Acute Nontraumatic Spinal Epidural Hematomas

Alexiadou-Rudolf, Chariklia; Ernestus, Ralf‐Ingo; Nanassis, K.; Lanfermann, Heinrich; Klug, N.

doi:10.1097/00007632-199808150-00018

Cited by 85 publications

(29 citation statements)

References 14 publications

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“…Only ten cases of pregnant women with SCEH have been described in the literature to date (Table 1). The SSEH is usually posterior or posterolateral to the thecal sac [9–12]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Only ten cases of pregnant women with SCEH have been described in the literature to date (Table 1). The SSEH is usually posterior or posterolateral to the thecal sac [9–12]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Significantly better neurologic recovery was associated with incomplete versus complete neurologic deficits and shorter duration of time between onset of neurologic symptoms and surgery (<12 h) [20]. Other groups have found that neurologic recovery depends largely on the time interval between the onset of symptoms and surgical decompression [21]. …”

Section: Discussionmentioning

confidence: 99%

Spontaneous Spinal Epidural Hematoma in an 11-Month-Old Girl

2007

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An 11-month-old girl was admitted for a 2-month history of regression of motor milestones and lateralizing neurologic findings. Tests for hypercoagulability were all within normal limits except for a moderately elevated fibrinogen level. Urine and blood cultures were negative for growth. Complete MRI of the spine revealed a well-defined extradural inhomogeneous signal intensity extending from C₄ to T₃ suggestive of a subacute hematoma with evidence of evolving hemorrhagic change. There was no evidence of underlying arterial venous fistula or malformation. She underwent a cervicothoracic laminoplasty and evacuation of the hematoma. The clot was confirmed to be a hematoma on pathologic investigation. She made an uneventful recovery with gradual return of neurologic function. This case represents the longest known duration between initial symptoms and definitive management of spontaneous spinal epidural hematoma.

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“…SSEH represents a rare spinal emergency, with a frequency accounting for less than 1% of spinal epidural space- occupying lesions 2,3. Jackson first described SSEH in a 14-year-old female in 1869,5 and the first surgically-treated case was reported by Bain in 1897 6.…”

Section: Epidemiology and Pathophysiologymentioning

confidence: 99%

“…The presence of concomitant cranial nerve signs or facial weakness generally prompts a search for cerebral etiologies such as stroke, neoplasms or inflammatory processes, while it may occasionally be due to a lesion located in the high cervical spinal cord 1. In this concise review, we describe the features of spontaneous spinal epidural hematoma (SSEH), which is a rare cause of spinal cord compression and a neurological emergency requiring prompt diagnosis and management to prevent morbidity and mortality 2,3. Most SSEH patients present with either paraplegia or tetraplegia; however, there are numerous descriptions about acute hemiparesis as an initial manifestation of SSEH, which may lead physicians to include an acute ischemic cerebrovascular event as a diagnostic consideration,4 thus leading to the concept that SSEH should be included in the large list of stroke mimics.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Spinal Epidural Hematoma as a Potentially Important Stroke Mimic

Akimoto

Yamada

Shinoda

et al. 2014

J Cent Nerv Syst Dis

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Hemiparesis develops in response to a wide range of neurological disorders, such as stroke, neoplasms and several inflammatory processes. Occasionally, it may also occur due to a lesion located in the high cervical spinal cord. In this concise review, we describe the features of spontaneous spinal epidural hematoma, which should be included in the large list of stroke mimics. Various concerns regarding the diagnostic and therapeutic conundrums relating to the condition are also discussed.

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Acute Nontraumatic Spinal Epidural Hematomas

Abstract: The results of the current series demonstrate both the superiority of magnetic resonance imaging for diagnosis of SSEH as well as the necessity of early decompressive surgery in cases of sensorimotor paralysis after SSEH.

Cited by 85 publications

References 14 publications

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

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

Spontaneous Spinal Epidural Hematoma in an 11-Month-Old Girl

Spontaneous Spinal Epidural Hematoma as a Potentially Important Stroke Mimic

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