Evacuation Of Epidural Hematoma Research Articles

Surgical Outcomes of Epidural Hematoma in Trauma Patients with Absent Pupillary Reactions: A National Trauma Data Analysis.

Absent pupillary reaction occasionally heralds a poor prognosis following severe head injury. The purpose of the study was to evaluate the outcome of all patients who underwent acute evacuation of epidural hematoma (EDH) despite absent bilateral pupillary reaction. The Trauma Quality Improvement Program (TQIP) database for the calendar years 2017 and 2018 was accessed for the study. Adult patients ≥18 years of age who sustained severe traumatic brain injury (TBI) with the diagnosis of EDH and underwent evacuation of the hematoma were included in the study. The patients' characteristics, injury severity score (ISS), Glasgow Coma Scale (GCS) score, midline shift, and comorbidities were compared between patients who had absence of both pupillary reaction (ABPR) and those who presented with presence of both pupillary reaction (PBPR). The primary outcome of the study was in-hospital mortality. Propensity score matching analyses were performed for the study. No significant differences were found between the ABPR and PBPR groups regarding the median age (37 years [interquartile range (IQR): 26-53] vs. 40 years [IQR: 28-55]), gender (males; 81.9 vs. 79.5%), median ISS (29 [25.5-34] vs. 27 [25-33]), GCS score (3 [3-4] vs. 3 [3-3], presence of significant midline shift (75.9 vs. 79.5%), and comorbidities. The patients who presented with ABPR had a significantly higher mortality (34.9 vs. 10.8%; p = 0.002). A higher number of patients were discharged to skilled nursing and rehabilitation facilities (16.7 vs. 10.8% and 46.3 vs. 41.9%, respectively; p = 0.045). Approximately 65% of severe TBI patients survived after the evacuation of the EDH despite the absence of pupillary reaction.

A Spherical Cap Model of Epidural Hematomas.

Background Epidural hematomas (EDHs), which have a characteristic biconvex shape, are a type of post-traumatic intracranial mass. EDHs and other types of intracranial hematomas are often diagnosed with computed tomography (CT). The volumes of EDHs are important in treatment decisions and prognosis. Their volumes are usually estimated on CT using the "ABC" method, which is based on the ellipsoid shape rather than their biconvex shape. Objective To simulate the biconvex shape, we modeled the geometry of EDHs with two spherical caps. We aim to provide simpler estimation of EDH volumes in clinical settings, and eventually recommend a threshold for surgical evacuation. Methods Applying the relationship between the sphere radius, spherical cap height, and base circle radius, we derived formulas for the shape of an EDH, relating its largest diameter and location to the other two diameters. We also estimated EDH volumes using the spherical cap volume and conventional ABC formulas and then constructed a lookup table accordingly. Results Validation of the model was performed using 14 CT image sets from previously reported patients with EDHs. Our geometric model demonstrated accurate predictions. Themodel also allows reducing the number of parameters to be measured in the ABC method from three to one, the hematoma length, showcasing its potential as a reliable tool for clinical decision-making. Based on our model, an EDH longer than 7 cm would occupy more than 30 mL of the intracranial volume. Conclusion The proposed model offers a streamlined approach to estimating EDH volumes, reducing the complexity of parameters required for clinical assessments. We recommend a length of 7 cm as a threshold for surgical evacuation of EDHs. This acceleration in decision-making is crucial for managing critically injured patients with traumatic brain injuries. Further validation across diverse patient populations will enhance the generalizability and utility of this geometric modeling approach in clinical settings.

Airway Management for Emergency Spinal Epidural Hematoma Evacuation With Awake Spine Surgery: Case Report and Literature Review.

Postoperative spinal epidural hematomas (pSEHs) are a rare complication of microdiscectomy surgery. The hematoma may be unnoticed intraoperatively, but timely treatment may prevent permanent neurologic impairment. Airway management in patients with a full stomach is generally performed with rapid sequence intubation and general anesthesia. Awake spine surgery without intravenous analgesia or sedation may be beneficial in patients with a full stomach who are at higher risk for pulmonary aspiration with general anesthesia due to a loss of non-per-oral (NPO) status. The authors propose that it can also be performed in cases of urgent/emergent postsurgical epidural hematoma evacuation. We present the airway management of a 41-year-old man who underwent a minimally invasive microdiscectomy with normal strength immediately after surgery but developed progressive weakness with right foot dorsiflexion, right extensor hallucis longus muscle weakness, and progressive right lower extremity ascending numbness over the course of the first 2 hours after surgery due to an epidural hematoma. The patient underwent urgent awake epidural hematoma evacuation with a spinal anesthetic. Afterward, the patient recovered neurological function and was discharged the following morning. pSEHs are a rare complication of microdiscectomy surgery. The purpose of this article is to describe the novel use of awake spine surgery in emergent epidural hematoma evacuation and demonstrate its feasibility. In emergencies, when a patient is not NPO, awake spine surgery can safely be performed with no sedation, ensuring the patient can protect their airway and avoid the risk of aspiration.

