Spontaneous Cervical Epidural Hematoma Research Articles

Spinal Cord Compression Secondary to a Spontaneous Cervical Epidural Haematoma.

We report the case of an 86-year-old female patient with chronic neck pain who presented with an initial misleading clinical picture suggesting an ischaemic stroke. No recent or previous anticoagulation treatment or fall history was reported. The patient developed a paraplegia of the upper limbs needing magnetic resonance imaging which revealed a compressive cervical haematoma. The patient benefitted from cervical laminectomy and evacuation of the cervical haematoma. Motricity in upper extremities was recovered but paresis in the lower extremities persisted 1 week after surgical intervention.LEARNING POINTSInsidious spontaneous cervical haematoma can mimic ischaemic stroke.Early recognition and treatment of cervical haematoma can improve prognosis.

Spinal Cord Compression Secondary to a Spontaneous Cervical Epidural Haematoma

Spinal Cord Compression Secondary to a Spontaneous Cervical Epidural Haematoma

Spontaneous cervical spinal epidural haematoma in a recent drug-eluting coronary stent recipient - A therapeutic challenge.

Spontaneous cervical spinal epidural haematoma in a recent drug-eluting coronary stent recipient - A therapeutic challenge.

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Spontaneous spinal epidural hematomas are rare and potentially disabling neurological emergencies. Its lead to devastating neurologic outcomes and most patient does not recover completely. The clinical presentation is diverse and includes a severe acute attack, radiating pain at the back, interscapular, or neurological deficits. We report a case of a young woman, 24-year-old, that was admitted to our department for sudden non-traumatic cervical spinal cord compression syndrome (Type A of the American Spinal Cord Injury Association “ASIA A”) including intense cervical back pain, sensory loss, and tetraplegia. Her past medical history was unremarkable. The MRI confirmed a cervical mass responsible for the spinal cord compression and the emergent surgical intervention allow us to evacuate acute C3-C7 hematoma. The patient never recovers from the neurologic deficit despite the emergent management of her case followed by functional musculoskeletal rehabilitation for two years.

Cervical Spinal Epidural Hematoma

A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out stroke, which did not detect any abnormalities. Subsequently, a neck CT scan was performed, which revealed a mild high-density structure compressing the dural sac within the cervical spinal canal. She was suspected to have a spinal hematoma. A MRI scan revealed a spindle-shaped structure with a heterogeneous high signal on T2-weighted and a mild high signal on T1-weighted sagittal images, which led to the diagnosis of a spontaneous spinal epidural hematoma. The patient was treated with conservative therapy upon which her symptoms improved. She was discharged seven days after admission. Spontaneous cervical spinal epidural hematoma often causes neck pain followed by unilateral spinal cord compression symptoms(such as hemiparesis and paresthesia)and can be misdiagnosed as a stroke. In cases of hemiparesis with sudden-onset neck pain, cervical lesions should be considered in the differential diagnoses in addition to stroke.

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

600: Spontaneous Cervical Epidural Hematoma as Presenting Symptom for Hemophilia B in a Pediatric Patient

600: Spontaneous Cervical Epidural Hematoma as Presenting Symptom for Hemophilia B in a Pediatric Patient

AN UNFORESEEN CATASTROPHIC CONSEQUENCE OF ENOXAPARIN: A RARE CASE OF ACUTE QUADRIPLEGIA AND APHASIA SECONDARY TO SPINAL EPIDURAL HEMATOMA

