Spontaneous Spinal Epidural Hematoma Research Articles

Cervical epidural hematoma: a case series highlighting uncommon causes

BackgroundCervical epidural hematoma (CEH) is a rare but potentially devastating condition, characterized by the accumulation of blood within the epidural space of the cervical spine, leading to spinal cord compression (Perron AD, Huff JS. Spinal cord disorders. In: Marx JA, et al. editors. Rosen’s emergency medicine: concepts and clinical practice. 8th ed. Philadelphia: Saunders; 2013. pp. 1419–27.); (Raasck K, Habis AA, Aoude A, Simoes L, Barros F, Reindl R. Spontaneous spinal epidural hematoma management: a case series and literature review. Spinal Cord Ser Cases. 2017;3:16043. https://doi.org/10.1038/scsandc.2016.43.); (Ryo Yamamoto M, Ito H, Shimuzu K, Wakabayashi H, Oyama. Two cases of cervical epidural hematoma presenting with left-sided hemiplegia and requiring surgical drainage. Cureus. 2022;14(4):e23915. https://doi.org/10.7759/cureus.23915.). While trauma and iatrogenic causes are well-documented, cases attributed to neck strain and acupuncture are uncommon. (Raasck K, Habis AA, Aoude A, Simoes L, Barros F, Reindl R. Spontaneous spinal epidural hematoma management: a case series and literature review. Spinal Cord Ser Cases. 2017;3:16043. https://doi.org/10.1038/scsandc.2016.43.); (Shiraishi S, Goto I, Kuroiwa Y, Nishio S, Kinoshita K. Spinal cord injury as a complication of an acupuncture. Neurology. 1979;29(8):1188–90. https://doi.org/10.1212/wnl.29.8.1188.) Here, we present two cases of CEH secondary to these unusual aetiologies. Both cases highlight the importance of considering uncommon causes of CEH to ensure early recognition and prompt treatment.Case presentationsCase 1 is an 81-year-old lady who presented with left hemiparesis and paraesthesia following a fall with neck strain. Magnetic resonance imaging (MRI) of cervical spine revealed left C3-C7 epidural haematoma with severe cord compression. In Case 2, a 35-year-old gentleman experienced sudden onset numbness and weakness in all limbs just 10 minutes after receiving acupuncture. MRI showed an epidural hematoma at the C2-C4 levels. Both patients underwent immediate surgical decompression and had significant recovery.ConclusionAlthough CEH is a rare occurrence, it can potentially be a neurosurgical emergency. Physicians must remain cognizant of the diverse aetiologies associated with CEH and the necessity for early recognition and immediate treatment.

Multilevel Spontaneous Spinal Epidural Hematomas in a Recreational Weight Lifter.

Spontaneous spinal epidural hematoma (SSEH) is a nontraumatic condition that potentially compresses the spinal cord by accumulating blood in the epidural space. We report a case of multilevel SSEH in a 27-year-old male recreational weight lifter, presenting with acute lower back pain and bilateral leg weakness after deadlifts. Initial magnetic resonance imaging (MRI) showed subacute epidural hematomas with distinct signal intensities. The hematomas spanned multiple thoracic and lumbar levels without any predisposing medical conditions. Conservative management, including strict bed rest and pain management, led to marked improvement, with follow-up MRI indicating reduced hematoma size and expanded dural sac dimension. This case highlights the rare possibility of long-extending SSEH from weight lifting in individuals without risk factors and underscores the effectiveness of conservative treatment for multilevel spinal epidural hematomas.

Catastrophic spontaneous spinal epidural hematoma following thrombolysis: An intersection of neurosurgical and cardiological challenges – An institutional experience

Catastrophic spontaneous spinal epidural hematoma following thrombolysis: An intersection of neurosurgical and cardiological challenges – An institutional experience

Clinical outcome after surgical management of spontaneous spinal epidural hematoma