Non-Traumatic Epidural Hematoma in Sickle Cell Disease

Non-traumatic epidural hematoma is an extremely rare finding in patients with sickle cell disease. Spontaneous intracranial epidural hemorrhage has been associated with coagulopathy, malignancy, and infection, but few cases secondary to sickle cell disease have been reported in the literature. The mechanism of hemorrhage in these patients is often unclear, although previous cases have suggested associations with vaso-occlusive pain crises, bone infarction, and/or vascular malformations. We report a 9 year old male with sickle cell disease type SS who presented with right shoulder pain, headaches, emesis, and no neurological deficits. CT head revealed large mixed density left frontoparietal epidural hematoma leading to complete left lateral ventricle effacement and 0.5 cm left to right midline shift. He subsequently underwent a left parietal craniotomy for evacuation of epidural hematoma from which he recovered well. The prevalence and proposed pathologic process behind this rare complication will be discussed.

Applications of supraorbital keyhole craniotomy in pediatric cranial trauma: illustrative series of two cases and systematic literature review.

Minimally invasive (MIS) approaches to neurosurgical diseases continue to increase in popularity due to their association with decreased infection risk, shorter recovery time, and improved cosmesis. Cosmesis and lower morbidity are especially important for pediatric patients. The supraorbital keyhole craniotomy (SOKC) is one MIS approach shown to be effective for both neoplastic and vascular pathologies in pediatric patients. However, it is limited data on its use in pediatric trauma patients. Two cases employing SOKC in pediatric trauma patients are presented here along with a systematic review of the literature. We queried PubMed, Scopus, and Web of Science databases from inception to August 2022 using the Boolean search term: (supraorbital OR eyebrow OR transeyebrow OR suprabrow OR superciliary OR supraciliary) AND (craniotomy OR approach OR keyhole OR procedure) AND (pediatric OR children OR child OR young) AND "trauma". Studies that discussed the use of an SOKC in a pediatric patient having sustained trauma to the frontal calvarium and/or anterior fossa/sellar region of the skull base were included. Details were extracted on patient demographics, trauma etiology, endoscope use, and surgical and cosmetic outcomes. We identified 89 unique studies, of which four met inclusion criteria. Thirteen total cases were represented. Age and sex were reported for 12 patients, 25% of whom were male; the mean age was 7.5years (range: 3-16). Pathologies included acute epidural hematoma (9), orbital roof fracture with dural tear (1), blowout fracture of the medial wall of the frontal sinus with supraorbital rim fracture (1), and compound skull fracture (1). Twelve patients were treated with a conventional operating microscope, while one underwent endoscope-assisted surgery. Only one significant complication (recurrent epidural hematoma) was reported. There were no reported cosmetic complications. The MIS SOKC approach is a reasonable option for select anterior skull base trauma in the pediatric population. This approach has been used previously for successful frontal epidural hematoma evacuation, which is often treated by a large craniotomy. Further study is merited.

Patient-reported Outcome After Surgical Evacuation of Postoperative Spinal Epidural Hematomas at One-year Follow-up.

