Spontaneous spinal epidural hematoma in a young individual associated with hypertension

Abstract

A 24-year-old male was admitted to a peripheral hospital with a history of sudden onset neck pain, radicular pain right upper limb associated with paresthesia bilateral lower limb. Over the next 24-36 h, patient developed rapidly progressive weakness of all four limbs initially involving the bilateral lower limbs with urinary retention. There was no history of trauma or breathing difficulty. At the time of admission in the peripheral hospital, patient was detected to have blood pressure of 186/106 mm Hg. Neurological evaluation revealed quadriparesis with power Medical Research Council (MRC) 3/5 in both upper limbs and MRC 2/5 in bilateral lower limbs. There was diminished pin prick sensation below CV7 dermatome. Deep tendon jerks were sluggish, and plantars were mute bilaterally. Hematological data including platelet count, coagulation profile, and biochemical parameters were within normal limits. Urgent magnetic resonance imaging (MRI) of the cervical spine revealed a mass lesion predominantly in left posterolateral region extending from CV4 to CV6 which was isointense to cord on T1-weighted images [ Figure 1a] and heterogeneously hyperintense to cord on T2-weighted images [ Figure 1b] as seen on sagittal images. On T1-and T2-weighted axial images, INTRODUCTIONSpontaneous spinal epidural hematoma (SSEH) is a very rare entity, and the first case was reported by Jackson.[1]The incidence has been estimated as 0.1 patients/100,000 individuals and represented <1% of all spinal space occupying lesions.[2] The usual clinical presentation of SSEH is sudden onset neck pain or back pain associated with para/quadriparesis or para/quadriplegia depending on the level of the lesion. This entity has been reported to be associated with blood dyscrasias, coagulopathy, anticoagulant treatment, infections, tumors, pregnancy vascular malformations, rheumatoid arthritis, Paget's disease, and rarely hypertension, however, no definite cause can be found in 40-50% of cases. [2][3][4][5] Although emergency surgical decompression is the recommended approach, [6,7] conservative management is advocated in the literature in few case reports if the patient has objective improvement in his neurological status early in the course of the disease. [6,8,9] We report our case which is unique in that the patient was detected to A B S T R A C TSpontaneous spinal epidural hematoma (SSEH) is a rare cause of acute spinal cord compression. The exact etiology of this entity is not known, and it has been associated with blood dyscrasias, coagulopathy, infection, tumor, vascular malformations, and hypertension in the literature. Emergency surgical decompression is the treatment of choice, however, lately conservative management of SSEH has been advocated in the literature for a particular group of patients whose clinical profile shows early improvement of their neurological status. We report a case of SSEH in a 24-year-old male who had severe hypertension at the onset of the SSEH leading to quadriparesis, and he was managed conservatively. The patient's ...