Spontaneous spinal epidural hematoma inducing acute anterior spinal cord syndrome

Abstract

<jats:p>Spontaneous spinal epidural hematoma (SSEH) is rare. Its etiology remains controversial; however, spinal venous wall susceptibility to intravenous pressure change and the resultant venous rupture seem to be involved. The authors report a case of SSEH dorsal to the spine producing acute anterior spinal cord syndrome. A posterior SSEH between the C-3 and T-5 levels caused progressive tetraparesis and the disappearance of superficial body sensation below the level of C-8, although deep sensation remained completely intact. This neurological false localizing sign seems to have resulted from counterforce by preexisting asymptomatic cervical intervertebral disc herniation at the C6–7 levels inducing direct pressure on the anterior spinal cord. This case is the first reported instance of posterior cervical SSEH manifesting acute anterior spinal cord syndrome as its false localizing sign.</jats:p>

A Case of Spontaneous Spinal Epidural Hematoma Mimicking a Stroke

“…They also considered that the blood flow in the anterior spinal artery was modified by a combination of the SSEH and the herniated intervertebral disc, causing a pinching effect. 11 In our case, asymptomatic intervertebral disc herniation was observed at the C6 level (Fig. 1).…”

“…10 The cause of SSEH is uncertain, but it has been associated with hypertension, anticoagulation, elevated venous pressure, pregnancy, labor, and vascular malformation. 11 The initial clinical manifestations of SSEH are back and neck pain and, eventually, compressive myelopathy symptoms. In most cases the hematoma is located on the dorsal aspect of the spinal cord, leading to the belief that the posterior epidural venous plexus is the main source of SSEH.…”

“…11 The authors suggested that the anterior spinal artery syndrome resulted from a counterforce due to a preexisting asymptomatic cervical intervertebral disc herniation inducing direct pressure on the anterior spinal cord. They also considered that the blood flow in the anterior spinal artery was modified by a combination of the SSEH and the herniated intervertebral disc, causing a pinching effect.…”

Spinal Epidural Hematoma Related to Intracranial Hypotension

“…Although it can occur anywhere in the spinal cord, it mostly occurs in the dorsal spine, especially in the thoracolumbar and cervicothoracic region (the posterior and posterolateral region of the spinal cord)4,11,18). It clinically manifests typically as sudden pain on the back or neck accompanied by sensory and motor paralysis symptoms, which progress fast according to the area and the degree of pressure on the spinal nerve2,8,9,11,18). It can be diagnosed according to the patient's medical history and the results of the neurological examination, spinal cord angiography, CT, and MRI9,11).…”

Exertional ventral epidural hematoma in the lumbar spine

“…To the authors' best knowledge, there is only one report of extertional spinal epidural hematoma [1]. Only two cases have been reported for spontaneous ventral spinal epidural hematomas in adults with one being in the cervical region [2] and the other in the thoracic [3].…”