Retrospective analysis of prospectively collected data from the National Swedish Spine Register (Swespine). The objective of this study was to evaluate the effects of symptomatic spinal epidural hematoma (SSEH) requiring reoperation on one-year patient-reported outcome measures (PROMs) in a large cohort of patients treated surgically for lumbar spinal stenosis. Studies exploring the outcomes of reoperations after SSEH are scarce and often lack validated outcome measures. As SSEH is considered a serious complication, understanding of the outcome after hematoma evacuation is important. After retrieving data from 2007 to 2017 from Swespine, we included all patients with lumbar spinal stenosis without concomitant spondylolisthesis who were treated surgically with decompression without fusion. Patients with evacuated SSEH were identified in the registry. Back/leg pain numerical rating scales (NRSs), the Oswestry Disability Index (ODI), and EuroQol Visual Analogue Scale were used for the outcome assessment. PROMs before and one year after decompression surgery were compared between evacuated patients and all other patients. Multivariate linear regression was performed to determine whether hematoma evacuation predicted inferior one-year PROM scores. A total of 113 patients with an evacuated SSEH were compared with 19527 patients with no evacuation. One-year after decompression surgery, both groups showed significant improvement in all PROMs. When comparing the two groups' one-year improvement, there were no significant differences in any PROM. The proportion of patients achieving the minimum important change was not significantly different for any PROM. Multivariate linear regression found that hematoma evacuation significantly predicted inferior one-year ODI (β=4.35, P =0.043), but it was not a significant predictor of inferior NRS Back (β=0.50, P =0.105), NRS Leg (β=0.41, P =0.221), or EuroQol Visual Analogue Scale (β=-1.97, P =0.470). A surgically evacuated SSEH does not affect the outcome in terms of back/leg pain or health-related quality of life. Commonly used PROM surveys may not capture neurological deficits associated with SSEH.

Patient-reported outcome after surgical evacuation of postoperative spinal epidural hematomas: One-year follow-up of 113 hematomas after 19640 decompression procedures for lumbar spinal stenosis

Patient-reported outcome after surgical evacuation of postoperative spinal epidural hematomas: One-year follow-up of 113 hematomas after 19640 decompression procedures for lumbar spinal stenosis

Prognostic Value of Swirl Sign in Acute Epidural Hemorrhage.

Objective The purpose of this study is to analyze and evaluate the incidence, prognostic value, and impact of swirl sign on the outcome of patients who underwent surgical treatment for epidural hematoma. Materials and Methods A retrospective analytical study on 307 acute epidural hematoma (AEDH) patients with and without swirl sign was conducted at our hospital between 2015 and 2019. All the patients in this study were treated initially as per the protocols of advanced trauma life support and surgically treated by craniotomy and evacuation of epidural hematoma. Patients with other concomitant intracerebral injuries such as subdural hematoma and contusion and those who were managed conservatively were excluded from the study. Various factors such as age, sex, mechanism of injury, Glasgow Coma Scale (GCS) score at admission, time from injury to surgery, preoperative mydriasis, location of bleed, midline shift, location of fracture, volume of hematoma, duration of stay in the hospital, and GCS score at discharge were taken into consideration and compared in between patients with and without swirl sign. Outcomes were assessed at the end of 6 months using the Glasgow Outcome Scale. Results Of the 307 patients who were operated for epidural hemorrhage, 92 had swirl sign (29.96%) and the rest had no swirl sign. Univariate analysis revealed a significant correlation between the presence of swirl sign and age, preoperative mydriasis, and time from injury to surgery. The patients with the swirl sign had an unfavorable outcome at the end of 6 months which was statistically significant. Conclusion It can be concluded that those patients with swirl sign in AEDH had an unfavorable outcome compared to those without swirl sign. Therefore, aggressive treatment and early surgery play an important role in the outcomes of the patients.

Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas.

Optimal treatment of children with traumatic intracranial epidural hematomas (EDHs) is unknown. We sought to identify clinical and radiographic predictors of delayed surgical intervention among children with EDH admitted for observation. We retrospectively identified patients younger than 15 years with acute traumatic EDHs evaluated at our level 1 pediatric trauma center. We excluded patients with penetrating head injuries, recent surgical evacuation of EDH, or depressed skull fracture requiring surgical repair and assigned the remaining subjects to the immediate surgery group if they underwent immediate surgical evacuation, to the supportive-therapy-only group if they underwent observation only, and to the delayed surgery group if they underwent surgery after observation. We abstracted clinical and laboratory findings, surgical interventions, and neurological outcome and measured EDH dimensions and volumes, adjusting for cranial size. We compared clinical and radiographic characteristics among groups and performed receiver-operator characteristic analyses of predictors of delayed surgery. Of 172 patients with EDH, 103 patients met the inclusion criteria, with 6 (6%) in the immediate surgery group, 87 (84%) in the supportive-therapy-only group, and 10 (10%) in the delayed surgery group. Headache, prothrombin time of >14 seconds, EDH maximal thickness of ≥1.1 cm, volume of ≥14 mL, EDH thickness/cranial width index of ≥0.08 and EDH volume/cranial volume index of ≥0.18, and mass effect were associated with delayed surgical intervention. There was no difference in length of stay or functional impairment between the immediate and delayed surgery groups. However, patients in delayed surgery group were more likely to have subjective symptoms at discharge than those in immediate surgery group. Among patients with EDH admitted for observation, larger EDH, mass effect, headaches, and prothrombin time of >14 seconds were associated with delayed surgical intervention. A larger-scale study is warranted to identify independent predictors of delayed surgery in children under observation for EDH.