PurposeSpontaneous spinal epidural hematoma (SSEH) is a rare pathology characterized by a hemorrhage in the spinal epidural space without prior surgical or interventional procedure. Recent literature reported contradictory findings regarding the clinical, radiological and surgical factors determining the outcome, hence the objective of this retrospective analysis was to re-assess these outcome-determining factors.MethodsPatients surgically treated for SSEH at our institution from 2010 – 2022 were screened and retrospectively assessed regarding management including the time-to-treatment, the pre-and post-treatment clinical status, the radiological findings as well as other patient-specific parameters. The outcome was assessed using the modified McCormick Scale. Statistical analyses included binary logistic regression and Fisher’s exact test.ResultsIn total, 26 patients (17 men [65%], 9 women [35%], median age 70 years [interquartile range 26.5]) were included for analysis. The SSEHs were located cervically in 31%, cervicothoracically in 42% and thoracically in 27%. Twenty-four patients (92%) improved after surgery. Fifteen patients (58%) had a postoperative modified McCormick Scale grade of I (no residual symptoms) and 8 patients (31%) had a grade of II (mild symptoms). Only 3 (12%) patients remained with a modified McCormick Scale grade of IV or V (severe motor deficits / paraplegic). Neither time-to-treatment, craniocaudal hematoma expansion, axial hematoma occupation of the spinal canal, anticoagulation or antiplatelet drugs, nor the preoperative clinical status were significantly associated with the patients’ outcomes.ConclusionEarly surgical evacuation of SSEH generally leads to favorable clinical outcomes. Surgical hematoma evacuation should be indicated in all patients with symptomatic SSEH.

Torticollis and right arm weakness due to atraumatic spinal epidural hematoma in a 5-year-old girl child

Spontaneous spinal epidural hematoma (SEH) is a rare presentation as cause of neurological weakness in children and is neurological emergency. The most commonly affected site in children is cardiothoracic region. Early management is associated with better functional outcomes. We report a 5-year-old girl who presented with long standing neck pain now presenting to emergency with torticollis and right arm weakness around shoulder joint. Magnetic resonance imaging of C-spine revealed posterior epidural hematoma that extend from C3/C4 level down to C6/C7 level, it is causing moderate spinal canal stenosis and mass-effect on the spinal cord, with mild intramedullary abnormal T2 signal intensity indicating myelomalacia. There were no predisposing factors in our patient. Epidural hematoma was drained surgically and post-surgery patient started showing neurological recovery on follow. Cases of spontaneous SEH have been reported in infants as well and the clinical features in children are often nonspecific leading to a delay in diagnosis. This case report aims to raise awareness about this neurological emergency, in which early intervention is crucial.

A rare case of spontaneous spinal epidural hematoma with spontaneous resolution

Spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of acute spinal cord compression. It is a neurological emergency that requires urgent imaging and appropriate treatment to prevent permanent neurological sequelae. Here, we present the case of a 30-year-old male with no known comorbidities who presented to the emergency department with a history of sudden onset of upper backache and chest discomfort followed by bilateral lower limb weakness. On examination, the blood pressure was 220/120 mmHg, and neurological examination showed decreased tone and power of 2/5 in bilateral lower limbs. In view of the initial chest discomfort, a cardiac evaluation was done, which was normal, followed by magnetic resonance imaging of the whole spine, which showed a lesion in the anterior epidural space suggestive of hematoma, causing spinal cord compression. A final diagnosis was C6-T2 dorsal SSEH secondary to a hypertensive emergency.

A case of spontaneous spinal epidural hematoma with stroke symptoms

Objective: Spontaneous spinal epidural hematoma (SSEH) can present with symptoms resembling stroke, potentially leading to misdiagnosis and inappropriate treatment. In this case report, we aim to present a patient with SSEH whose clinical findings mimicked those of ischemic stroke. Case Presentation: A 78-year-old woman presented to the emergency department with sudden weakness in her left arm and leg. Motor examination revealed a strength value of 3-4/5 in the left upper and lower extremities. Brain computed tomography (CT) and brain diffusion magnetic resonance imaging (MRI) showed no acute neurological pathology. However, cervical MRI revealed heterogeneous signal areas in the extradural region posterior to the C3-C5 level. Further evaluation with cervical spinal CT identified an epidural hematoma. The patient was referred to neurosurgery, and surgical intervention was planned. Following surgery, the patient's motor strength was assessed as 2-3/5 in the upper and lower extremities. Conclusions: SSEH can occur in patients with multiple risk factors, although significant risk factors were not identified in our case. Paraparesis and tetraparesis are more commonly observed presentations of SSEH than hemiparesis. In our case, hemiparesis was an initial finding that resembled stroke symptoms. SSEH most frequently occurs at the C6 and T12 vertebral levels, making the location of our patient's lesion between the C3-C5 vertebrae even rarer. In summary, SSEH may rarely present with symptoms mimicking stroke, emphasizing the importance of accurate diagnosis to avoid mismanagement.

