Spontaneous spinal epidural hematoma at the 16th week of a twin pregnancy

Abstract

Spontaneous spinal epidural hematoma without discernable underlying conditions is a rare complication during pregnancy. We report a pregnant woman who developed the hematoma at 16 weeks of pregnancy; the earliest occurrence ever reported. A 36-year-old Japanese primipara with twins felt shoulder, neck and back pain at 16(+1) weeks with progressive quadriplegia. Magnetic resonance imaging revealed a mass in the C3-7 epidural space, compatible with a spinal epidural hematoma, and decompression was performed 9 h after symptom onset. Rehabilitation started and she gave birth abdominally to healthy twin infants at the 29th week. Motor, sensory and sphincter disturbances remained. This case demonstrates that spinal epidural hematoma can occur even without known underlying conditions and even at an early gestational age.

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).…”

“…18 One patient presented with twin pregnancy. 28 The remaining 21 patients had no significant medical history.…”

“…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.…”

Spontaneous Thoracic Epidural Haematoma during Pregnancy: Another Case!

“…Many situations could contribute to this haematoma such as aretrial hypertension, vasculitis, ankylosing spondylitis, physical strain, coagulation disorders [1], angiolipoma [5], preeclampsia and hellp syndrome [6,7] and the use of low molecular weight heparin [8]. It occurs early in pregnancy [9], during second and third trimester and in the post partum stage as well [10][11][12].…”

Spontaneous spinal epidural hematoma during pregnancy

“…Recently, we reported a woman with twin pregnancy suffering SSEH at the 16 th week of gestation 2 . To our knowledge, 14 cases of SSEH during pregnancy have been reported 2,3 : decompression surgeries were performed in all cases. Both veins and arteries can be candidates of origin for SSEH.…”