Spontaneous Spinal Epidural Hematoma in Pregnancy

Abstract

Spinal epidural hematoma (SEH) is an uncommon condition. Spontaneous SEH, accounting for 0.3–0.9% of all spinal epidural space occupying lesions, instead is associated with risk factors (such as substantial soft trauma or coagulation abnormalities).The pathophysiology of spontaneous and idiopathic SEH is still under debate: There are only a few reports in literature of spontaneous evolving SEH with progressively increasing pain and neurological impairment. Magnetic resonance imaging may be inconclusive for differential diagnosis. Here, we present a 38-years old female on the 2nd trimester of her pregnancy preset with spontaneous spinal epidural hematoma with a sudden onset of weakness and back pain fallowed by a sudden paraplegia. MR imaging showed high intensity irregular dotted lesion seen in the lower thoracic region (T12), in addition, MRI revealed an intervertebral disk prolapse with a cord compression between (L3-L4) (L4-L5). The Surgical treatment of the case, the patient underwent laminectomy and an evacuation of the hematoma by the neurosurgical team allowed a correct diagnosis but still paraplegic. Our aim is to discuss the clinical and radiological features and the treatment options.