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Spontaneous spinal epidural hematomas (SSEH) are a rare but catastrophic consequence of anticoagulation that causes an acute onset of neurological deficits. Here we present the first case of a patient presenting with quadriplegia and aphasia due to SSEH. CASE PRESENTATION: A 60 year-old African-American woman with a history significant for hypertension and prior DVT was admitted after a syncopal event. On presentation, she was found to be in respiratory distress with hypotension due to massive pulmonary embolism accompanied by lower extremity DVT. She required tissue plasminogen activator (tPA) administration followed by therapeutic anticoagulation with enoxaparin. On day 3 of hospitalization she acutely developed quadriparesis and aphasia. An MRI of the cervical spine showed fluid in the posterior paraspinal musculature from the midline skull base to C5 and in the right posterior paraspinal musculature from C7 into the upper thoracic spine with moderate cord compression. These findings were consistent with a spontaneous spinal epidural hematoma. The patient underwent urgent temporary IVC filter placement. Anticoagulation was reversed with protamine sulfate and the patient was taken to the OR for hematoma evacuation and cervical spine decompression. Post-intervention, the patient had a full neurological recovery, and was discharged without complications on post operative day 7. DISCUSSION: SSEH is a rare entity that if not diagnosed and treated promptly can lead to detrimental outcomes including death. It is characterized by an accumulation of blood in the vertebral epidural space that compresses the spinal cord or spinal nerve roots. It is typically attributed to coagulopathies and arteriovenous malformations. Standard therapy is decompressive laminectomy, with only 50% of patients exhibiting full neurological recovery. To our knowledge, this is the first case of a patient presenting with quadriplegia and aphasia due to a spontaneous cervical spine epidural hematoma from anticoagulation. The added complexity of this patient, in which she also had a lower extremity DVT that required IVC filter placement and reversal of her anticoagulation for surgical decompression, adds to the distinctiveness of this case. CONCLUSIONS: Due to the broad nature of clinical presentation of SSEH, ranging from severe neck pain to aphasia and quadriplegia, it is of utmost importance for clinicians to quickly diagnose and treat this devastating condition. After identification, resources and care teams must rapidly be mobilized in order for evacuation and decompression. In patients who experience this rare disorder due to therapeutic anticoagulation with enoxaparin and who have a deep venous thrombosis, rapid placement of IVC filter followed by protamine reversal and emergent laminectomy and decompression within 12 hours of symptom onset can potentially allow full recovery of neurological deficits. Reference #1: Spinal epidural hematoma. J Am Acad Orhop Surg. 2010 Aug; 18(8):494-502. Reference #2: Spontaneous Spinal Epidural Hematoma in a Patient on Rivaroxaban: Case Report and Literature Review. J Emerg Med. 2017 Oct;53(4):536-539. Reference #3: Spontaneous spinal epidural hematoma: the importance of preoperative neurological status and rapid intervention. J Clin Neurosci. 2015; 22(1) 123 DISCLOSURES: No relevant relationships by Shahrzad Abdollahi, source=Admin input No relevant relationships by Hadiatou Barry, source=Web Response no disclosure on file for Jennifer Frabizzio; No relevant relationships by Rajesh Patel, source=Web Response No relevant relationships by Andrew Tran, source=Web Response

A Case Report: The Challenging Diagnosis of Spontaneous Cervical Epidural Hematoma.

IntroductionWe present the case of a patient with a spontaneous cervical epidural hematoma that presented with neck pain and mild, left arm parasthesia.Case ReportA 59-year old man presented with sudden onset of severe neck pain, without history of injury or trauma. The patient also complained of associated left arm parasthesias that progressed to left arm and leg weakness while in the emergency department. Multiple diagnoses were considered and worked up; eventually the correct diagnosis was made with magnetic resonance imaging of the cervical spine.ConclusionSpontaneous cervical epidural hematoma typically presents with neck pain, and variable neurologic complaints. This case illustrates the challenge in making this uncommon but serious diagnosis.

A case of spontaneous cervical epidural hematoma causing Brown-Séquard syndrome

A case of spontaneous cervical epidural hematoma causing Brown-Séquard syndrome

Spontaneous cervical epidural haematoma—diagnosis as unexpected finding by CT: case series

Spontaneous cervical epidural haematoma (SCEH) is a rare emergency condition which may mimic more common acute neurological, vascular and spinal disorders.

A Mysterious Case of Spontaneous Cervical Epidural Hematoma and Bilateral Primary Spontaneous Pneumothorax caused by a Rare Etiology.

ABSTRACTSpontaneous spinal epidural hematoma (SSEH) is a rare disorder that can present as an acute onset of pain and radicular symptoms that mimic disk herniation. Primary spontaneous pneumothorax (PSP) can be defined as presence of air in the pleural space without apparent underlying lung disease or trauma. We describe a rare case of SSEH in cervical spine (C5–7) presenting with a novel association, a bilateral PSP, which has never been documented before. Both SSEH and spontaneous pneumothorax, though rare, can be associated with vasculopathy and our patient had signs of vasculopathy of intracranial vessels and pulmonary vasculature. Vasculopathy also needs to be considered while evaluating a case of PSP without emphysema-like changes (ELCs) and if diagnosed as the cause, pleurodesis could be considered as a part of the management to avoid the sequel of recurrent pneumothorax and prolonged ICU stay in this subset of patients.How to cite this article Thakkar K, Ajayan N, et al. A Mysterious Case of Spontaneous Cervical Epidural Hematoma and Bilateral Primary Spontaneous Pneumothorax caused by a Rare Etiology. Indian J Crit Care Med 2019;23(4):186–187.

