Spinal Hematoma Research Articles

Evaluation of Lumbar Sonography as a Learning Aid for Performing Subarachnoid Block Using the Paramedian Approach by Medical Junior Resident Anaesthesiologists: A Randomized Controlled Trial.

Pre-procedural ultrasound can be used to identify the subarachnoid space in difficult spinal procedures. However, multiple punctures can result in numerous complications, including post-dural puncture headache, neural trauma, and spinal and epidural haematoma. Thus, the following hypothesis was proposed: in contrast to the conventional blind paramedian dural puncture, pre-procedural ultrasound results in a successful dural puncture on the first attempt. In this prospective, randomised controlled study, 150 consenting patients were randomly assigned to one of the two groups: ultrasound-guided paramedian (UG) and conventional blind paramedian (PG). In the UG paramedian group, pre-procedural ultrasound was performed to mark the insertion site, whereas, in the PG group, the landmark technique was used. A total of 22 different anaesthesiology residents performed all subarachnoid blocks. The time taken to perform spinal anaesthesia in the UG group was 38-49.5 s, which is shorter than the time taken in the PG group, which was 38-55 s, with a p-value < 0.046, which is statistically significant. The primary outcome of a successful dural puncture on the first attempt was not significantly higher in the UG group (49.33%) than in the PG group (34.67%), with a p-value< 0.068. The number of attempts taken for a successful spinal tap in the UG group was a median of 2.0 (1 to 2), and the PG group had a median of 2 (1 to 2.5), with a p-value <0.096, which is statistically non-significant. Ultrasound guidance showed improvement in the success rate of paramedian anaesthesia. In addition, it improves the success rate of dural puncture and the rate of puncture on the first attempt. It also shortens the time required for a dural puncture. In the general population, the pre-procedural UG paramedian group did not outperform the PG paramedian group.

P88 Subdural spinal haematoma following presumed inadvertent subdural catheter placement during labour

P88 Subdural spinal haematoma following presumed inadvertent subdural catheter placement during labour

Screw fixation without fusion for low lumbar chance fracture accompanied by spinal epidural hematoma in patient with ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease involving the sacroiliac joint and axial spine. AS may render the ankylosed spine prone to trauma and cause an increased frequency of associated epidural hematomas in spine fractures. Herein, we report a rare case of L5 chance fracture and epidural hematoma in a 27-year-old female patient with AS. She was treated surgically but without bone fusion or decompressive laminectomy due to the neurologically intact status despite significant neural compression by the spinal epidural hematoma (SEH). We believe that conservative treatment with close observation of neurological status may be effective in SEH presenting with mild neurological symptoms despite significant neural compression.

Postoperative Spinal Hematoma and Seroma.

Fluid collections after spine surgery are rare complications, although potentially grave, and may be broadly grouped into two major categories. Symptomatic postoperative epidural hematomas have some known risk factors and can present with a widely variable profile of signs and symptoms. Treatment involves emergent surgical evacuation to reduce the risk of permanent neurologic deficit. Postoperative seroma may lead to disruption of wound healing and deep infection and has been associated with the use of recombinant human bone mineral protein. These diagnoses may present diagnostic challenges; thorough understanding of the involved pathophysiology, meticulous clinical evaluation, and radiographic interpretation are critical to appropriate management and optimal outcome.

Spinal Hematoma Visualized with Dual-energy CT-derived Electron Density Overlay Maps.