Emergency Decompressive Craniostomy "Burr Hole" Using an Intraosseous Vascular Access System in a Resource-Limited Setting: A Technical Report on a Cadaver.

This paper describes an alternative approach to emergency burr hole evacuation of epidural hematoma using the intraosseous (IO) vascular access system. The IO vascular access system is commonly available in the Emergency Department. We demonstrate that it can be used in rare situations where immediate neurosurgical intervention and the standard cranial drill and brace are not available for burr hole craniostomy.

Postoperative cerebral infarction after evacuation of traumatic epidural hematoma in children younger than two years: Single-center experience.

Background: Epidural hematoma (EDH) forms about 2–3% of all head injuries in the pediatric population. We evaluated clinical data and risk factors for postoperative infarction in children younger than 2 years presented with traumatic EDH.Methods: We retrospectively reviewed and analyzed the data of 28 children with traumatic EDH operated in our institute during a period of 26 months (from December 2016 to Febuary 2019).Results: Nineteen children were boys (68%) and nine were girls (32%), the mean age was 15 months (range from 5 to 24 months). Postoperative cerebral infarction was detected in seven cases (25%). Factors could be linked to postoperative cerebral: preoperative pediatric Glasgow Coma Scale (P = 0.036), neurological deficit on admission (P = 0.023), size of hematoma (P < 0.001), time between trauma and surgery (P = 0.004), midline shift (MLS) (P = 0.001), and basal cistern compression (P = 0.004).Conclusion: Traumatic EDH in young children represents a neurosurgical challenge that needs rapid surgical intervention for the best surgical outcome. Delay in the time of surgery for more than 6 h, large hematoma volume >100 ml3, MLS >10 mm, and basal cisterns compression will push the intracranial pressure to the point of decompensation and the resultant ischemic sequel occurs.

Octogenarian Survival After Neurosurgical Procedures To Treat Severe Head Trauma

Falls are common for persons of advanced age and can result in severe traumatic brain injury (TBI). The purpose of the present study was to determine the survival benefit from aggressive operative intervention. The trauma quality improvement program database from 2013 to 2016 was accessed for the present study. All patients aged 80-89 years who had sustained a severe TBI with a Glasgow coma scale (GCS) score of ≤8 and brain abbreviated injury scale score of ≥3 and had undergone operative intervention (craniotomy or craniectomy) were included in the present study. The patients were divided into 2 groups, those who had survived and those who had died, and the characteristics, injury severity score (ISS), types of intracranial hemorrhage, and comorbidities were compared. Multivariable logistic regression analysis was performed to determine the factors associated with survival. A receiving operating characteristic curve was created to test the model, and the area under the curve was calculated. Of the 1266 patients who had met the inclusion criteria for the present study, only 477 (37.68%) had survived. A lower ISS, higher GCS score, and no history of coagulopathy were factors indicating a greater chance of survival. Operative intervention for epidural hematoma, brain contusion, and subdural hematoma was associated with 3.5, 2.25, and 1.86 odds of survival, respectively. Procedure type (craniectomy vs. craniotomy) did not affect the outcome. The area under the curve was 0.723 (95% confidence interval, 0.694-0.752). The octogenarians who had undergone craniotomy or craniectomy for severe TBI after a fall had very high mortality. A lower ISS, higher GCS score, no history of coagulopathy and evacuation of subdural hematoma, epidural hematoma, or brain contusion indicated a greater probability of survival.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Surgical Evacuation of Intracerebral Hemorrhage: The Potential Importance of Timing.

Prospective Randomized Evaluation of Decompressive Ipsilateral Craniectomy for Traumatic Acute Epidural Hematoma (PREDICT-AEDH): study protocol for a randomized controlled trial

