Sudden back pain as clinical presentation of spontaneous spinal epidural hematoma

Abstract

An 89-year-old woman admitted to the Emergency Care Department with reported back pain nine days earlier that started suddenly when sitting. This subsequently evolved into progressive paraparesis (Frankel D). An MRI of the lumbosacral spine revealed an extensive lumbar epidural hematoma ( Figure). The patient underwent decompressive laminectomy of T12-L1.Spontaneous epidural hematoma is a rare disease, most often involving the thoracolumbar region, followed by the cervical region 1 . Non-traumatic causes include hypertension, coagulopathies, use of anticoagulants, arteriovenous abnormalities, tumors of the backbone and lumbar puncture. In approximately 40% of cases, the etiology cannot be determined. Typically, pain is the root of the acute onset, accompanied by neurological deficit 1,2 . References 1.Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience.

Acute Spinal Epidural Hematoma, Clinical and Etiopathogenic Diagnostic Difficulties – Case Presentation and Synthesis of the Literature

“…Typically an epidural hematoma is preceded / accompanied by local pain in the spine, [3], [9], [10]. Sometimes spontaneous cervical epidural hematoma is not always an obvious diagnosis [10], because in some elderly patients, back or neck pain might be absent [29].…”

“…Acute SEDH is a rare neurosurgical emergency most often associated with acute symptomatic spinal cord compression and potentially permanent Acute spinal epidural hematoma, clinical and etiopathogenic diagnostic difficulties -Case presentation and synthesis of the literature neurologic deficits. Most patients present with sudden (radicular) back pain and paraplegia or tetraplegia (in variable degrees of severity), possibly associating neurogenic bladder [3], [4], [7], [8], [9], [10]. It can cause severe morbidity and mortality in 5.7% of cases [11].…”

Acute spontaneous thoracic epidural hematoma, triggered by weight-lifting training, in a retired sportsman: case report and literature review

“…The typical clinical presentation is characterized by a sequential evolutive paradigm, including a sudden onset with spinal radicular pain, followed by progressive neurological deficits due to spinal cord compression. Most patients present with paraplegia or tetraplegia (in variable degrees of severity), possibly associating neurogenic bladder [2,6,[8][9][10]. Misleading symptoms of acute hemiparesis mimicking stroke, have been described in a few cases of cervical epidural hematoma presenting as Brown-Séquard syndrome [8][9][10][11].…”

“…Any age groups can be affected, but most cases have been in their 60s or 70s, with a slight predominance of the masculine gender (1.4:1) [2,[4][5][6]8]. The SSEH appears to have a bimodal topographic distribution, with highest frequencies in the upper thoracic (Th3-5) and middle to low cervical regions (C4-6) [8][9][10][11][12], distribution strongly dependent on age [8].…”