Spontaneous Spinal Epidural Hematoma During Pregnancy

Abstract

ABSTRACT:Background:Spontaneous spinal epidural hematoma is a rare phenomenon that has no distinct etiology. Spontaneous spinal epidural hematoma (SSEH) during pregnancy is extremely rare. We present what we believe to be the fifth reported case of spontaneous spinal epidural hematoma associated with pregnancy in the English literature.Methods:A 31-year-old female presented with acute onset of paraplegia at 32 weeks of pregnancy. The patient had a T2 sensory level and complete paralysis of all lower extremity motor groups. Magnetic resonance imaging of the thoracic spine showed an acute epidural hematoma posterior to the thoracic spinal cord between the second and fourth thoracic vertebrae.Results:The patient was taken to the operating room were her child was delivered by caesarean section. She then underwent a posterior laminectomy and evacuation of a spinal epidural hematoma. Followup selective spinal angiography was negative for any vascular malformation. The patient gradually recovered lower extremity function and was independently ambulating at six month follow-up. Voluntary bowel and bladder function returned within four months but twice daily intermittent catheterization remained necessary for excessive post-void residual urine.Conclusions:Spontaneous spinal epidural hematoma in pregnancy is a rare phenomenon. It is postulated that elevated venous pressure associated with pregnancy may be a contributing factor. In the reported cases of SSEH in pregnancy most patients presented with acute symptoms, thoracic location and profound neurological deficits but, with prompt surgical treatment, generally had good long term recovery.

Postpartum Spinal Cord Injury in a Woman With HELLP Syndrome

“…There have only been 9 previously published cases of SSEH occurring during pregnancy (1)(2)(3). We present what we believe is the first reported case of SSEH associated with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome occurring directly postpartum.…”

“…Clinically, SSEH presents as severe localized back pain, often with a radicular component (3). Onset of pain may be related to minor straining but is mostly spontaneous.…”

“…Neurological symptoms appear rapidly and may progress to SCI. When neurological abnormalities develop, MRI of the spinal cord and a coagulation profile should be performed (3). MRI is recommended for identifying the level of injury, presence of hemorrhage and edema, and degree of cord compression (5).…”

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].…”

“…It is postulated that high venous pressure associated with pregnancy must be a contributing factor [11,12], also, pregnancy-induced structural changes of the vascular walls and hemodynamic changes may play a role in the pathogenesis of spontaneous spinal epidural hematoma.…”