Spontaneous Spinal Hematoma Research Articles

Spontaneous spinal hematomas: A case series

PurposeSpontaneous spinal hematoma (SSH), a rare neurological disorder, demands immediate diagnostic evaluation and intervention to prevent lasting deficits. This case series analyzes instances, particularly highlighting cases where vascular causes were identified despite inconclusive initial imaging.MethodsIn a retrospective study of 20 patients treated for SSH at a Level I spine center from 01/01/2017 to 11/15/2023, we examined demographics, clinical presentation, imaging, and treatment details. Excluding traumatic cases, we present 4 instances of SSH associated with diverse vascular pathologies.ResultsPatient ages ranged from 39 to 85 years, with a median age of 66 years. 45% were male, and 55% were female. Among 20 cases, 14 were epidural hematomas, 4 subdural, 1 combined epidural and subdural, and 1 subarachnoid hemorrhage. 85% presented with neurological deficits, while 3 solely had pain-related symptoms. 55% were under anticoagulant medication, and vascular anomalies were found in 25% of cases. The cause of SSH remained unclear in 20% of cases. MRI was performed for all patients, and DSA was conducted in 25% of cases. The 4 highlighted cases involved individuals with distinct vascular pathologies managed surgically.ConclusionUrgent attention is crucial for SSH due to possible lasting neurological consequences. The study emphasizes comprehensive diagnostics and surgical exploration, especially in cases with unclear etiology, to identify and address vascular causes, preventing hematoma progression or recurrence. Despite their rarity, vascular malformations contributing to spinal hematomas warrant particular attention.

Brown sequard syndrome as a manifestation of acute spontaneous spinal haematoma: A diagnostic challenge

Brown-Sequard Syndrome (BSS) is a neurological disorder caused by hemisection lesion of the spinal cord. BSS causes can be dichotomized in traumatic and atraumatic, and they can include vascular causes, as ischemia or haemorrhage. We describe the case of a 52-year-old woman presenting with limbs paraesthesia and right leg hyposthenia, associated with cervical acute nontraumatic pain (C6-C7 level). Neurological consultant was requested with a suspicious of vertebral artery dissection: clinical examination revealed right leg flaccid weakness, loss of pain and temperature sensation in left hemisoma, hypopallesthesia of right limbs and T1-T2 sensory level. Those symptoms were suggestive of a Brown Sequard Syndrome. MRI showed an epidural haematoma compressing spinal cord, associated with abnormal signal to C6-C7 and D1 level of spinal cord. Urgent laminectomy and evacuation were performed. Neurological symptoms improved avoiding permanent paraplegia

A case of treatment of acute spontaneous spinal subdural hematoma in a patient with the novel coronavirus COVID-19. Literature review

The aim of the work is to describe a case of spontaneous subdural spinal hematoma surgical treatment in a patient with a new coronavirus infection COVID-19, manifested by compression myeloradiculopathy. Materials and methods. In patient N., 70 years old, during the treatment of a new coronavirus infection COVID-19, signs of myelopathy from the dermatome level were revealed. Subdural hematoma was diagnosed at the Th7-L4 level with compression of the dural sac, ponytail and left spinal nerves at the Th12-L2 vertebral level. Results. Performed in the volume of decompressive laminectomy L1, removal of subdural hematoma with a good result in the form of restoration of spinal cord function. Early rehabilitation was carried out in the Department of neurosurgery. Conclusion. Spinal subdural hematomas are extremely rare. We have not found any reports of spinal hematomas in patients with COVID-19 in the Russian-language literature. Alertness to possible hemorrhagic complications in patients with a new coronavirus infection receiving anticoagulants, rapid diagnosis in a multidisciplinary hospital will allow timely neurosurgical care and achieve a good functional result.

Spinal Cord Compression Secondary to a Spontaneous Spinal Haematoma in a Patient Newly Treated with Rivaroxaban.

Apixaban could be preferred as the first choice for direct oral anticoagulation (DOAC) in older patients.DOACs can have important side effects even if the switch from vitamin K antagonist to this group is correctly carried out.