Spontaneous Spinal Epidural Hematoma Presented with Acute Hemiparesis: A Stroke Mimicker (P11-5.015)

Spontaneous Spinal Epidural Hematoma Presented with Acute Hemiparesis: A Stroke Mimicker (P11-5.015)

Literature review of spinal hematoma case reports: causes and outcomes in pediatric, obstetric, neuraxial and pain medicine cases

BackgroundThe risk of spinal epidural hematoma (SEH) has been described in the literature but the impact in various patient populations has not been assessed in the same study. We identified...

Spontaneous spinal epidural hematoma leading to acute paraplegia: a case report

BackgroundSpontaneous spinal epidural hematoma is an infrequent yet potentially debilitating condition characterized by blood accumulation in the epidural space, with only 300 documented cases globally. Although the exact etiology of spontaneous spinal epidural hematoma remains poorly understood, theories suggest arteriovenous malformations, rupture of epidural vessels, or epidural veins as possible causes.Case presentationThis study presents a 58-year-old Malay woman patient from Singapore with well-controlled hypertension, hyperlipidemia, type II diabetes mellitus, and microscopic hematuria. Despite a prior cystoscopy revealing no abnormalities, she presented to the emergency department with sudden-onset back pain, weakness, and numbness in both lower limbs. Rapidly progressing symptoms prompted imaging, leading to the diagnosis of a spinal epidural hematoma from thoracic (T) 9 to lumbar (L) 1. Prompt decompressive surgery was performed, and the patient is currently undergoing postoperative rehabilitation for paralysis.ConclusionThis case emphasizes the severity and life-altering consequences of spontaneous spinal epidural hematomas. Despite various proposed causative factors, a definitive consensus remains elusive in current literature. Consequently, maintaining a low threshold of suspicion for patients with similar presentations is crucial. The findings underscore the urgent need for swift evaluation and surgical intervention in cases of acute paraplegia.

Use of MRI in the Characterization and Management of Spontaneous Spinal Epidural Hematoma.

Use of MRI in the Characterization and Management of Spontaneous Spinal Epidural Hematoma.

Spontaneous posterior cervical epidural hematoma: A case report

Spontaneous spinal epidural hematoma (SSEH) is a rare neurological emergency affecting the spinal cord. The etiology of SSEH is unknown, but it may occur due to using anticoagulants and antiplatelet agents, which are commonly used to treat vascular diseases. Because of its rarity and non-specific initial symptoms, early and accurate diagnosis can be difficult, potentially negatively impacting a patient's survival and quality of life. In this report, we present the case of a young male patient with SSEH who had no comorbidities, did not use anticoagulants, and presented with sudden-onset neck pain without predisposing factors. Regarding survival and prognosis, postoperative patient follow-up is equally important as prompt diagnosis and treatment of SSEH.

A case report of Spontaneous Spinal Epidural Hematoma in Elderly Patient with Surgical Decompression

