Spontaneous spinal epidural haematoma during pregnancy: case report and review of the literature

Abstract

Spontaneous epidural haematoma is rare in pregnancy and only five cases have been reported. We present a case of a 31-year-old female G2P1 who at 32 weeks of gestation developed progressive ascending paralysis and numbness to a level of approximately T4. An urgent MRI of the spine was performed, which demonstrated a posterior epidural lesion at T1-T4 level. The lesion showed signal changes consistent with an epidural haematoma in the hyperacute stage. An emergency cesarean section was performed followed by spinal decompression and removal of an epidural haematoma. The patient's neurological function subsequently improved. The diagnosis and management of spontaneous epidural haematoma in pregnancy is presented with a review of the literature.

Nontraumatic spinal epidural hematoma during pregnancy: diagnosis and management concerns

“…A further three articles were excluded; the first as it was the same case as reported in another study, published in another language, 9,10 the second because the article presented SEH occurring after chiropractic manipulation 11 and the third reported a case of unilateral epidural nerve root hematoma in a pregnant patient. 12 The remaining 21 articles were all case report design; 4,5,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] to be noted, the article by Tada et al 30 reported 3 cases, making a total of 23 cases (Table 1).…”

“…4,[14][15][16][17][18]20,21,[23][24][25][26][27][28][29][30] The hematoma was located in the anterior epidural space in 7 cases and the posterior epidural space in 14 cases. In two cases, the antero- Abbreviations: Ant, anterior; C, cervical; CS-D, cesarean section delivery; G1, first gestation; Gest.…”

“…It has been postulated that an acute increase of the spinal epidural vein pressure is a probable contributing factor 40 and that epidural veins are more susceptible to congestion during pregnancy. 15,25 In addition, aortocaval compression may significantly impede venous return as early as the middle of the second trimester, and may increase spinal vein congestion within the negative pressure compartment of the epidural space. 15,25 However, such phenomena are common in pregnancy, whereas pregnancy-related SEH is a rare occurrence.…”

Spontaneous Spinal Epidural Hematoma Causing Paraplegia: A Case Report

“…It is also a rare occurrence during pregnancy, with only six cases reported in the literature [12]. Statistically, idiopathic cases account for approximate 40% of all cases [13] [14]. The most common site of a spontaneous spinal epidural hematoma is the cervicothoracic region or thoracolumbar region [7] [15].…”

“…Valsalva maneuvers, such as straining, coughing, or lifting, increase intra abdominal and intrathoracic pressure [6] [22]. This, in turn, is transferred to the spinal epidural venous system and is thought to contribute to the rupture and hemorrhage of the epidural venous vessels [14] [23]. The typical clinical presentation of SSEH is the sudden onset of severe back, neck or inter scapular pain followed by progressive neurological deficits (paraparesis or quadriparesis).…”