Spontaneous Spinal Epidural Hematoma in a Known Case of Hemophilia a Managed Conservatively

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.

Spontaneous spinal intramedullary hematoma in an infant: A rare entity and a diagnostic challenge

ABSTRACTIntroduction:Spontaneous spinal intramedullary hematoma is a rare cause of acute paraplegia in adults and is extremely uncommon in children. Very few cases with no apparent etiology (such as trauma, vascular lesions) have been reported in adults. We did not find any apparent cause for the hematoma in our patient and to the best of our knowledge, this is first case reported in infants.Case Report:We present the case of a 6-month-old female child admitted with acute-onset paraplegia, bladder bowel involvement, and no history of trauma or bleeding diathesis. The MRI showed an intramedullary mass extending from the D11-L1 level. The mass was excised and histopathology revealed it to be an organizing hematoma.Conclusion:Our case highlights that though it is a rare entity, there is a need for more awareness when dealing with children with sudden paraplegia, acute retention of urine, or neurological deficit. Early diagnosis and prompt surgery are crucial to achieve the best neurological outcome.

Spontaneous spinal hematoma

Background. Spontaneous spinal hematoma (SSH) is a rare condition that can result in severe functional disability and even death. But early detection and prompt intervention can substantially reduce the morbidity. We present a series of seven operated cases of SSH. Methods. All operated cases of SSH between 2017 and 2019 were studied. The demographic and clinical features, risk factors and imaging features were analyzed. The functional outcome at discharge and 6 months were assessed. Results. Seven operated cases of SSH with mean age 35(SD-20.9) were studied. Six cases were spontaneous spinal extradural hematomas (SSEDH) and one case was spontaneous spinal subdural hematoma (SSSDH). The most common site was cervicothoracic. Risk factors associated with SSH were thrombocytopenia, pregnancy, and necrotising pancreatitis. Two patients had preoperative Frankel’s grade A-B, three had grade C and two had D. The mean interval between the onset of symptoms and surgery was 4.7days. The functional outcome was dependent on the pre-operative functional status of the patient. Patients with SSEDH and thrombocytopenia had a poor outcome. Conclusion. SSH even though spontaneous may be associated with risk factors. The presence of thrombocytopenia and preoperative functional status predicted outcome. This is the only single institution case series to report thrombocytopenia as a factor predicting poor outcome.

Risk Factor Analysis and Surgical Outcomes of Acute Spontaneous Spinal Subdural Hematoma. An Institutional Experience of Four Cases and Literature Review

Spontaneous spinal subdural hematoma (SSSDH) is exceedingly rare, with significant morbidity in most patients. Acute neurologic deficit in the context of a SSSDH is considered a neurosurgical emergency. We performed a literature review and compared the results with our institutional experience to evaluate the risk factors and neurologic outcomes of SSSDH. We retrospectively collected the medical, radiologic, and surgical information of 4 patients with SSSDH who were operated on in our neurosurgical unit. A literature review of surgically managed patients with SSSDH and their neurologic outcomes was performed. Ordered logistic regression statistics were used to study the risk factors influencing the postoperative Domenicucci grade. A total of 112 patients were evaluated, with a female/male ratio of 1.3:1. Mean patient age was 60.25 years. Our analysis of the data showed that the cohort of patients presenting with bladder dysfunction in addition to paraparesis were found to have worse neurologic outcomes postoperatively. Adjusted analysis identified 3 clinical characteristics that influenced surgical outcome: cervical SSSDH (P= 0.029), neurologic deficit (P < 0.001), and anticoagulation medication (P < 0.001). This review shows that patients aged ≥60 years and on anticoagulation are at an increased risk of sustaining a spontaneous subdural spinal hematoma without history of trauma. To our knowledge, this is also the first study to show a presenting symptom of bladder dysfunction as a significant risk factor for poor surgical outcome in SSSDH. Our study supports surgical evacuation of acute SSSDH in the presence of these risk factors.

