J Korean Soc Spine Surg.  2008 Sep;15(3):194-198. 10.4184/jkss.2008.15.3.194.

Spontaneous Spinal Epidural Hematoma of the Thoracic Spine in Young Adult: A Case Report

Affiliations
  • 1Department of Orthopedic Surgery, School of Medicine, Gyeongsang National University, Jinju, Korea. dhkim8311@yahoo.co.kr

Abstract

A spontaneous spinal epidural hematoma (SSEH) of the thoracic spine is a rare space-occupying disease that accompanied with severe axial pain in the spine. Because there is the possibility of a significant neurological injury such as paraplegia, SSEH requires careful diagnosis and management. A SSEH is mainly caused by a coagulating disorder or anticoagulant medication, while certain cases have shown that this disease is related with spinal inflammatory conditions. A SSEH tends to occur in patients who have risk factors for hemorrhage. However, the incidence of SSEH is quite low, and there are few domestic reports of a SSEH in young adults who are without the risk factors for hemorrhage. We encountered a 25 years old young male without a prior significant medical history and he was suffering from severe back pain and paraplegia due to a SSEH at the thoracic spine. The early diagnosis was made via MRI. We report here on a favorable clinical outcome that was achieved with immediate operative treatment, and we include a review of the relevant literature.

Keyword

Spontaneous spinal epidural hematoma (SSEH); Thoracic spine; Young adult; Operative treatment

MeSH Terms

Back Pain
Early Diagnosis
Hematoma, Epidural, Spinal
Hemorrhage
Humans
Incidence
Male
Paraplegia
Risk Factors
Spine
Stress, Psychological
Young Adult

Figure

  • Fig. 1. (A, B) T1 and T2-weighted sagittal image demonstrates fusiform-shaped hematoma in the spinal canal, (C) sagittal image after Gadolinium-DTPA injection shows poorly enhanced hematoma filled the spinal canal, extending from T7-T9. (D) T2 weighted axial image demonstrates spinal cord-compressing hematoma with high and intermediated signal intensity at posterior aspect of spinal cord. (E) T1 weighted enhanced axial image shows poorly enhanced mass-like lesions.

  • Fig. 2. The x-rays at 2 year 6 months follow-up show no kyphosis and spinal instability (arrow: laminectomy site).


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