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologySpinal Hematoma Visualized with Dual-energy CT-derived Electron Density Overlay MapsChristian Nelles, Simon Lennartz Christian Nelles, Simon Lennartz Author AffiliationsInstitute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.Address correspondence to S.L. (email: [email protected]).Christian NellesSimon Lennartz Published Online:Apr 11 2023https://doi.org/10.1148/radiol.222680MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 67-year-old man was admitted to the hospital with spontaneous, sudden-onset, severe thoracic back pain, radiating to the neck and lower back, accompanied by an episode of transient paraplegia of unknown severity, which lasted for 30–45 minutes. Three years prior, he had undergone mechanical aortic valve replacement with resection of an ascending aortic aneurysm associated with a bicuspid aortic valve. Consecutively, he had been treated with phenprocoumon for anticoagulation, with an international normalized ratio value of 4.5 at the time of admission (therapeutic range: 2.0–3.0). As the symptoms raised suspicion for aortic dissection, CT angiography of the chest and abdomen was performed with dual-layer dual-energy CT (dlDECT). dlDECT is a detector-based dual-energy CT technique in which a stacked scintillator registers lower energetic photons in the upper layer, whereas higher energetic photons are detected within the subjacent layer (1). The examination did not show signs of aortic dissection or other acute vascular pathologic conditions. Apart from persistent back pain, the patient’s symptoms receded. He was kept under surveillance for 3 days, after which worsening of the pain and the development of new high-grade paraplegia occurred, prompting an emergency MRI examination of the spine. The MRI scan showed extensive spinal hematoma, ranging from T1 to L1, with the maximum diameter and spinal cord compression at the level of T4-6 but without abnormal signal intensity of the spinal cord (Figure, A). The hematoma could not unequivocally be assigned to either the epi- or subdural space. Additionally, subarachnoid hemorrhage was noted along the cauda equina. The patient underwent successful emergency surgical evacuation of the hematoma, which during surgery showed extension to both the epi- and subdural as well as the subarachnoid space. Because digital subtraction angiography scans showed no vascular cause of the hematoma, spontaneous hemorrhage due to over-anticoagulation was determined as the most likely cause. After surgery, the pain and neurologic symptoms resolved rapidly, and the patient was discharged for subsequent rehabilitation. At retrospective review, different spectral data were reconstructed to determine if any of them might have facilitated earlier diagnosis of spinal hematoma with CT. Besides conventional images, virtual noncontrast and iodine images were also unremarkable. However, electron density overlay maps (Figure, B) clearly depicted the hematoma. The increased content of hemoglobin within the hematoma results in a higher material density at this location with a lesser effect on the average atomic number. There is only one study that showed that electron density maps may improve detection of prevertebral hematoma (2), which is in line with the finding in the case presented here. However, the application for detecting intraspinal hematoma has not been described yet. This might be a promising topic for systematic scientific evaluation, as electron density maps could improve CT-based detection of spinal hematoma in the emergency setting, potentially decreasing morbidity by enabling earlier treatment.(A) MRI scans of the spine in a 67-year-old man. Sagittal T2-weighted (top left) and T1-weighted (top right) images and axial contrast-enhanced, fat-saturated, T1-weighted image (bottom) show extensive spinal hematoma (arrows). The maximum diameter is located at the level of thoracic vertebrae T4-6 with effacement of the perimedullary cerebrospinal fluid and spinal cord compression. (B) Dual-layer dual-energy CT reconstructions show the corresponding CT angiography scans of the chest. Electron density overlay images (left) clearly depict the hematoma (green; arrows) that is protruding in the spinal canal. Conventional images (right) in the sagittal and axial plane. The hematoma is almost entirely imperceivable (arrows).Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: C.N. No relevant relationships. S.L. Senior deputy editor for Radiology In Training; member of the Radiology editorial board.

Idiopathic spinal epidural hematoma in an infant: A case report with peculiar manifestation

Idiopathic spinal epidural hematoma (SEH) might be an extremely rare cause of spine compression. It is most common between the fourth and fifth decades of life. It is sporadic in children and is often complicated due to the limitations of a neurologic examination and nonspecific symptoms within the pediatric population. It is typically an isolated event. Only a few cases of relapsing paraparesis due to idiopathic SEH have been mentioned in the literature in adults. We are presenting a rare case of idiopathic SEH in a 1-year-old girl whose diagnosis was deferred after a recent similar history of paraparesis occurred after her scheduled immunization and went on for around 2 weeks, after which the patient recovered completely. However, 2 months later, the patient presented again with paraparesis, and the magnetic resonance imaging revealed an idiopathic SEH. We are detailing this case to raise the plausibility of a remission and relapse phenomenon within the idiopathic SEH presentation that may mimic some neurological disorders of infancy and childhood. The present case was managed surgically and yielded full recovery.

Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia

Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia

Expansion of a Spinal Epidural Hematoma During Imaging

This case documents the rapid development of a spontaneous spinal epidural hematoma captured during an MR imaging examination.

