J Korean Soc Spine Surg.  2006 Dec;13(4):332-335.

Surgical Treatment of Spontaneous Cervicothoracic Spine Epidural Hematoma without Risk Factors: A Case Report

• Song KS
• Jang EC

Abstract

Spinal epidural hematomas can often result from a spinal tap, trauma, pregnancy, bleeding diathesis, vascular malformations, hypertension, etc. However, a spontaneous spinal epidural hematomas (SSEH) without any risk factors are relatively rare clinical entities and the clinical suspicion is very difficult in an acute setting. The outcome for patients with SSEH usually is determined by the speed of the diagnosis and the initiation of the appropriate treatment. We present a good surgical outcome of a rare case of acute SSEH without any risk factors. The patient presented initially with paresis of both upper and lower extremities, upper thoracic and neck pain and mild headache. We report the diagnosis and treatment method of SSEH in this case with a review of the relevant literature.

Keyword

Cervicothoracic spine; Spontaneous; Epidural hematoma; Risk factor; Surgical treatment

MeSH Terms

Diagnosis
Disease Susceptibility
Headache
Hematoma*
Hematoma, Epidural, Spinal
Hemorrhage
Humans
Hypertension
Lower Extremity
Neck Pain
Paresis
Pregnancy
Risk Factors*
Spinal Puncture
Spine*
Vascular Malformations

Figure

• 

  Fig. 1. The cervicothoracic spine magnetic resonance imaging show epidural spaceoccupying lesion (arrows) extending from C5 to T2. The lesion is isointense to the spinal cord on the T1-weighted image (A), a little hyperintense or mixed signal than spinal cord on the T2-weighted image (B) and poorly enhanced (C). On the axial T2-weight image (D), the hematoma (blank arrow) was located on dorsal portion to the cord (arrow) is severely compressed.

• 

  Fig. 2. The laminas from C6 to T2 is opened at left side (A). The epidural hematoma is wrapped in a fibrous membrane (arrows). The hematoma after removal of fibrous membrane (B). The decompressed cord after removal of epidural hematoma (C).

• 

  Fig. 3. Well decompressed cord (arrows) at postoperatively 4 weeks.

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