Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression.

Langmayr, J.; Ortler, Martin; Dessl, A.; Twerdy, K; Aichner, F.; Felber, Stefan

doi:10.1136/jnnp.59.4.442

Cited by 66 publications

(47 citation statements)

References 18 publications

(4 reference statements)

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“…There is controversy in the human literature regarding the time of removal of the hematoma related to outcome. In 1 study, rapidly evacuated hematomas had a good prognosis,18, 27 whereas other studies indicate there is no correlation between time to surgery and outcome 19, 20…”

Section: Discussionmentioning

confidence: 87%

“…Many hypotheses have been proposed: increased blood pressure spikes associated with coughing or straining causes increased intra‐abdominal or intrathoracic pressure which increases the pressure on valveless veins in the internal vertebral plexus, axial movement of the thecal sac, and abnormal vessels 18, 19. Although none of the cases in this report had histopathologic evidence of extruded disk material present in the material removed surgically, it is possible that the amount of this material was so small that it was not sampled during surgery.…”

Section: Discussionmentioning

confidence: 99%

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Clinical, Magnetic Resonance Imaging, and Histopathologic Findings in 6 Dogs with Surgically resected Extraparenchymal Spinal Cord Hematomas

Hague

Joslyn

Bush³

et al. 2015

Veterinary Internal Medicne

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BackgroundExtraparenchymal spinal cord hematoma has been described in veterinary medicine in association with neoplasia, intervertebral disk disease, and snake envenomation. There are rare reports of spontaneous extraparenchymal spinal cord hematoma formation with no known cause in human medicine. Multiple cases of spontaneous extraparenchymal spinal cord hematoma have not been described previously in veterinary medicine.ObjectivesTo describe the signalment, clinical findings, magnetic resonance imaging (MRI) features, and surgical outcomes in histopathologically confirmed extraparenchymal spinal cord hematomas in dogs with no identified underlying etiology.AnimalsSix dogs had MRI of the spinal cord, decompressive spinal surgery, and histopathologic confirmation of extraparenchymal spinal cord hematoma not associated with an underlying cause.MethodsMulti‐institutional retrospective study.ResultsSix patients had spontaneous extraparenchymal spinal cord hematoma formation. MRI showed normal signal within the spinal cord parenchyma in all patients. All hematomas had T2‐weighted hyperintensity and the majority (5/6) had no contrast enhancement. All dogs underwent surgical decompression and most patients (5/6) returned to normal or near normal neurologic function postoperatively. Follow‐up of the patients (ranging between 921 and 1,446 days) showed no progression of neurologic clinical signs or any conditions associated with increased bleeding tendency.Conclusions and Clinical ImportanceBefore surgery and histopathology confirming extraparenchymal hematoma, the primary differential in most cases was neoplasia, based on the MRI findings. This retrospective study reminds clinicians of the importance of the combination of advanced imaging combined with histopathologic diagnosis. The prognosis for spontaneous spinal cord extraparenchymal hematoma with surgical decompression appears to be favorable in most cases.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Clinical, Magnetic Resonance Imaging, and Histopathologic Findings in 6 Dogs with Surgically resected Extraparenchymal Spinal Cord Hematomas

Hague

Joslyn

Bush³

et al. 2015

Veterinary Internal Medicne

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“…Although the exact mechanism of the development and resolution of spontaneous SDH is unknown, our case is unusual in that the hematoma was extensive and an adhesive arachnoid cyst developed at the expense of resolving the hematoma. Similarly Langmyre et al 4 According to the theory of`isolated SDH', the signal intensities of SDH combined with SAH are likely to correspond to acute to subacute hemorrhage, and those of isolated SDH, to subacute to chronic hematoma with MR imaging. The patient in our case showed the lesion, which was hyperintense on both the T1-weighted and T2-weighted MR images taken 10 days after onset of the symptoms.…”

Section: Discussionmentioning

confidence: 95%

“…Further follow-up is necessary since the remained adhesive arachnoid cyst might become symptomatic and may require an additional treatment. 4 …”

Section: Discussionmentioning

confidence: 99%

“…2,3 Spinal cord compression by SSH is known to be a neurosurgical emergency. 4 Although the surgical treatment by decompressive laminectomy and drainage of hematoma is mandatory in most cases of SSH, 2,4 some cases of spontaneous resolution of SSH have been reported: 3,5 ± 7 two of these cases were of spontaneous onset. 3,6 We report another case of SSH of spontaneous onset and spontaneous resolution without coagulation problems.…”

Section: Introductionmentioning

confidence: 99%

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