age of 45.4 years (range, 18-83 years). Etiological factors were noted in 9 patients, 3 with hypertension, 2 with angioma, 2 with laminar osteoblastoma, 1 with neuroblastoma, and 1 with thrombolysis treatment. Six patients presented with acute onset of neck or back pain. Two patients initially presented with incomplete paralysis. One patient emerged with ascending bilateral lower extremity weakness and loss of sensation after thrombolysis treatment. Neurologic deficit was four as Frankel A, two as Frankel B, one as Frankel C and two as Frankel D. Evacuation of the hematoma was carried out in eight patients. One patient of thrombolysis treatment was treated conservatively because of loss of optimum for operation. Eight hematomas were located in thoracic region, one was found in the cervicothoracic region. Mean extension was 3.7 segments (range, 2-8 segments). One patient died of severe pulmonary infection 50 days postoperatively. The average follow-up observation was 7. 5 months. Evaluation of the neurological function showed that 2 patients being classified as Frankel B, 1 as Frankel D and 4 patients as Frankel E. There was no improvement of neurological function in 1 patient with conservative treatment. The keys to the early diagnosis of SSEH are the characteristic of clinical symptoms, and the lesion site, the extent of the lesion demonstrated by MRI. The prognosis is worse for SSEH with etiological factor of hypertension. Early diagnosis and surgical treatment might get better results for SSEH resulting from tumour.