Epidural hematoma of the lumbar spine: 18 surgically confirmed cases.

Abstract

The authors report 18 cases of surgically proved spontaneous epidural hematoma of the lumbar spine. The clinical findings in spontaneous epidural hematoma were identical to those in acute disk herniation. Underlying disk abnormalities were common; the majority of hematomas (14 of 18, 78%) were associated with small concomitant disk herniations or underlying annular tears. The magnetic resonance imaging and computed tomographic findings were similar to those in extruded/free-fragment disk herniation. The strong coincidence between epidural hematoma and underlying disk disruption (annular tear or herniation) leads the authors to postulate that spontaneous epidural hematoma results from tearing of fragile epidural veins lying adjacent to the displaced anulus or nucleus.

Multilevel Acute Spinal Epidural Hematoma in a Patient With Chronic Renal Failure-Case Report-

“…7,16,20) ASEH with progressive neurological deficit should be treated by emergent evacuation of the hematoma and decompression of the spinal cord. 1,2,10,16,18,23) Multilevel ASEH requires removal of all or every other lamina of the involved spinal levels and evacuation of the hematoma. However, conservative treatment with spontaneous resolution of the hematoma may be preferred to surgical decompression.…”

Spontaneous Spinal Epidural Hematomas: Case Series with Review of Literature

“…At present, MRI is considered as the imaging modality of choice for SSEH as has been documented by many authors (28)(29)(30)(31)(32) . The advantages include information about the extent and nature of the hematoma, degree of cord compression.…”

“…Such spontaneous spinal EDHs have been attributed most commonly to a venous source (5)(6)(7) . Some of the risk factors include coagulopathy, anticoagulation, vascular anomalies, inter vertebral disk herniation, Paget disease of bone, Valsalva maneuver, and, in some cases, hypertension (1,5,(8)(9)(10)(11)(12)(13) .…”

Spontaneous and idiopathic chronic spinal epidural hematoma: two case reports and review of the literature

“…This plexus has extensive connection via venous rami with the external plexus through each vertebral body and the posterior vertebral elements [11,12,21]. Considering these anatomical prerequisites, some of the previously analyzed factors in association with any circumstance able to transiently raise the venous pressure (e.g., Valsalva maneuver) can lead to bleeding and organizing hematoma.…”

“…As for clinical symptoms, SEH can mimic disc herniation, canal stenosis [21,27] or tumor signs and they are characterized by severe axial back pain with or without acute or delayed neurological deficits [12,27,31]. The pain onset, often related to minor strain or Valsalva-like maneuvers, can be acute or slowly progressive, especially in the rare case of chronic epidural hematoma.…”