Traumatic epidural hematoma of the cervical spine: diagnosis with magnetic resonance imaging

Pan, Golden; Kulkarni, M. V.; MacDougall, David J.; Miner, Michael E.

doi:10.3171/jns.1988.68.5.0798

Cited by 105 publications

(62 citation statements)

References 15 publications

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“…The formation of spinal epidural hematoma after trauma is rare. Because the use of MR imaging in trauma has become more common, asymptomatic spinal epidural hematomas have been discovered and treated conservatively [19]. It is conceivable that some of these hematomas, which were diagnosed by imaging alone, actually may be CSF collections associated with a small amount of blood products in the cerebrospinal fluid.…”

Section: Discussionmentioning

confidence: 99%

Anterior spinal pseudomeningocele after C0–C2 traumatic injuries: role of the “dural transitional zone” in the etiopathogenesis

2013

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Purpose Spinal pseudomeningoceles (SPM) are extradural collections of CSF (cerebrospinal fluid); a frequent association with upper cervical injuries (UCI) has been observed. We propose a possible etiopathogenetic mechanism supporting the formation of cervical SPM based on some considerations. Methods We present four cases of SPM. All patients sustained a severe UCI. Three patients were symptomatic with delayed and progressive clinical signs. Results One patient was misinterpreted as epidural hematoma and operated on due to progressive signs with postoperative clinical improvement. The rest of patients were treated conservatively; spontaneous reduction of CSF collection occurred. From a radiological standpoint: (1) a line of demarcation separated the intradural cervical compartment from the anterior epidural space, (2) CSF epidural collection was never evident at C0-C2 level and extended from C2 downwards, and (3) shape of collection was similar to epidural hematomas suggesting a ball-valve mechanism. Conclusions The dural layer at C0-C2 level is adherent to the thick ligamentous apparatus, as opposed to the segments below where it is solely covered by the posterior longitudinal ligament. A ''transitional zone'' of dura exists between the C0-C2 region and subaxial segment of the cervical spine. This watershed area constitutes a point of minor resistance. Lacerations of the meningeal layers, caused by severe UCI at the ''transitional zone'', drain CSF into the anterior epidural space and form SPM.

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Section: Discussionmentioning

confidence: 99%

Anterior spinal pseudomeningocele after C0–C2 traumatic injuries: role of the “dural transitional zone” in the etiopathogenesis

2013

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“…1,14) Traumatic spinal epidural hematoma is frequently associated with pre-existing degenerative vertebral disease. 12) However, the exact mechanisms of the bleeding remain controversial. Direct mechanical injury to the surrounding soft tissue, as seen in vertebral trauma, epidural injection, lumbar puncture, and birth…”

Section: Discussionmentioning

confidence: 99%

“…Rupture of the epidural venous plexus in response to trauma or to an increase in venous pressure may be the mechanism in such cases. 12) Other possible mechanisms for hematoma include deterioration of preexisting chronic hematoma, minor pinching of small arteries resulting in delayed bleeding, formation of traumatic arteriovenous fistula, and``true'' spontaneous hematoma occurring incidentally after spinal injury.…”

Section: T Kondoh Et Almentioning

confidence: 99%

Cervical Epidural Hematoma After Snowboarding Injury. Case Report.

Kondoh

Kurihara

Kohmura

2002

Neurol. Med. Chir.(Tokyo)

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A 21-year-old man developed cervical spinal epidural hematoma one month after a snowboarding injury. He fell down while snowboarding and hit his occiput. Immediately after the injury, he suffered hypesthesic pain in the C-8 area associated with dull neck pain, which persisted for a month. Radiography of the cervical spine detected no pathological findings. The second attack of pain occurred when he was resting, followed by paraparesis and loss of urinary sensation within 24 hours. Emergent magnetic resonance (MR) imaging demonstrated an epidural hematoma at the levels of C-7 to T-2 which compressed the spinal cord. During the operation for removal of the hematoma, arterial rebleeding occurred from a small artery in the dural sac on the right C-8 root, which was thought to be responsible for the hematoma. The patient was discharged with no neurological deficits. Snowboarding-related injuries occur with higher frequency and involve greater risks compared to skiing-related injuries. Repeat MR imaging is strongly recommended to follow up any spinal injury, particularly in cases associated with focal neurological signs.

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“…Nevertheless, for up to one-third of the SEHs, no clear etiology can be found and if associated with co-factors such as minor trauma, these are termed ''spontaneous'' spinal epidural hematomas (SSEH). Finally, SEHs are defined ''idiopathic'' when not any associated causal condition can be identified [29].…”

Section: Casementioning

confidence: 99%

Spontaneous and idiopathic chronic spinal epidural hematoma: two case reports and review of the literature

Sarubbo¹,

Garofano

Maida

et al. 2009

Eur Spine J

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Spinal epidural hematoma (SEH) represents the most frequent entity of acute or chronic spinal bleeding. Based upon pathogenesis, SEH can be classified as idiopathic, spontaneous, and secondary. The idiopathic forms are considered not to be attributed to any specific risk factors. Spontaneous SEH, accounting for 0.3-0.9% of all spinal epidural space occupying lesions, instead is associated with risk factors (such as substantial soft trauma or coagulation abnormalities). The chronic form, as our literature review revealed, is the rarest and its most frequent location is the lumbar spine. The pathophysiology of spontaneous and idiopathic SEH is still under debate: There are only a few reports in literature of chronically evolving SEH with progressively increasing pain and neurological impairment. Magnetic resonance imaging may be inconclusive for differential diagnosis. Here, we present two cases of lumbar chronic SEH with slow, progressive, and persistent lumbar radicular impairment. The first patient reported a minor trauma with slight back contusion and thus was classified as spontaneous SEH. In the second case not even a minor trauma was involved, so we considered it to be idiopathic SEH. In both cases preoperative blood and coagulation tests were normal and we did not find any other or cofactors in the patients' clinical histories. MR imaging showed uncertain spinal canal obstructing lesions at L3 and L4 level in both cases. Surgical treatment allowed a correct diagnosis and resulted in full clinical and neuroradiological recovery after 1 year follow-up. Our aim is to discuss pathogenesis, clinical and radiological features, differential diagnosis and treatment options, on the background of relevant literature review.

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Traumatic epidural hematoma of the cervical spine: diagnosis with magnetic resonance imaging

Cited by 105 publications

References 15 publications

Anterior spinal pseudomeningocele after C0–C2 traumatic injuries: role of the “dural transitional zone” in the etiopathogenesis

Anterior spinal pseudomeningocele after C0–C2 traumatic injuries: role of the “dural transitional zone” in the etiopathogenesis

Cervical Epidural Hematoma After Snowboarding Injury. Case Report.

Spontaneous and idiopathic chronic spinal epidural hematoma: two case reports and review of the literature

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