Spinal Epidural Hematoma Related to Intracranial Hypotension

Abstract

A 45-year-old female patient visited the hospital complaining of severe sudden headache and posterior neck pain. The patient did not have any traumatic history or abnormal neurologic finding. The patient had sudden quadriplegia and sensory loss. Cervical spine MRI scan was taken, and the compatible findings to acute epidural hematoma were shown. The emergency operation was performed. After the operation, the patient recovered all motor and senses. As there was CSF leakage in the postoperative wound, this was confirmed by cervical spinal computed tomography (CT). Then lumbar drainage was thus performed. The opening pressure upon lumbar puncture was not measured as it was very low. As a result of continous CSF leakage, dural repair was performed. After the operation, the patient had been discharged without neurologic deficits. In this case, it is sensible to suspect intracranial hypotension as a possible cause of spinal EDH.

Iatrogenic Spinal Epidural Hematoma Associated with Intracranial Hypotension

“…Our patient had intracranial hypotension concomitantly with a spinal epidural hematoma. Although intracranial subdural hematoma is a well-known complication of intracranial hypotension, spinal epidural hematoma has been only described once in the setting of intracranial hypotension [8]. We believe we have a similar case with an important difference: the former case involved a spontaneous spinal epidural hematoma, and our case appears to be iatrogenic secondary to a seemingly uncomplicated cervical ESI causing a dural leak.…”

“…Conflicting literature exists on whether the bleeding is arterial or venous [7]. Spontaneous spinal epidural hematoma is reported to be rare [4,8], and those iatrogenically induced from epidural injections appear to be even rarer. According to Caputo et al, millions of ESIs have been completed since 1960.…”

Intracranial hypotension as a complication of lumbar puncture prior to elective aneurysm clipping

“…Persistent intracranial hypotension is a known complication of dural access procedures including lumbar puncture,[ 2 ] lumbar drain placement,[ 3 ] epidural steroid injections,[ 12 ] and epidural catheter placement. [ 11 ] Although it often presents only as postural headaches, serious complications including cranial nerve palsies,[ 3 11 ] venous thrombosis,[ 6 ] and spinal epidural hematomas[ 4 ] have been reported. In our case, the patient's family noted that she continued to have persistent headaches through the day of surgery following her lumbar puncture at the outside facility, but because her initial reason for presentation was headache, there was little suspicion of any relationship between this symptom and her lumbar puncture.…”