Since its introduction through safe motherhood initiative, little is known about its existence in. The patient presented with a 7month history of low back pain and bilateral sciatica. Paul rosman, in swaimans pediatric neurology sixth edition, 2017. Acute spinal epidural hematoma may occur spontaneously with no apparent or only trivial antecedent cause. Spinal subdural or epidural hematoma neurologic disorders. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 515% of patients with fatal head injuries. These hematomas may result in longterm or permanent paralysis 5.
The usual clinical presentation of sseh is sudden neck or back pain that progresses toward paraparesis. Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. Epidural and subdural hematomas hematomas are bruises that are caused by injuries to blood vessels underneath the skin, known as a bruise. Spinal epidural hematomas edh are a rare spinal pathology which can result in serious morbidity with delayed or nontreatment.
Bleeding may also occur secondary to trauma, spinal surgery, angioma, vascular malformation or coagulopathies, most particularly anticoagulant therapy. Acute spinal subdural hematoma assh is an uncommonly recognized condition that if left untreated can result in severe irreversible neu rologic deficits 17. Spontaneous spinal epidural hematoma sseh is a rare disease that can lead to the acute onset of severe neurological deficits, 1 requiring early. Spontaneous spinal epidural hematoma sseh is a relatively rare disease. Some of the most likely causes of an epidural hematoma include. Incidence of epidural hematoma could be calculated within goal precision 0. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Etiopathogenesis of traumatic spinal epidural hematoma ncbi. Hematomas below the level of the conus medullaris are more likely to be chronic because the spinal roots appear to tolerate pressure better than the spinal cord and its arteries.
Acute spinal epidural hematoma arrows in thoracic spine diagnosed by sharply demarcated focal areas of increased density of 104110 hounsfield units h. Spinal epidural hematoma is a rare, but potentially devastating, consequence of accessing the epidural space for anesthesia or interventional pain procedures. Monitor patients frequently for signs and symptoms of neurological. Postoperatively, the back pain was resolved and the patient was discharged 6 days after the operation without further neurological problems or persisting pain. Spinal epidural hematoma without significant trauma is a rare condition with potentially severe outcome. The patient presented had a presumed spinal cerebrospinal fluid leak with symptoms of intracranial hypotension. A metaanalysis of spinal hematomas showed that 75% are epidural in origin. The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting. Dec 07, 2017 an epidural hematoma is a potentially lifethreatening complication of a head injury. However, the first attempt failed at l34 because of repeated bone contact as well as a sanguine puncture presumed to be outside the epidural space. Spinal epidural hematoma after spinal cord stimulator. Spontaneous spinal epidural hematoma sseh is a rare disease that can lead to the acute onset of severe neurological deficits, 1 requiring early diagnostics and rapid treatment to reduce the. However, it has been reported to occur in all age groups, and it is a very rare clinical entity in children.
Clinical indications for epidural anesthesia and analgesia have expanded significantly over the past several decades. The presentation, investigation, and management of four patients with spontaneous spinal epidural haematoma is presented. Of note, this is the only epidural hematoma to result from spinal injection in the primary authors 21 years of practice. Traumatic sehs are considered to occur secondary to spinal surgeries, lumbar puncture, vertebral fractures, and any spinal intervention. Seh may be acute or chronic, spontaneous, posttraumatic, or iatrogenic. Spinal epidural hematoma without significant trauma in.
The usual clinical presentation of sseh is sudden neck or back pain that progresses toward paraparesis or quadriparesis, depending on the. A 60yearold female experienced sudden back pain combined with numbness and weakness. This patient had a spinal epidural hematoma, which is defined as a spontaneous collection of blood in the spinal epidural space. A spinal subdural or epidural hematoma is an accumulation of blood in the subdural or epidural space that can mechanically compress the spinal cord. Spinalepidural hematoma following epidural anesthesia in. Oct 29, 2018 spinal epidural hematoma seh is an idiopathic aggregation of blood in epidural space which can be as acute, chronic, spontaneously, post traumatic, or iatrogenic. Epidural analgesia is often used to supplement general anesthesia ga for surgical procedures in patients of all ages with moderatetosevere comorbid disease. Spinal epidural hematoma radiology reference article. However, sseh after taking herbal medicines has not been described yet.
