MR Imaging in the Diagnosis of Spontaneous Spinal Epidural Hematomas

Rothfus, William E.; Chedid, Mokbel; Deeb, Ziad L.; Abla, Adnan A.; Maroon, Joseph C.; Sherman, Randall L.

doi:10.1097/00004728-198709000-00020

Cited by 75 publications

(26 citation statements)

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“…After hours to days of initiation of symptoms this insidiously progresses to a complete or partial paraplegia or even quadriplegia. The clinical course is so characteristic that it was called 'the syndrome of spinal epidural hematoma' by Markham et al 15) , and Rothfus et al 21) . The suspicion of spinal epidural hematoma should be made relatively early if this typical clinical course is observed.…”

Section: Discussionmentioning

confidence: 99%

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Spinal Epidural Hematoma after Pain Control Procedure

Nam

Choi

Yang

et al. 2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 48 : [281][282][283][284] 2010 Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.

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Section: Discussionmentioning

confidence: 99%

“…In particular, the MRI signal characteristics of various stages of hemorrhage are relatively unique that can lead to a specific diagnosis than those obtained by CT myelography 21) . With these advantages MRI imaging has replaced CT myelography as the first-choice diagnostic technique for the confirmation of spinal epidural hematoma.…”

Section: Discussionmentioning

confidence: 99%

Spinal Epidural Hematoma after Pain Control Procedure

Nam

Choi

Yang

et al. 2010

J Korean Neurosurg Soc

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“…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.…”

Section: Imagingmentioning

confidence: 99%

“…Gundry and Heithoff (10) in a series of 18 surgically confirmed cases of lumbar EDH, described the signal characteristics of spinal EDH after an average of 169 days on T2WI but did not discuss T1-weighted imaging signal characteristics. Subacute and chronic spinal EDH have usually been described as hyperintense (1,11,12,30,31,34,35,36,37) , and less often as isointense (1,31,34) , to the spinal cord on T1-weighted images. In a series of three cases of spontaneous spinal EDH within 48 and 72 hours, Rothfus et al (31) described the MR signal characteristics.…”

Section: Imagingmentioning

confidence: 99%

Spontaneous Spinal Epidural Hematomas: Case Series with Review of Literature

Khan¹

2017

JMSCR

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“…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.…”

Section: Casementioning

confidence: 99%

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

Sarubbo¹,

Garofano

Maida

et al. 2009

Eur Spine J

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Spinal epidural hematoma (SEH) represents the most frequent entity of acute or chronic spinal bleeding. Based upon pathogenesis, SEH can be classified as idiopathic, spontaneous, and secondary. The idiopathic forms are considered not to be attributed to any specific risk factors. Spontaneous SEH, accounting for 0.3-0.9% of all spinal epidural space occupying lesions, instead is associated with risk factors (such as substantial soft trauma or coagulation abnormalities). The chronic form, as our literature review revealed, is the rarest and its most frequent location is the lumbar spine. The pathophysiology of spontaneous and idiopathic SEH is still under debate: There are only a few reports in literature of chronically evolving SEH with progressively increasing pain and neurological impairment. Magnetic resonance imaging may be inconclusive for differential diagnosis. Here, we present two cases of lumbar chronic SEH with slow, progressive, and persistent lumbar radicular impairment. The first patient reported a minor trauma with slight back contusion and thus was classified as spontaneous SEH. In the second case not even a minor trauma was involved, so we considered it to be idiopathic SEH. In both cases preoperative blood and coagulation tests were normal and we did not find any other or cofactors in the patients' clinical histories. MR imaging showed uncertain spinal canal obstructing lesions at L3 and L4 level in both cases. Surgical treatment allowed a correct diagnosis and resulted in full clinical and neuroradiological recovery after 1 year follow-up. Our aim is to discuss pathogenesis, clinical and radiological features, differential diagnosis and treatment options, on the background of relevant literature review.

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MR Imaging in the Diagnosis of Spontaneous Spinal Epidural Hematomas

Cited by 75 publications

References 0 publications

Spinal Epidural Hematoma after Pain Control Procedure

Spinal Epidural Hematoma after Pain Control Procedure

Spontaneous Spinal Epidural Hematomas: Case Series with Review of Literature

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

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