Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma

Abstract

A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS). The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI) showed an image of a mass compressing the medulla.

A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma

“…Secondly, the cervical epidural hematoma usually produces rapid deterioration. Beatty and Winston proposed arterial bleeding as the source in cervical epidural hematomas [1,3,4,17].…”

“…Although early surgery is recommended, there are reports of successful conservative treatment [1]. There is a trend towards hemilaminectomy and partial laminectomy also [3,4].…”

Spontaneous spinal epidural hematomas

“…Early recognition of the symptoms and rapid diagnostic evaluation is essential to minimize delay in treatment of SSEH. Several studies have shown that MRI is the preferred diagnostic method of SSEH, [ 1 , 5 , 10 , 11 ] which may explain the increased report of the SSEH. Conventional MRI can estimate the bleeding occurrence, location, size, and severity of the spinal cord compression, based on the signal intensities of hematomas in T1 and T2-weighted images.…”

“…It was first described by Blauby in 1808. [ 1 ] The incidence is estimated at 0.1 per 100,000 individuals. [ 2 , 3 ] The classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression.…”

“…[ 4 , 5 ] The true etiology of the SSEH is still unknown, but the associations with some predisposing conditions, such as coagulopathy, use of anticoagulants, arteriovenous malformation, have been reported. [ 1 , 5 ] The progressive neurological deficit requires urgent treatment, and emergency decompression of the spinal cord and the evacuation of the hematoma remain the standard management. [ 6 , 7 ] Early and individualized rehabilitation program after recovery of the operation is beneficial for SSEH patients.…”