Paradoxical contralateral hemiparesis in spontaneous spinal epidural hematoma: a case report

BackgroundHemiparesis associated with spontaneous spinal epidural hematoma (SSEH) usually occurs ipsilateral to the hematoma. We here report the case of a patient with paradoxical hemiparesis contralateral to a spinal lesion due to SSEH.Case presentationA 70-year-old woman was identified in routine clinical practice; she presented with acute-onset neck pain and left hemiparesis. Neurological examination showed left-sided sensory-motor hemiparesis without facial involvement. Cervical MRI showed a dorsolateral epidural hematoma compressing the spinal cord at the C2 to C3 level. Axial imaging demonstrated a crescent hematoma on the right side, which is contralateral to the hemiparesis, and lateral displacement of the spinal cord. Spinal angiography revealed no abnormal vessels. Based on clinical presentation and MRI findings, a diagnosis of SSEH was made. The patient was managed conservatively. The symptoms completely resolved without any neurological deficits, and the hematoma disappeared on the follow-up MRI.ConclusionsParadoxical contralateral hemiparesis is one of the possible presenting symptoms in patients with SSEH. This case demonstrates the existence of the paradoxical contralateral hemiparesis associated with spinal compressive lesions. A plausible mechanism of the phenomenon is discussed.

Effect of Complex Korean Medical Treatment on Spinal Epidural Hematoma: A Case Report

Effect of Complex Korean Medical Treatment on Spinal Epidural Hematoma: A Case Report

Safety of lumbar puncture for people who are treated with ADP receptor antagonists.

Current guidelines state that clopidogrel and other adenosine-diphosphate receptor antagonists (ADPra) should be stopped for at least 7days before lumbar puncture (LP). This practice may delay the diagnosis of treatable neurological emergencies and may increase the risk of cardiovascular morbidity due to withholding antiplatelets. We aimed to summarize all cases under our care, in which LP was performed without discontinued ADPra. A retrospective case series study of all patients who underwent LP without interruption of ADPRa or with treatment interruption that was shorter than 7days. Medical records were searched for documented complications. Traumatic tap was defined as cerebrospinal fluid red cell count ≥ 1000 cell/μL. Incidence of traumatic tap among people who underwent LP under ADPRa was compared to traumatic tap incidence in two control groups: LP under aspirin and LP without any anti-platelet. 159 patients underwent LP under ADPRa [Age: 68.4 ± 12.1, Female: 63 (40%), 81 (51%) were treated with both aspirin and ADPRa]. 116 procedures were carried out without any interruption of ADPRa. In the other 43, the median delay between treatment interruption and the procedure was 2days (range: 1-6days). Incidence of traumatic tap was 8/159 (5%), 9/159 (5.7%) and 4/160 (2.5%) among those who underwent LP under ADPRa, under aspirin and without any anti-platelet, respectively. [X2(2) = 2.13, P = 0.35)]. No patient developed spinal hematoma or any neurological deficit. Lumbar puncture without discontinuation of ADP receptor antagonists seems safe. Similar case series may ultimately lead to guidelines change.

Analysis of the efficacy and safety of CT-guided dorsal root ganglion pulsed radiofrequency combined with ozone injection in the treatment of acute herpes zoster neuralgia in the neck and upper extremities

Objective: To investigate the efficacy and safety of pulsed radiofrequency of dorsal root ganglion combined with ozone injection on acute herpes zoster neuralgia in the neck and upper extremities. Methods: A total of 110 patients with acute phase herpes zoster neuralgia in the neck and upper extremities treated in the Department of Pain of Jiaxing First Hospital from January 2019 to February 2020 were retrospectively included. The patients were divided into two groups according to different treatment modalities: the pulsed radiofrequency group (group A, n=68) and the pulsed radiofrequency combined with ozone injection group (group B, n=42). In group A, there were 40 males and 28 females, aged (71.9±9.9) years, while group B consisted of 23 males and 19 females, aged (66.3±16.9) years. Patients were followed up, and numerical rating scale (NRS) score, dose of adjuvant gabapentin, incidence of clinically significant postherpetic neuralgia (PHN) and adverse effects were recorded preoperatively (T0) and at 1 d (T1), 3 d (T2), 1 week (T3), 1 month (T4), 2 months (T5), and 3 months (T6) postoperatively. Results: The NRS score of patients [M (Q1, Q3)] in group A at time points T0, T1, T2, T3, T4, T5 and T6 was 6 (6, 6), 2 (2, 2), 3 (3, 4), 3 (2, 3), 2 (2, 3), 2 (1, 3) , 1 (0, 2), respectively, while the NRS score at aforementioned time points in group B was 6 (6, 6), 2 (1, 2), 3 (3, 4), 3 (2, 3), 2 (2, 3), 2 (1, 3), 1 (0, 2), respectively. Compared with preoperative NRS scores, NRS scores decreased in both groups at all postoperative time points (all P<0.05). Compared with group A, the NRS scores of group B at time points T3, T4, T5, and T6 decreased more significantly, with statistically significant differences (all P<0.05). The dose of gabapentin in group A [M (Q1, Q3)] was 0.6 (0.6, 0.6), 0.3 (0.3, 0.6), 0.3 (0.0, 0.3) and 0.0 (0.0, 0.3) mg/d at time points T0, T4, T5, and T6, respectively, and 0.6 (0.6, 0.6), 0.3 (0.2, 0.3), 0.0 (0.0, 0.3) 0.0 (0.0, 0.0) mg/d in patients in group B, respectively. Compared with the preoperative period, the doses of gabapentin taken by patients in both groups reduced significantly at all postoperative time points (all P<0.05). Moreover, compared with group A, the gabapentin dose in group B decreased more significantly at time points T4, T5, and T6, with statistically significant differences (all P<0.05). The incidence of clinically significant PHN was 25.0% (17/68) and 7.1% (3/42) in groups A and B, respectively, and the differences were statistically significant (P=0.018). No serious adverse effects such as pneumothorax, spinal cord injury and hematoma were observed during the treatment period in both groups. Conclusion: Pulsed radiofrequency of dorsal root ganglion combined with ozone injection is safer and more effective for the treatment of acute phase herpes zoster neuralgia in the neck and upper extremities, and it can reduce the incidence of clinically significant PHN, with high safety profile.