Spinal Subdural Hematoma in a Young Adult with Hemophilia A: A Case Report

Hemophilia is a set of hereditary hemorrhagic disorders of coagulation-dysfunction that can cause repeated bleeding in various tissues and organs. And the patient can be disabled due to bleeding from bones, joints, and soft tissue, or die due to splenic rupture or intracranial bleeding. So it is crucial to detect the site of bleeding in hemophilia patients quickly. Spontaneous spinal canal hematoma is a rare complication of hemophilia, with less than 50 cases reported to date. It can be easily missed and cause serious harm to patients. Hematoma, if untreated, causes irreversible nerve damage by compression of the spinal cord. Early recognition and treatment are most useful to prevent spontaneous spinal canal hematoma. We describe the case of a 21-year-old man with severe lumbago for two days, who had hemophilia A for a decade. The patient was diagnosed with spinal subdural hematoma by magnetic resonance imaging (MRI) after ruling out other causes of lumbago and treated with drugs by a neurologist. The hematoma showed absorption by MRI after six months. In conclusion, spontaneous spinal canal hematoma is a severe complication of hemophilia, which is often missed. This successful case confirms the importance of early diagnosis and treatment of spontaneous spinal canal hematoma. We hope to increase the clinicians’ vigilance of this disease.

Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report

BackgroundThrombotic thrombocytopenic purpura (TTP) is a rare, potentially fatal disease with multisystem involvement. Cytomegalovirus (CMV) infection as a cause of refractory TTP, has been reported only in immunocompromised individuals. We report a case of CMV-induced refractory TTP in an immunocompetent individual.Case presentationA 35-year-old, previously healthy Sri Lankan man, presented with fever for 3 days with gum bleeding and progressive drowsiness. His Glasgow coma scale score was 10/15. He did not have papilloedema or neck stiffness. Laboratory evaluation showed a severe thrombocytopenia with microangiopathic haemolytic anaemia. There was marginal renal impairment and normal coagulation profile. Non-contrast CT scan of brain was normal. A diagnosis of thrombotic thrombocytopenic purpura was made. Despite daily plasma exchanges and high-dose steroids, he failed to achieve the expected therapeutic response, thus demonstrating refractory TTP. On exploring for possible causes of refractoriness to treatment, a clinically significant PCR titre of CMV was detected. Treatment of CMV infection lead to complete recovery of TTP. His disease course was further complicated with spontaneous spinal haemorrhage leading to neurological sequelae.Discussion and conclusionsThis is the first report of CMV induced refractory TTP in an immunocompetent adult. It is also the first report of clinically significant spontaneous spinal haematoma in TTP. These two rare occurrences should be considered when patients with refractory TTP do not improve as expected.

Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review.

Spinal cord haematoma, or haematomyelia, is a rare condition caused by several unusual disease processes. Traumatic events, such as spinal cord injury and surgery or procedures involving the spinal cord, are the most important causes of spinal cord haematoma. Rarely, it is associated with anticoagulation therapy. Irrespective of cause, spinal cord haematoma is considered a neurosurgical emergency and must be treated promptly in order to prevent neurological sequelae. The authors describe the case of a 69-year-old patient taking warfarin in the therapeutic range for a mechanic mitral valve, who developed chest pain with cervical and dorsal radiation, and experienced sudden paraparesis of the limbs. A CT of the spine confirmed haematomyelia. A high index of suspicion, prompt recognition and immediate intervention are essential to prevent major morbidity and mortality from intraspinal haemorrhage.LEARNING POINTSThis article reports an unusual presentation of spontaneous spinal haematoma, imposing the careful elaboration of differential diagnoses, which is very important in internal medicine.The description of this low-incidence case allows the scientific community to assist in approaching patients with similar symptoms.The lack of studies about the etiology and treatment of spontaneous spinal haematoma underlines the need for further studies and research in the area in order to increase the scientific evidence on the approach of these patients.

Spontaneous Spinal Intradural Haematoma in an Anticoagulated Woman.

