Spontaneous Epidural Hematoma Research Articles

Spontaneous Spinal Subdural Hematoma: A Case Report

Spinal epidural hematomas (SEH) are a rare form of hematoma affecting the nervous axis. Spontaneous epidural hematomas are defined as the presence of blood in the epidural space without any known cause. They may be associated with coagulopathies or arteriovenous malformations. HSSE can lead to disabling neurological deficits. Imaging and rapid intervention should be initiated as soon as a patient presents with symptoms suggestive of HGSS. We report the case of a 36-year-old patient who presented with SEH in a setting of acute spinal cord compression.

Two case reports of Glanzmann thrombocytopenia with intracranial hemorrhage and a review of the literature

Background: Glanzmann’s thrombasthenia (GT) is a rare autosomal recessive disorder characterized by impaired platelet function. Symptoms range from mild to life-threatening bleeding. However, it is extremely rare for a patient to have intracranial bleeding. This study presents two cases of GT: one with a spontaneous epidural hematoma (EDH) and the other with a subarachnoid hemorrhage due to traumatic causes. The discussion that follows then derives relevant supporting insights through a review of the literature. Case Description: Case Report 1: A 9-year-old girl with a known case of GT presented to an emergency department with a severe headache but no other complaints or history of trauma. The physical examination was normal. Computed tomography (CT) head without contrast revealed multiple EDHs with no midline shift. She received factor VII, tranexamic acid, and platelets transfusion and was admitted to the intensive care unit to be managed conservatively. After a month, a CT head follow-up showed complete resolution of all hematomas. Case Report 2: A 20-year-old male with a known case of GT was brought to the hospital with a history of loss of consciousness for several minutes after a road traffic accident. He suffered from a headache on regaining consciousness and received analgesia. CT head showed diffuse subarachnoid hemorrhage. He was managed with factor VII, tranexamic acid, and platelets transfusion and was admitted to an intermediate care unit for close observation. Conclusion: In a GT patient with intracranial hemorrhage, conservative management with close clinical observation and platelet transfusion in combination with recombinant activated factor VII and/or antifibrinolytics can be safely conducted.

Spontaneous Epidural Hematoma: A rare neurological complication in a patient following routine coronary angiography

Spinal epidural hematoma is an uncommon but potentially devastating complication associated with various medical interventions. We present a case report of this rare neurological complication following a routine coronary angiography. A 69-year-old male with Aortic Stenosis presented for a scheduled coronary angiography to assess his cardiac status before valve replacement. The procedure was uneventful but approximately 15 minutes after the angiography, he developed sudden-onset of rapidly progressing weakness and numbness in bilateral lower extremities. An urgent neurologic evaluation revealed signs of spinal cord compression, prompting a magnetic resonance imaging (MRI) scan which showed an extensive spinal epidural hematoma spanning multiple levels within the cervicothoracic spine. This case highlights the importance of recognizing this rare but a potential complication following routine coronary angiography even in the absence of signifcant procedural complications. Timely diagnosis and prompt surgical intervention are crucial for achieving favorable outcomes and minimizing morbidity associated with this condition.

Widespread spontaneous spinal epidural hematoma treated with a combined technique using a flexible neuroendoscope after hemilaminectomy: A case report

Background: One-third of spinal epidural hematomas occur spontaneously, and these may be associated with the acute onset of severe paralysis. Here, we present a case of T4-L4 symptomatic spontaneous spinal epidural hematoma which was successfully removed using a flexible neuroendoscope after hemilaminectomy. Case Description: Using flexible neuroendoscopy, we successfully treated a T4-L4 spinal epidural hematoma in an 89-year-old Japanese female who spontaneously developed back pain and paraparesis. The hematoma was removed utilizing a hemilaminectomy at three vertebral levels (T11, T12, and L1), while the remaining hematoma debris was completely evacuated with flexible neuroendoscopy. Neurological improvement was observed immediately postsurgery. Conclusion: Flexible neuroendoscopy provided a less extensive surgical method for removing a T4-L4 spontaneous epidural hematoma.

Spontaneous bilateral epidural hematomas caused by chronic sinusitis: illustrative case.