Stroke-like manifestation of a spontaneous spinal epidural hematoma with spontaneous resolution: a case report

BackgroundThis case report presents the case of a man with no known coagulopathy or preceding trauma, who spontaneously developed a spinal epidural hematoma (SEH). This is an uncommon condition which can have variable presentations including hemiparesis mimicking stroke, resulting in the potential for misdiagnosis and inappropriate treatment.Case presentationA 28-year-old Chinese male with no past medical history presented with sudden onset neck pain associated with bilateral upper limbs and right lower limb subjective numbness but intact motor function. He was discharged after adequate pain relief but re-attended the emergency department with right hemiparesis. A magnetic resonance imaging of his spine revealed an acute cervical spinal epidural hematoma at C5 and C6. While admitted, he had spontaneous improvement of his neurological function and was eventually managed conservatively.ConclusionsSEH, although uncommon, can be a mimic of stroke and it is important to avoid misdiagnosis as it is a time critical diagnosis, and administration of thrombolysis or antiplatelets can lead to unfavourable outcomes. Having a high clinical suspicion can help to guide us in the choice of imaging and interpretation of subtle signs to reach the correct diagnosis in a timely manner. Further research is required to better understand the factors that would favour a conservative approach as opposed to surgical treatment.

Lesión medular asociada a hematoma epidural espinal espontáneo

IntroductionSpontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. Material and methodsIn order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). ResultsCases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. ConclusionSSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

Post-COVID-19 Thoracic Aortic Rupture with an Unforeseen Spinal Epidural Hematoma

The importance of prompt diagnosis and early stenting of an aortic rupture cannot be overemphasized. We present a case of thoracic aortic rupture in a middle-aged gentleman who had recently suffered coronavirus disease 2019. The case was further complicated by the development of an unexpected spinal epidural hematoma.

Ultraearly Hematoma Evacuation (

Early decompressive surgery within 24 hours improves the functional outcome of patients with traumatic spinal cord injury; however, little is known about the effect of early surgery for spontaneous spinal epidural hematoma (SSEH). In this study, we aimed to investigate the effectiveness of ultraearly hematoma evacuation (<12 hours) for SSEH. Patients with SSEH treated with surgical hematoma evacuation at our institution between January 2000 and July 2021 were retrospectively analyzed. Neurologic function was evaluated using the American Spinal Injury Association Impairment Scale (AIS). AIS grades A-C were defined as severe, and grades D and E as mild. AIS grades D and E at the final follow-up were considered favorable outcomes. Preoperative status and postoperative treatment results were compared between patients who had hematoma evacuation within 12 hours of onset and those who underwent surgery after 12 hours. Twenty-five consecutive patients were included in the analysis. Preoperatively, 23 patients (92.0%) had severe AIS. Fourteen (56.0%) patients underwent early surgery. At the final follow-up, 21 patients (84.0%) achieved favorable outcomes. Patients treated with ultraearly surgery had significantly better outcomes (100% vs. 63.6%, P= 0.03). Additionally, the time from onset to surgery was significantly shorter in patients with AIS improvement by 2 or more grades than that in patients with AIS improvement of 1 or less (median 8 hours vs. 14 hours, P= 0.0001). Ultraearly surgery within 12 hours for SSEH was associated with better functional outcomes.