BackgroundThe expeditious surgical evacuation of acute epidural hematoma (AEDH) is an attainable gold standard and is often expected to have a good clinical outcome for patients with surgical indications. However, controversy exists on the optimal surgical options for AEDH, especially for patients with brain herniation. Neurosurgeons are confronted with the decision to evacuate the hematoma with decompressive craniectomy (DC) or craniotomy.Methods/designPatients of both sexes, age between 18 and 65 years, who presented to the emergency room with a clinical and radiological diagnosis of AEDH with herniation, were assessed against the inclusion and exclusion criteria to be enrolled in the study. Clinical and radiological information, including diagnosis of AEDH, treatment procedures, and follow-up data at 1, 3, and 6 months after injury, was collected from 120 eligible patients in 51 centers. The patients were randomized into groups of DC versus craniotomy in a 1:1 ratio. The primary outcome was the Glasgow Outcome Score-Extended (GOSE) at 6 months post-injury. Secondary outcomes included incidence of postoperative cerebral infarction, incidence of additional craniocerebral surgery, and other evaluation indicators within 6 months post-injury.DiscussionThis study is expected to support neurosurgeons in their decision to evacuate the epidural hematoma with or without a DC, especially in patients with brain herniation, and provide additional evidence to improve the knowledge in clinical practice.Trial registrationClinicalTrials.govNCT 04261673. Registered on 04 February 2020

Location of Traumatic Cranial Epidural Hematoma Correlates with the Source of Hemorrhage: A 12-Year Surgical Review

Epidural hematoma (EDH) can result in a catastrophic outcome of traumatic brain injury. Current management guidelines do not consider the source of hemorrhage in decision making. The purpose of this study was to examine the relationship between EDH location and the source of hemorrhage. We report retrospectively reviewed, prospectively obtained surgical data of patients with acute traumatic cranial EDH treated between 2007 and 2018. Computed tomography (CT) scans were used to categorize EDH location as lateral or medial. The source of hemorrhage was identified intraoperatively by a single surgeon. Overall, of 92 evacuated EDHs (in 87 patients), 71 (77.2%) were in the lateral location. Arterial bleeding was the cause of EDH in 63.4% of the lateral EDHs and 9.2% of the medial EDHs (P < 0.0001). In the cases where surgery was done primarily to treat EDH, 65.3% had an arterial bleed source (P < 0.0001). In those treated for primary reasons other than EDH evacuation, 75% had a venous bleed source (P= 0.002). The location of EDH correlates with the source of hemorrhage. The decision to operate on EDH may be influenced by this factor.

Usefulness of Percutaneous Ultrasonography for Deciding the Need of Surgical Evacuation of Epidural Hematoma After Cervical Double-door Laminoplasty.

This was a retrospective study. The objective of this study was to investigate the diagnostic utility of percutaneous ultrasonography (PUS) for postoperative epidural hematoma (EH) as a postoperative complication. We investigated the usefulness of PUS for determining the need of surgical evacuation of postoperative EH by comparing the postoperative magnetic resonance imaging (MRI) and PUS of the spinal cord. This study included patients who underwent cervical laminoplasty using suture anchors. Regular MRI and PUS were performed 1 week postoperatively. Whenever the patients exhibited neurological deterioration, MRI and PUS were performed. The spinal cord decompression status was classified into 3 grades using MRI and PUS. The existence of spinal pulsation was determined by PUS. One hundred thirty-one patients were investigated. The decompression status by MRI and PUS, and the pulsation status by PUS showed a correlation with neurological deterioration (P<0.001). Four cases showed postoperative neurological deterioration and required revision surgery. The decompression status in these cases was classified as "poor" by both MRI and PUS, and as "no-pulsation" by PUS pulsation. The sensitivity and specificity for neurological deterioration was 100% and 95.1% in MRI decompression, 100% and 92.9% in PUS decompression, and 100% and 99.2% in PUS pulsation, respectively. This is the first report that the disappearance of spinal pulsation was associated with neurological deterioration. PUS was useful in determining the need of surgical evacuation for postoperative EH. PUS should be the first choice of examination in the event of postoperative neurological deterioration following a cervical laminoplasty. When the disappearance of pulsation is confirmed, an additional hematoma evacuation surgery should be considered immediately without undertaking MRI. Level III.

Influence of Decompressive Craniectomy Post Evacuation of Epidural Hematoma in Comatose Patients