Spontaneous bilateral epidural hematomas (EDHs) are rare. The aim of this study was to report a 21-year-old male with spontaneous bilateral EDHs to discuss the pathogenesis of spontaneous bilateral EDHs caused by chronic sinusitis. A 21-year-old male with no history of head trauma was admitted to the hospital for headache and unconsciousness. The patient had bilateral nasal bleeding on the day before admission and had chronic sinusitis since childhood. The head computed tomography examination after admission showed bilateral EDHs and bilateral sinusitis, the head magnetic resonance imaging showed chronic sinusitis, and the endoscopic examination during surgery further confirmed that the patient had severe sinusitis with erosion of the bilateral nasal mucosae. The patient underwent emergent surgical treatment. The cerebral vascular malformation, autoimmune diseases, low intracranial pressure, blood system diseases (such as sickle cell disease), abnormal blood coagulation, and skull or meningeal lesions were all excluded after operation. Chronic sinusitis may lead to EDHs through causing vascular degeneration, and abruption of the dura mater and skull. For young patients with spontaneous EDHs, neurosurgeons should carefully ask patients whether they have a history of chronic sinusitis to exclude the possibility of bleeding caused by chronic sinusitis.

Spontaneous epidural and subdural hematomas of the spine: Review of anatomy and imaging findings.

Spontaneous epidural (SEH) and subdural hematomas (SSH) of the spine are a rare cause of spinal injury and morbidity. They often present in the emergency setting, though magnetic resonance imaging is the gold-standard for diagnosis. Knowledge of anatomy, and in particular of the dural layers of the spine, is crucial to understand the location of SEH and SSH and their relationship with spinal structure. In this pictorial review, we aim to explain imaging features of the SEH and SSH, and to rule out their main differential diagnosis.

Dissecting a radiculomedullary artery as an infrequent cause of low back pain: illustrative case.

There is currently no case described in the literature of epidural hematoma associated with subarachnoid hemorrhage due to dissection of a spontaneous radiculomedullary artery at the lumbar level and therefore its incidence and prevalence are not known. However, its etiology is thought to be similar and may not be diagnosed given its nonspecific symptomatology. The authors present the case of an adult patient who consulted the emergency department for 2 weeks of low back pain. On physical examination there were negative signs of radiculopathy without neurological focalization. The patient was evaluated by neurosurgery via thoracic and lumbosacral spine magnetic resonance imaging, with findings of epidural hematoma associated with subarachnoid hemorrhage in the lumbosacral region. After that, panangiography was done. In the study, it was possible to visualize a dissection of the radicular artery at the L2 level. The patient was not a candidate for surgical management and continued with medical pain management. The patient has a good clinical evolution and was discharged. The aim of the present case is to describe a unique case of radiculomedullary artery dissection as a cause of spontaneous epidural hematoma associated with a subarachnoid hemorrhage in the lumbar region.

Spontaneous Epidural Haematoma in Sickle Cell Anaemia: case report and literature review

Spontaneous Epidural Haematoma in Sickle Cell Anaemia: case report and literature review

Nontraumatic Intracranial Epidural Hematoma: Systematic Review of the Literature

Abstract Introduction Epidural hematoma (EDH) is generally a direct sequela of head injury. Spontaneous EDH is rarely described in the literature. Spontaneous EDH can be caused by infections of adjacent regions, vascular malformations of the dura mater, metastases to the bone skull, and disorders of blood coagulation. The preferred treatment is surgical. The prognosis is directly related to the size, location, and Glasgow Coma Scale score on admission and the underlying disease. Methods A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed the search in the PubMed/MEDLINE, Embase, and Scopus databases. Abstracts and articles were screened according to our inclusion and exclusion criteria. Results The literature review yielded 1,156 records from the databases, of which a total of 164 full-text articles were included in the final synthesis, plus 22 additional relevant studies. A total of 89 case report studies were included, providing 95 unique patients. There was a predominance of coagulopathies as the main etiology of spontaneous EDH. A total of 45.3% of the patients presented lesions in > 1 brain lobe. The frontal lobe was the most prevalent location of EDH. The most used neuroimaging exam was computed tomography (CT). Surgical intervention was the most common treatment performed. A total of 24.2% of the patients died. Conclusion Nontraumatic EDH represents an uncommon manifestation of several pathologies. Clinical investigation should be aware of such a possibility. Healthcare professionals should value the physical examination and clinical history of the patient. Given the scarcity of information on the pathogenesis of spontaneous EDH, further studies are needed to better define intervention strategies and therapies for these patients.

Prognosis and outcome of chronic pain after spontaneous spinal epidural hematoma.