A 57-year-old woman, with a history of deep venous thrombosis and medicated with warfarin, presented at the hospital with acute back pain with paraplegia, headache, high blood pressure and vomiting. Imaging of the spine showed an acute intradural extramedullary haemorrhage with blood clot formation. The patient underwent surgery and received intensive post-surgical physiotherapy but remains paraplegic. Non-traumatic spinal intradural extramedullary haematoma (SIEH) is a rare neurological emergency that can result in spinal cord compression. Physicians should always consider this clinical entity as a differential diagnosis, especially in a patient presenting with acute back pain on anticoagulant therapy.LEARNING POINTSNon-traumatic spinal intradural extramedullary haematoma is extremely rare.Acute cases can lead to spinal cord compression.Physicians should consider this clinical entity in anticoagulated patients presenting with acute onset of back or radicular pain followed by paraplegia, intestinal and bladder dysfunction.

Factors predicting outcome of surgical treatment of spontaneous spinal hematomas: a retrospective cohort study in four tertiary reference centers.

Spontaneous spinal extradural hematoma (SSEH) is a rare but disabling disorder. Most of the previous assumptions regarding the factors that contribute to poor neurological recovery from SSEH are based on small case samples or conditions with similar clinical presentations but different physiopathologies. Our goal was to find the most relevant prognostic factors for neurological recovery in patients suffering SSEH treated with surgical evacuation. From a retrospective database of 29 surgical patients with SSEH, several clinical and radiological variables were recorded. These variables were compared between patients with good and poor neurological recovery, considering good as an improvement by at least one point in the ASIA Scale. Among the patients included, morbidity and mortality rate was 6.9% and 3.4%, respectively, with a mean follow-up of 7.1 months. Neurological full recovery was experienced by 33% of the patients included, and 86% of individuals had an improvement in their neurological condition at last follow-up. Lesser intramedullary lesions were significantly associated with greater chances of improvement in ASIA Scale at discharge and at follow-up. Surgical decompression within the first 24 hours of onset of symptoms were correlated with better neurological outcomes at follow-up. MRI is a powerful tool to predict the neurological outcome in SSEH patients, and it should be considered as an another resource to better know the patients with greater chances of having neurological recovery, especially in cases where the neurological examination is not reliable at the initial exam.

Clinical Features, Management, and Prognostic Factors of Spontaneous Epidural Spinal Hematoma: Analysis of 24 Cases.

Spontaneous spinal epidural hematoma (SSEH) is a rare neurosurgical emergency. It presents as acute spinal cord compression and usually requires surgical decompression. The patients who will benefit most from decompression surgery are unknown, and the factors associated with prognosis remain controversial. The purpose of our study was to identify the clinical features, treatments, and main factors related to the prognosis of SSEH. We reviewed the records of 24 patients treated for SSEH from September 2010 to January 2016 at West China Hospital. Clinical features, radiologic images, treatment methods, and clinical outcomes were reviewed retrospectively. To ascertain which factors were related to outcomes, statistical analysis was performed. Among 24 patients, 19 presented with severe initial neurologic deficits (American Spinal Injury Association grade A-C) underwent decompressive surgery, and the remaining patients (initial American Spinal Injury Association grade D or E) received conservative treatment. Among the 19 patients in the operation group, seven (36.8%) had good outcomes, whereas 12 (63.2%) had poor outcomes. All patients in the conservative group had good outcomes. SSEH is a rare but serious illness. It is more likely that SSEH arises from a ruptured internal vertebral venous plexus. The initial neurologic status is the determining factor influencing the treatment method and clinical outcome. The number of involved segments cannot be used to decide the treatment method or predict prognosis. Patients with shorter operative intervals appear to have better neurologic recovery.

In Reply to the Letter to the Editor “Spontaneous Spinal Extradural Hematoma: A Rare Neurosurgical Emergency”

In Reply to the Letter to the Editor “Spontaneous Spinal Extradural Hematoma: A Rare Neurosurgical Emergency”

Spontaneous Spinal Extradural Hematoma: A Rare Neurosurgical Emergency

Spontaneous Spinal Extradural Hematoma: A Rare Neurosurgical Emergency

Spontaneous chronic epidural hematoma in the lumbar spine associated with Warfarin intake: a case report.

