Spontaneous spinal epidural haematoma: a therapeutical challenge?: Report of an unusual case

Schröder, J.

doi:10.1136/emj.2003.014027

Cited by 11 publications

(4 citation statements)

References 10 publications

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“…Because these symptoms can mimic a disc herniation, epidural tumor or an infection, differential diagnosis is important. MRI has been currently recognized as the most accurate diagnostic method for establishing a differential diagnosis10,19,27). The MR imaging appearance of SSEH is heterogeneously hyperintense on the T2-weighted MR images and homogeneously isointense on the T1-weighted images.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment

Kim

Lee

Hyun

et al. 2012

J Korean Neurosurg Soc

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ObjectiveThe incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome.MethodsWe included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size.ResultsAmong fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods.ConclusionFor the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment

Kim

Lee

Hyun

et al. 2012

J Korean Neurosurg Soc

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“…The etiologies of spinal epidural hematoma varied from idiopathic to various identifiable causes such as spinal trauma, coagulopathy, pregnancy and child delivery, and spinal invasive procedures. 8 Spontaneous rupture of Batson's venous plexus was attributed in idiopathic or spontaneous cases. 9 There was no identifiable causes or notable precipitating factors of spinal epidural hematoma in the presented case.…”

Section: Discussionmentioning

confidence: 99%

Thunderclap headache as a presentation of spontaneous spinal epidural hematoma with spontaneous recovery

Sathirapanya

Setthawatcharawanich

Limapichat

et al. 2013

The Journal of Spinal Cord Medicine

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Background: Spontaneous spinal epidural hematoma (SSEH) is a rare spinal cord compression disorder. Thunderclap headache mimicking subarachnoid hemorrhage as an initial manifestation of this disorder has been scarcely reported. Moreover, the neurological outcome of conservative treatment is satisfactory only in some clinical settings. The unusual presentation and mechanisms for spontaneous recovery of SSEH are discussed. Objective: To report a case of SSEH that presented with acute severe headache that mimicked subarachnoid hemorrhage. After a period of neurological deficit, spontaneous improvement was seen, which progressed to full recovery without neurosurgical intervention. Findings: A 62-year-old man presented with acute occipital headache and neck stiffness for which subarachnoid hemorrhage was initially suspected. An emergency computed tomographic brain scan and cerebrospinal fluid analysis excluded subarachnoid hemorrhage. Later, he developed acute paraparesis, hypoesthesia up to the fourth thoracic dermatomal level (T4) as well as bowel and bladder dysfunction. The magnetic resonance imaging eventually revealed spinal epidural hematoma, located anterior to C7 through T4 spinal level. He had no previous history of spinal injury, systemic, and hematological disorders. The neurological recovery began 20 hours after the onset and continued until complete recovery, 4 months after the onset without neurosurgical intervention. Conclusion: SSEH could sometimes imitate subarachnoid hemorrhages when it located in the cervical region. Spontaneous recovery of SSEH without surgical intervention might be possible in cases with continuing neurological recovery, although the recovery began much later in the clinical course.

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“…[17][18][19] Conservative management of the SSEH may be appropriate if early and substantial neurologic recovery is noticed. 19 Conservative management is often successful, but it can also put such patients at risk for developing spinal cord damage that may not be reversed by an evacuation of the hematoma. 10 On the other hand, the cornerstone for the treatment of spinal epidural abscess is decompression and sampling contents.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Cervical Epidural Hematoma Masquerading as an Abscess on Magnetic Resonance Imaging Scan

Nourbakhsh

Chaljub

Garges

2009

Journal of Manipulative and Physiological Therapeutics

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Spontaneous spinal epidural haematoma: a therapeutical challenge?: Report of an unusual case

Cited by 11 publications

References 10 publications

Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment

Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment

Thunderclap headache as a presentation of spontaneous spinal epidural hematoma with spontaneous recovery

Spontaneous Cervical Epidural Hematoma Masquerading as an Abscess on Magnetic Resonance Imaging Scan

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