Chronic pain is a common symptom experienced by patients after spontaneous epidural hematoma (SSEH), and it seriously affects their quality of life. The outcome and prognosis of chronic pain after SSEH are rarely reported. Thus, we conduct this study to present the outcomes and explore prognostic factors of chronic pain in patients with SSEH. We retrospectively reviewed patients diagnosed with SSEH and invited them to complete the American Spinal Injury Association (ASIA) and Neuropathic Pain Symptom Inventory (NPSI) scales. Pearson χ2 and binary logistic regression were used to explore prognostic factors related to chronic pain after SSEH. A total of 55 patients were reviewed; 21 patients (38.2%) were lost to follow-up, 3 patients (5.4%) died, and 31 patients (56.4%) completed the scales, with a mean follow-up time of 20.6 ± 17.3months. The ASIA and NPSI results showed significant improvement after surgery. Pearson χ2 showed that timely surgery (≤ 12h) was related to better outcomes (p < 0.05, Fisher test), and binary logistic regression revealed that patients with a preoperative NPSI score of 11-20 were prone to achieving significant pain relief (OR 23.67, 95%CI 1.11-503.48, p = 0.04). Chronic pain is a common symptom during follow-up after SSEH, and timely intervention is suggested to obtain satisfactory outcomes. Patients who receive emergent surgery within 12h or who have a preoperative NPSI score of 11-20 may achieve significant relief of chronic pain.

Chronic spontaneous epidural hematoma in the lumbar spine with cauda equina syndrome and severe vertebral scalloping mimicking a spinal tumor: a case report

BackgroundChronic spinal epidural hematomas (SEHs) are rare clinical entities. SEH with vertebral scalloping is extremely rare, with only a few cases having been reported to date. We report a unique case of spontaneous chronic SEH in the lumbar spine with severe vertebral scalloping mimicking an epidural tumor.Case presentationA 71-year-old man presented with a 2-month history of lumbar pain and a 3-week history of paresthesia and pain in the right lower extremity, hypesthesia in the perineal and perianal regions, and bladder dysfunction. Computed tomography following myelography revealed an epidural mass lesion on the right side that compressed the dural sac and was associated with severe bony scalloping on the posterior wall of the L4 vertebral body. Magnetic resonance imaging (MRI) on T1- and T2-weighted images revealed a space-occupying lesion with heterogeneous intensity, and T1-gadolinium images showed an intralesional heterogeneous enhancement effect. A tumoral lesion in the spinal canal was suspected, based on preoperative imaging; therefore, a total spinal tumor resection was planned. Intraoperative findings revealed that the brownish lesion adhered to the dura and epidural tissues in the spinal canal, and the space-occupying mass in the scalloped cavity of the posterior wall of the L4 vertebra was encapsulated in red-brownish soft tissues. The lesion was totally resected in a piecemeal fashion, and pathological examination revealed a mixture of tissues that contained a relatively new hematoma with hemoglobin, as well as an obsolete hematoma with hemosiderin and amyloid deposits. The mass was diagnosed as a chronic epidural hematoma with recurrent hemorrhage. The postoperative course was uneventful, and the preoperative neurological symptoms immediately improved.ConclusionsThe preoperative diagnosis of chronic SEHs is challenging, as MRI results may not be conclusive, particularly in patients with scalloping of bony structures. Thus, chronic SEHs should be considered as a differential diagnosis in cases of suspected tumoral lesions in the spinal canal. To the best of our knowledge, this is the first reported case of acute exacerbation of chronic SEH with cauda equina syndrome and severe vertebral scalloping.

Spontaneous Epidural Hematoma during Pregnancy

Spontaneous epidural hematoma during pregnancy is rare but it requires urgent diagnosis and decompressive surgery because the prognosis is mainly linked to the speed of treatment. Reporting the case of a pregnant woman in the 8th month of pregnancy who presented back pain with paraplegia, an MRI was performed on her returning in favor of a compressive hematoma at the D1D2 level. Followed by a D1D2 laminectomy with evacuation of the hematoma. The postoperative period is marked by total neurological recovery.

Surgical outcomes of spontaneous epidural hematoma

Surgical outcomes of spontaneous epidural hematoma

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.

