Spontaneous anterior cervicothoracic spinal epidural hematoma extending to clivus in SARS-CoV-2 infection

Abstract

Background: The treatment of spontaneous spinal epidural hematomas (SSEHs), depending on the lesion size and myeloradicular involvement, can be surgical or conservative. Here, we present a 55-year-old patient who sustained a SSEH several months following a systemic SARS-CoV-2 infection. Case Description: A 55-year-old immunocompromised female (i.e., history 17 years ago of Hodgkin’s lymphoma, nodular sclerosis variant) recently developed a SARS-CoV-2 infection treated with nonsteroidal anti-inflammatory agents. She then reported the sudden onset of cervicodorsalgia after a slight cervical flexion/extension maneuver. The brain and cervicothoracic spine MRI studies documented a clival anterior spinal epidural hematoma with maximum spinal compression at the T1-T2 level; it also extended inferiorly to the T6 level. Two weeks later, the follow-up MRI showed a remarkable reduction in the anteroposterior diameter of the hematoma that correlated with significant neurological improvement and almost complete pain regression. She was discharged after a total 15-day hospital stay, with complete symptoms relief. Conclusion: We present a 55-year-old chronically immunocompromised (i.e., due to the history of Hodgkin’s lymphoma) female who, following a SARS-CoV-2 infection, developed an anterior SSEH extending from the clivus to the T6 spinal level that spontaneously regressed without surgical intervention.

Spontaneous Cervical Epidural Hematoma Following COVID-19 Illness Presenting to a Chiropractor: A Case Report

“…To our knowledge, this case is the first report of a chiropractor identifying SEH. As the patient had no specific risk factors for SEH and diclofenac is not associated with SEH to our knowledge [ 14 ], it seems possible given other similar recent studies [ 5 - 8 ] that his COVID-19 illness could have been a predisposing factor for SEH.…”

“…According to a search of PubMed and Google Scholar on November 18, 2022, we identified four previously published cases of spontaneous SEH in patients following COVID-19 infection [5][6][7][8]. Several mechanisms have been suggested to explain these events, including venous thromboembolism, disseminated intravascular coagulation, increased pressure in the epidural venous plexus, and vasculitis [5][6][7], however, there is no clear unifying pathophysiological explanation. In addition, larger studies have identified an association between COVID-19 and other conditions involving bleeding such as intracranial hemorrhage and spontaneous muscle hematoma [9,10].…”

“…In addition, recent case reports have suggested that SEH may develop as a complication of coronavirus disease 2019 (COVID-19) [5][6][7][8]. While research relating SEH to COVID-19 is limited, recent systematic reviews have suggested that several bleeding conditions such as intracranial hemorrhage and muscle hematomas are also potential complications of COVID-19 [9,10].…”

Post-COVID-19 Spondylodiscitis: A Case Study and Review of the Literature

“…Immunosuppression induced by the viral infection, the corticotherapy or immunomodulator agents are generally increasing the susceptibility for infections. Particularly for severe COVID-19 pneumonia, the respiratory disfunction associate increased intrathoracic pressure, microtrauma of the small vessels and haematomas of ligamental or muscular tissues, that could be favoured by the anticoagulant treatment [ 37 ]. The epidural vascular plexus is communicating with thoraco-abdominal venous vascularization and epidural or vertebral discs haematoma could be ruptured during the intense cough, with consecutive adjacent necrosis [ 37 ].…”

Spontaneous spinal epidural hematoma in a pediatric hemophiliac

“…In adults, SSEH occurs with a frequency of 0.1 cases/100,000/year, and account for 0.6% of all spinal hemorrhages; in children, their incidence remains unclear. [ 19 , 31 , 34 ] Conservative treatment (i.e., infusion of recombinant coagulation factors, corticosteroids) may suffice where there are no major neurological deficits, while surgery is warranted for those with significant paresis. [ 4 , 6 , 8 ] Here, a 1-year-old hemophiliac male with a significant C5-T10 SSEH that contributed to a severe quadriparetic deficit warranted emergent surgical decompression.…”