Spontaneous spinal epidural hematoma (SSEH), uncommon disorder with potentially devastating consequences as high morbidity. Incidence around 0.1 in 100,000 per/year, male- female ratio is approximately 1.4:1, most cases in 4th-5th decades. The etiology was associated with lumbar puncture and myelography, arteriovenous malformations, bleeding disorders, pregnancy, spinal manipulation. Anticoagulation is also a risk factor for spontaneous spinal epidural hematomas, warfarin is the most common related with SSEH. SSEH present clinically as a cord compression syndrome, acute onset pain and neurological deficit such as progressive motor or sensory symptoms, sphincter dysfunction, ultimately leads to complete/incomplete motor deficit caused by spinal cord/nerve root compression or cauda equina. The symptoms depending on the location of the hematoma. The worst prognostic factors are thoracic location, anticoagulation, severe neurologic deficits on admission, sphincter dysfunction, rapid progression. Magnetic resonance imaging (MRI) is the gold standard technique to diagnose SSEH. Once the diagnosis is established with clinical and imaging results, early surgical intervention should be considered. Currently, appropriate management is emergence decompression laminectomy and hematoma evacuation. We present the case of 87-year-old female, on warfarin for atrial fibrillation. Without recent trauma events. Presented sudden thoracic and lumbar pain, paresthesias with irradiation to legs. Progression with sudden paraplegic and anesthesia in lower extremities. Thoracolumbar MRI revealed a posterior SSEH extended from T9-T12. Was released a laminectomy and SSEH aspiration within 6 hours from the symptom’s onset. The patient was discharged one week after the surgery, symptoms improved during the follow-up.

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 Spinal Epidural Hematoma in an Infant: A Case Report

A spontaneous spinal epidural hematoma (SSEH) is an uncommon but severe condition with a high morbidity rate, especially in infants. It results from an accumulation of blood in the spinal epidural space. It requires early diagnosis and urgent management to achieve recovery of neurologic function. It refers to a non-traumatic etiology and excludes other possible causes such as hemophilia, neoplasms, arteriovenous malformation, coagulopathies, and iatrogenic causes. The clinical features are often nonspecific, leading to a delay in diagnosis. MRI provides the most valuable visualization of the location and hematoma mass as well as the presence of the spinal cord compression. SSEH can occur in any spinal cord segment but predominantly at the posterior cervicothoracic and thoracolumbar levels. The source of hemorrhage SSEH can be both vertebral venous plexus system and arterial source. We report a rare case of an infant spontaneous spinal epidural hematoma whose diagnosis was delayed because of a recent history of angina before his development of neurologic deficits. Magnetic resonance imaging of the spine revealed a dorsal spinal epidural hematoma with compression extending from C7 to T3 a. There were no predisposing factors. Laminectomy of C7 and the first three dorsal vertebrae and complete evacuation of hematoma was done.

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.

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.

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.

Spontaneous spinal epidural hematoma in children: a case report and literature review

Spontaneous spinal epidural hematoma in children: a case report and literature review

Emergency surgical decompression for spontaneous spinal epidural hematoma in octogenarians: risk factors, clinical outcomes, and complications

PurposeSpontaneous spinal epidural hematoma (SSEH) is a rare but disabling disease. Although several cases have been reported in the literature, their treatment remains unclear, especially in patients with advanced age. We, therefore, aimed to describe the clinical outcomes of cervical SSEH in octogenarians with an acute onset of neurological illness undergoing laminectomy.MethodsElectronic medical records from a single institution between September 2005 and December 2020 were retrieved. Data on patient demographics, neurological conditions, functional status, surgical characteristics, complications, hospital course, and 90-day mortality were also collected.ResultsTwenty-two patients aged ≥ 80 years with SSEH undergoing laminectomy were enrolled in this study. The mean Charlson comorbidity index was 9.1 ± 2.0, indicating a poor baseline reserve. Ten individuals (45.5%) were taking anticoagulant agents with a pathologic partial thromboplastin time (PTT) of 46.5 ± 3.4 s. Progressive neurological decline, as defined by the motor score (MS), was observed on admission (63.8 ± 14.0). The in-hospital and 90-day mortality were 4.5% and 9.1%, respectively. Notably, the MS (93.6 ± 8.3) improved significantly after surgery (p < 0.05). Revision surgery was necessary in 5 cases due to recurrent hematoma. Anticoagulant agents and pathological PTT are significant risk factors for its occurrence. Motor weakness and comorbidities were unique risk factors for loss of ambulation.ConclusionsLaminectomy and evacuation of the hematoma in octogenarians with progressive neurological decline induce clinical benefits. Emergent surgery seems to be the “state of the art” treatment for SSEH. However, potential complications associated with adverse prognostic factors, such as the use of anticoagulants, should be considered.