Epidural hematoma causing brain herniation is a major cause of mortality and morbidity after severe traumatic brain injury, even if surgical treatment is performed quickly. Decompression may be effective in decreasing intracranial pressure, but its effect on outcomes remains unclear. A retrospective analysis of deeply comatose patients (Glasgow Coma Scale score 3-5) who underwent surgical treatment during a 12-year period, either via osteoplastic craniotomy (OC) or decompressive craniectomy, was carried out. Patient groups were compared on the basis of demographics, admission clinical state, head computed tomography imaging characteristics, and discharge outcome. A total of 60 patients were examined. The first group of 31 patients (52%) needed decompression during primary surgery. The second group of 29 patients (48%) underwent OC with evacuation of epidural hematoma without decompression. Both patient groups were similar according to age (40.9 ± 13 vs. 40.6 ± 12.5 years), Glasgow Coma Scale score before surgery (4 [3-5] vs. 4 [3-5]), hematoma thickness (based on computed tomography) (3.44 ± 1 vs. 3.36 ± 1.62 cm), and midline shift (1.42 ± 0.83 vs. 1.36 ± 0.9 cm). Mortality was more evident in the decompression group (45.2% vs. 13.8%; P= 0.008), and the Glasgow Outcome Score was also lower, 2.26 ± 1.5 versus 3.45 ± 1.5 (P= 0.003). Decompressive craniectomy following the evacuation of an acute epidural hematoma in deeply comatose patients demonstrated inferior outcomes in comparison with OC. Brain injury in the decompressive craniectomy patient group was more severe (concomitant subdural hematoma, early brain ischemia, and early brain herniation), which may have influenced the outcome. Further prospective studies are needed.

Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

AbstractTraumatic brainstem injury can be classified as primary or secondary. Secondary brainstem hemorrhage that evolves from raised intracranial pressure (ICP) and transtentorial herniation is referred to as Duret hemorrhage. We report a 25-year-old male who underwent emergency craniotomy, with evacuation of acute epidural hematoma, and postoperatively developed fatal Duret hemorrhage. Duret hemorrhage after acute epidural hematoma (EDH) evacuation is a very rare complication and the outcome is grave in most of the cases.

Hematological factors predicting mortality in patients with traumatic epidural or subdural hematoma undergoing emergency surgical evacuation: A retrospective cohort study.

Hematological abnormalities at admission are common after traumatic brain injuries and are associated with poor outcomes. The objective of this study was to identify the predictive factors of mortality among patients who underwent emergency surgery for the evacuation of epidural hematoma (EDH) or subdural hematoma (SDH).This was a single-center retrospective cohort study of 200 patients who underwent emergency surgical evacuation of EDH or SDH between September 2010 and December 2018. Data on hematological parameters and clinical and intraoperative features were collected. The primary end-point was 1-year mortality after surgery. Univariate and multivariate analysis were performed, and the receiver operating characteristic (ROC) curves were assessed.Of the 200 patients included in this study, 102 (51%) patients died within 1 year of emergency surgery. Lymphocyte count at admission, creatinine levels, activated partial thromboplastin time (aPTT), age, intraoperative epinephrine use, and Glasgow Coma Scale (GCS) score were significantly associated with mortality in the multivariate analysis. The areas under the ROC curve for the GCS score, aPTT, and lymphocyte counts were 0.677 (95% confidence interval [CI] 0.602–0.753), 0.644 (95% CI 0.567–0.721), and 0.576 (95% CI 0.496–0.656), respectively.Patients with elevated lymphocyte counts on admission showed a higher rate of 1-year mortality following emergency craniectomy for EDH or SDH. In addition, prolonged aPTT and a lower GCS score were also related to poor survival.

Acute spontaneous epidural hematoma of cervical spine presenting as quadriparesis in a young patient: a case report

Introduction: Spontaneous spinal epidural hematoma (SSEH) is a relatively uncommon pathology of the spine. The incidence of SSEH is approximately 0.1 – 1 per 100,000 individuals. SSEH can cause acute spinal cord compression and rapid onset of neurologic deficits. Although rare, SSEH must be considered in the differential diagnosis of patients presenting with sudden onset of neurologic symptoms without a history of trauma.Case presentation: We report a case of a 19-year-old female patient who presented with sudden onset of weakness of all four limbs with pain in the upper cervical region. She has no history of trauma. Magnetic Resonance Imaging (MRI) of the spine was done, which showed an epidural mass in the cervical region, causing severe cord compression. Emergency cervical laminectomy and evacuation of epidural hematoma has was done with excellent post-operative recovery.Conclusion: Spontaneous spinal epidural hematoma is a relatively rare entity of the spine. The signs and symptoms of this rare condition are non-specific. In patients presenting with a sudden onset of neurologic deficits, the condition should be one of the differential diagnoses. MRI is the investigation of choice in patients suspected to have SSEH. Early surgical intervention results in a better outcome. The level of preoperative neurologic deficit, the severity of the condition, and operative interval are important factors affecting the postoperative outcome.Keywords: cervical spine, laminectomy, spontaneous spinal epidural hematoma