Spontaneous cervical spinal epidural haematoma in late pregnancy

SummarySpontaneous spinal epidural haematoma (SSEH) is rare, especially in pregnancy, and may lead to permanent neurological damage. Presentation varies from altered sensation to paralysis depending on the location and severity of the haematoma. A multi‐disciplinary approach is essential for effective management of such cases. A 39‐week primigravida presented to a district general hospital with an acute cervical neurological deficit. She was transferred to a specialist centre for urgent magnetic resonance imaging followed by sequential caesarean section and cervical epidural haematoma evacuation. The combined procedures were uneventful with a healthy baby delivered and recovering maternal neurology. Co‐ordinating multiple specialties from geographically separate sites created a number of peri‐operative challenges.

Spontaneous Epidural Hematoma of Cervical Spine.

Spontaneous cervical epidural hematoma is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not recognized early can have catastrophic consequences. Acute cervical epidural hematoma is definitely a condition of neurologic emergency. Although it is a rare condition, it must be considered in nontraumatic patients with sudden onset of neurologic deficits. Patients with spontaneous spinal epidural hematoma typically present with acute onset of severe back pain, and they rapidly develop signs of compression of the spinal cord or cauda equina. Here, we present a case of a 31-year-old man who presented with acute onset of neck pain with radicular component with progressive neurologic deficit. Emergent magnetic resonance imaging revealed cervical extradural hematoma with cord compression that was promptly evacuated. Functional recovery was achieved within 48 hours. The level of preoperative neurologic deficit and its severity, as well as operative interval, are important factors significantly affecting the postoperative outcome.

Spontaneous cervical epidural hematoma with stroke manifestations

Spontaneous cervical epidural hematoma with stroke manifestations

Two cases of spontaneous cervical epidural hematoma

Two cases of spontaneous cervical epidural hematoma

Anesthetic management of spontaneous cervical epidural hematoma during pregnancy: a case report

BackgroundSpontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression. Anesthetic management should also include measures to maintain the mean arterial pressure to improve spinal cord perfusion. Furthermore, spine surgery in pregnant patients needs special consideration in terms of positioning and in the postoperative period.Case presentationWe present a case of a 35-year-old white woman at 21 weeks of gestation with a spontaneous cervical epidural hematoma. Fiberoptic bronchoscope-guided nasal intubation was a safe option to ensure a higher rate of successful endotracheal intubation while minimizing the risk of aggravating the injury. Her care posed other multiples challenges that required a multidisciplinary team approach.ConclusionsThe case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia.

Spontaneous Cervical Epidural Hematoma during Pregnancy

Spontaneous spinal epidural hematoma (SSEH) is rare in pregnancy and only few cases have been reported in literature. Herein, author presents a case of a 26-year-old female with 17 weeks of gestation who developed progressive descending quadriparesis (tetraparesis) and numbness below the level of C4. Magnetic resonance imaging (MRI) of the cervical spine demonstrated an epidural hematoma extending from C3 to C7 vertebrae. Posterior decompressive laminectomy was performed with removal of the epidural hematoma. The patient's neurological function subsequently improved. The diagnosis and management of spontaneous epidural hematoma in pregnancy is presented with a review of literature. Rege S, Gupta R, Patil H, Narayan S, Tadghare J. Spontaneous Cervical Epidural Hematoma during Pregnancy. J Spinal Surg 2016;3(4):154-156.

Spontaneous cervical epidural hematoma with incomplete Brown-Sequard Syndrome

Cervical epidural hematoma, without a traumatic etiology, is a rare clinical entity. In the neurosurgical literature it is called spontaneous cervical epidural hematoma (SCEH) and, both the venous and arterial theories provide plausible explanations for its occurrence. The potential causes include coagulopathies, hypertension, vascular malformations and conditions that increase venous pressure such as sneezing, coughing or vomiting (25). The clinical presentation is usually characterized by acute radicular pain followed by progressive paralysis and sensory loss of symmetric nature. The Brown-Sequard syndrome is an exceptional result of SCEH (7, 16, 28). Surgical evacuation of the hematoma is the standard therapy, although conservatively treated SCEH cases have been reported (9). We presented a case of a cervical spontaneous epidural hematoma presenting with an incomplete Brown-Sequard syndrome and treated by surgical evacuation. Case report