How should we measure platelet count before central neuraxial blockade in parturients with thrombocytopenia?

Patients with low platelet counts are a concern to the obstetric anaesthetist as, although rare, there is a risk of a spinal epidural haematoma following central neuraxial blockade. Although conventional plasma-based tests are frequently used to guide central neuraxial blockade in patients with thrombocytopenia, interest in the use of viscoelastic haemostatic assays is increasing.

Thoracic spine extradural hematoma secondary to thrombotic thrombocytopenic purpura: A case report

Thrombotic thrombocytopenic purpura is a rare but a fatal disease with a life-threatening thrombotic microangiopathy. We report a case of 35-year-old male, admitted with abdominal pain and fever, growing into progressive crural spastic paraparesis level II, and urinary retention. On investigations, thoracic MRI showed an extradural hematoma in thoracic spine between T11 and L1 and spinal compression. After 5 days of treatment with glucocorticoids, clinical picture got better. In this condition, we decided to have non-surgical intervention. The literature says that the true correlation between severe thrombocytopenia and spine epidural hematoma formation is unknown due to limited data.

Conservative management for spontaneous lumbar facet joint hemarthrosis in severe hemophilia a: A rare case report

Spontaneous lumbar facet joint bleeding is rarely observed in patients with hemophilia. Since it is categorized as a spinal epidural hematoma, surgery is the main treatment. Conservative treatment was successful in patients with minor or absent neurological deficits. We aimed to present the case of a patient with severe hemophilia who suffered from acute sciatica caused by lumbar facet joint hematoma. Nonsurgical treatment using a multidimensional approach was provided. The hemarthrosis is completely resolved. The patient recovered from clinical neurological symptoms without recurrence throughout the 4-year follow-up period. Spontaneous lumbar facet joint hemarthrosis in patients with severe hemophilia who present with mild neurological symptoms can be conservatively treated if the hemarthrosis is recognized early. Moreover, a multidisciplinary team approach is paramount in achieving good patient outcomes.

The Influence of Systolic Blood Pressure at the Time of Extubation on the Development of Postoperative Spinal Epidural Hematoma.

The most common cause of neurological complications after a biportal endoscopic spine surgery (BESS) is postoperative spinal epidural hematomas (POSEH). The objective of this study was to determine the influence of systolic blood pressure at extubation (e-SBP) on POSEH. A total of 352 patients who underwent single-level decompression surgery including laminectomy and/or discectomy with BESS under the diagnosis of spinal stenosis and herniated nucleus pulposus between August 1, 2018, and June 30, 2021, were reviewed retrospectively. The patients were divided into two, a POSEH group and a normal group without POSEH (no neurological complication). The e-SBP, demographic factors, and the preoperative and intraoperative factors suspected to influence the POSEH were analyzed. The e-SBP was converted to a categorical variable by the threshold level that was decided by maximum area under the curve (AUC) in receiver operating characteristic (ROC) curve analysis. Antiplatelet drugs (APDs) were taken in 21 patients (6.0%), discontinued in 24 patients (6.8%), and not taken in 307 patients (87.2%). Tranexamic acid (TXA) was used in 292 patients (83.0%) in the perioperative period. Of the 352 patients, 18 patients (5.1%) underwent revision surgery for the removal of POSEH. The POSEH and normal groups were homogenous in age, sex, diagnosis, operation segments, operation time, and lab findings that were related to blood clotting, whereas there were differences in e-SBP (163.7 ± 15.7 mmHg in POSEH group and 154.1 ± 18.3 mmHg in normal group), APD (4 takers, 2 stoppers, 12 non-takers in POSEH group and 16 takers, 22 stoppers, 296 non-takers in normal group), and TXA (12 use, 6 not use in POSEH group and 280 use, 54 not use in normal group) in single variable analysis. The highest AUC in the ROC curve analysis was 0.652 for 170 mmHg e-SBP (p < 0.05). There were 94 patients in the high e-SBP group (≥ 170 mmHg) and 258 patients in the low e-SBP group. In multivariable logistic regression analysis, only high e-SBP was a significant risk factor for POSEH (p = 0.013; odds ratio, 3.434). High e-SBP (≥ 170 mmHg) can influence the development of POSEH in biportal endoscopic spine surgery.