Spinal epidural hematoma in an infant patient: a differential diagnostic of spinal cord compression syndrome

A spontaneous spinal epidural hematoma is a collection of blood in the epidural space of the spine occurring in the absence of trauma or other pathological blood conditions, this epidural blood clot has the risk to compress the spinal cord and impact negatively on the neurological outcome of the patients. With a low incidence on pediatrics this condition has not been studied deep, with difficulties on the clinical approach in infants and children due to the limitation in the pediatric neurological exam with the risk to be misdiagnosed. We describe a rare case of spinal cord compression on a young 14 month old patient with a spontaneous cervicothoracic epidural hematoma that presented with a ascending paralysis. Magnetic resonance imaging of the spine demonstrated an extensive epidural hematoma between C4 to T5 with spinal cord compression. An emergency laminectomy was performed with evacuation of the epidural blood clot with a total improve of the neurologic symptoms and without any residual hematoma following 3 months of the surgery. The spontaneous spinal epidural heamtoma is rare cause of spinal cord compression on infants and children with high risk of neurological impact without prompt diagnosis with MRI and emergent surgical evacuation.

Spontaneous spinal epidural hematoma: a case report

BackgroundSpinal epidural hematomas usually occur under certain conditions; they rarely occur spontaneously. The prevalence of spontaneous spinal epidural hematoma is ~ 0.1 per 100,000, and the male-to-female ratio is approximately 1.4 to 1. Herein, we describe a rare case of spontaneous spinal epidural hematoma.Case presentationA 63-year-old Taiwanese woman, with underlying hypertension, anemia, and a history of cardiovascular accident without sequela, was admitted to our emergency department with a chief complaint of sudden bilateral weakness in the lower limbs. Magnetic resonance imaging revealed a spontaneous epidural hematoma. The patient underwent emergency surgery to remove the epidural hematoma and laminectomy for decompression. The bilateral lower limb weakness was alleviated immediately after the surgery.ConclusionIn patients with no risk factors related to spinal epidural hematoma, symptoms of bilateral lower limb weakness must be investigated carefully because this condition may occur spontaneously.

Extruded disc causes acute cervical epidural hematoma and cord compression: a case report

Cervical spontaneous epidural hematoma is a serious neurosurgical pathology that often requires prompt surgical intervention. While a variety of causes may contribute, the authors present the first case in the literature of cervical disc extrusion provoking epidural hemorrhage and acute neurological deterioration. A 65 year old male presented with six months of worsening signs and symptoms of cervical myelopathy. He had progressive deterioration over the course of two weeks leading to ambulatory dysfunction requiring a cane for assistance. While undergoing his medical workup in the emergency department, the patient became acutely plegic in the right lower extremity prompting emergent surgical decompression and stabilization. Based on imaging, pathology, and intraoperative findings, it was concluded that the patient had an extruded disc segment that may have precipitated venous bleeding in the epidural space and findings of acute cervical cord compression. Cervical disc extrusion may lead to venous damage, epidural hematoma, and spinal cord compression. If this unique presentation is recognized and addressed in a timely manner, patient outcomes may still be largely positive as this case demonstrates.

Non-traumatic epidural posterior fossa hematomas in child with Sensenbrenner syndrome: a case report and literature review

Background: Posterior fossa extradural hematomas are an uncommon condition with more than half of cases appearing in the pediatric population. Although the majority of cases are caused by substantial trauma, it may also be related to systemic diseases and bleeding disorders without the history of head trauma. Case report: We present the case of a 6-year-old female affected by Sensenbrenner syndrome with a non-traumatic subacute posterior fossa epidural hematoma. The patient was surgically treated and medically discharged without further neurological alteration. This is the first report of spontaneous cerebral hematoma associated with this syndrome in the literature. A literature review of the main aspects of both topics was performed. Conclusions: Although spontaneous posterior fossa epidural hematomas are rare, clinicians should be aware and highly suspicious of this differential diagnosis in certain situations such as coagulopathies and other specific systemic diseases, as fast recognition and assertive treatment are important for better outcomes.

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 hematoma in a known case of hemophilia a managed conservatively: A rare case report

Spontaneous spinal extradural hematomas are rarely attributed to hemophilia. When it occurs, magnetic resonance imaging (MRI) best establishes the diagnosis that should prompt immediate medical or surgical management. Here, we present a case with large spinal epidural hematomas (EDH) which was managed conservatively with good neurological outcome. A 12-year-old male who is a known case of hemophilia A was admitted with a complaint of neck pain, was neurologically intact on examination with no motor or sensory deficits. MRI cervical spine revealed a large spinal EDH in the cervical region compressing the cord posteriorly. The patient was managed conservatively with tranexamic acid and factor VIII replacement and observed over few days. He recovered well with interval resolution of hematoma. this case depicts the role of conservative management of spontaneous EDH in patients with Hemophilia A utilizing factor replacement therapy, steroids, and tranexamic acid and emphasizes that surgery is not always required even in such radiologically large appearing lesions.