IntroductionSpontaneous spinal epidural hematomas are rare. However, in patients on anticoagulant treatment the risk may increase. Symptomatically patients may present with radiculopathy and even progressive neurological deficits.Case descriptionWe present a case of a warfarin treated patient with left L5 radiculopathy. MRI was evaluated as showing a lumbar disc prolapse or synovial cyst at L4–L5 level. The patient was operated and an organized material was removed and analysed as a hematoma. No prolapsed disc or synovial cyst was found. The patient was neurologically restored following the operation.Discussion and EvaluationThis case illustrates how spontaneous epidural spinal hematomas can present with symptoms of radiculopathy and radiologically be misinterpreted as a protruding disc or cyst.ConclusionWarfarin treated patients may have an increased risk of spontaneous spinal epidural hematomas.

Spontaneously developed paraplegia in a patient with Factor V Leiden mutation

Factor V Leiden (FVL) mutation is the one-point mutation in G1691A in the tenth exon of the gene for Factor V, caused by the substitution of glutamine for arginine at codon 506. We present here a patient with a mutation of the Factor V gene and taking anticoagulant therapy, who became paraplegic following surgery for dural hematoma and spontaneous spinal intramedullary hematoma. His physical examination revealed T5 ASIA A, complete paraplegia. Our case is important in the literature, as being the first case with spinal intramedullary hematoma that developed due to anticoagulant use.

Large, spontaneous spinal subdural-epidural hematoma after epidural anesthesia for caesarean section: Conservative management with excellent outcome.

Background:Iatrogenic or spontaneous spinal hematomas are rarely seen and present with multiple symptoms that can be difficult to localize. Most spontaneous spinal hematomas are multifactorial, and the pathophysiology is varied. Here, we present a case of a scattered, multicomponent, combined subdural and epidural spinal hematoma that was managed conservatively.Case Description:A 38-year-old woman came to the emergency department (ED) complaining of severe neck and back pain. She had undergone a caesarean section under epidural anesthesia 4 days prior to her arrival in the ED. She was placed on heparin and then warfarin to treat a pulmonary embolism that was diagnosed immediately postpartum. Her neurological examination at presentation demonstrated solely the existence of clonus in the lower extremities and localized cervical and low thoracic pain. In the ED, the patient's international normalized ratio was only mildly elevated. Spinal magnetic resonance imaging revealed a large thoracolumbar subdural hematoma with some epidural components in the upper thoracic spine levels. Spinal cord edema was also noted at the T6-T7 vertebral level. The patient was admitted to the neurosurgical intensive care unit for close surveillance and reversal of her coagulopathy. She was treated conservatively with pain medication, fresh frozen plasma, and vitamin K. She was discharged off of warfarin without any neurological deficit.Conclusions:Conservative management of spinal hematomas secondary to induced coagulopathies can be effective. This case suggests that, in the face of neuroimaging findings of significant edema and epidural blood, the clinical examination should dictate the management, especially in such complicated patients.

LUMBAR EXTRADURAL SPONTANEOUS HEMATOMA WITH ACUTE PARAPARESIS

Abstract Introduction: Primary epidural hematomas or “hematorrachis” are rare and less frequent in the lumbar region. It presents with acute onset of severe back pain and rapid development of signs of compression Objective: To report a case of lumbar extradural spontaneous hematoma with acute paraparesis. Case Report: A 65 year old male presented with acute back ache of 2weeks duration with Radicular pain and numbness of both feet. He had progressive asymmetrical weakness of the lower extremities without bowel/bladder involvement and inability to walk.Radiograph of spine shows Grade 1 listhesis of L4-L5.MRI of LS Spine s/o synovial cyst at L2-L3 level.Left Facet joint arthropathy L2-L3. Patient underwent L2 laminectomy with removal of synovial cyst and hematoma Results: The patient had motor improvement of grade 3 power in hip and knee flexors and EHL AND EDL.3 months follow up showed grade 4 of all lower limb muscles with sensory numbness present on L3-L4 and L4-L5. Conclusion: Spontaneous spinal extradural hematoma should be suspected in any patient who complains of local or referred spinal pain associated with acute limb weakness, sensory deficits, with or without cauda equina symptoms.