Spontaneous spinal epidural hematoma is rare in children. It is usually confined to the dorsal epidural space. To the best of our knowledge, we present the first case of a patient with an iatrogenic hypercoaguable state performing selfneck manipulation, which resulted in a spinal epidural hematoma and subsequent quadriparesis. Spinal epidural hematoma after spinal cord stimulator trial. Epidural hematoma epidural hematoma clinical presentation. Epidural hematoma traumatic brain injury tbi causes. Spinal epidural hematoma seh is a very rare cause of acute spinal cord compression and is estimated to occur in approximately 0. Epidural hematoma is usually found on the same side of the brain that was impacted by the blow, but on very rare occasions it can be due to a contrecoup injury.
Quencer 1 an acute spinal epidural hematoma is a neurosurgical emergency. Thus, the current study may overestimate epidural hematoma incidence after interlaminar injection. Acute spontaneous spinal epidural hematomas american. It is especially related to medication or disease associated with coagulopathy. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries. Chronic nontraumatic spinal epidural hematoma of the lumbar. Acute spontaneous sehs do not present with any underlying condition in almost half of the patients, although.
Peripheral contrast enhancement may be due to dural inflammation secondary to hematoma. Iatrogenic causes have been outlined, namely surgical procedures, lumbar puncture and chronic anticoagulant therapy 1. We report a case of a 62yearold man with posttraumatic epidural hematoma in the cervicothoracic spine, who developed progressive neurological deficit which. Spinal epidural hematoma after spinal cord stimulator trial lead placement in a patient taking aspirin asokumar buvanendran, md, and adam c. Spinal anesthesia was performed by an experienced staff anesthesiologist using a 22gauge sprotte needle. Spontaneous spinal epidural hematoma of the thoracic spine. Epidural hematoma an overview sciencedirect topics. Patients with mild symptoms may be managed conservatively after consultation with a. Under assumption of an epidural hematoma caused by spinal anesthesia, lumbar decompression and removal of the hematoma was performed by laminectomy at l23 under general anesthesia. The hemorrhage generally occurs at the level of the spinal cord with sudden symptoms of focal and then radicular pain leading to paresis or paralysis. Epidural hematoma may be intracranial edh or spinal sedh. Jul 20, 2008 a spinal epidural hematoma is a rare but significant neurological condition. Spinal epidural hematoma is bleeding into the epidural space in the spine.
Like acute spinal epidural hematomas, these asshs can expand rapidly and extend over many spinal segments, caus ing sudden spinal cord andor cauda equina compression 119. This term refers to a hematoma between the lining of the spinal cord and the vertebrae. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. The patient was admitted to a private clinic with a threeday history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the guillainbarre syndrome gbs. Spontaneous epidural hematomas sehs can be classified into two categories. Spinal epidural hematoma is a collection of blood in the potential space between the dura and the bone, along the spinal canal. They are typically considered a surgical emergency.
These hematomas are typically considered a surgical emergency. Oct 29, 2018 spontaneous spinal epidural hematoma sseh is an uncommon disease, but it can lead to acute cord compression with disabling consequences. Haematoma can be acute, chronic, spontaneous, traumatic or iatrogenic. This term refers to a hematoma between the lining of the spinal.
We report a 14 yearold boy who had tetraplegia on awakening. Spinal epidural hematoma due to anticoagulant therapy. If surgical decompression can be accomplished early, the results are favorable. Often there is loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again. Epidural hematoma is a rare complication of neuraxial techniques, with an incidence ranging from 1.
Unusually the patient had both an intracranial subdural hygroma and rarely reported extensive spinal intradural extraarachnoid collection following a lumbar epidural, administered in labour. When neuraxial anesthesia epidural spinal anesthesia or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low molecular weight heparins or heparinoids for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma which can result in longterm or permanent. Spinal epidural hematoma seh is a rare cause of nerve root or cord compression. The syndrome of spontaneous spinal epidural hematoma in. Chronic encapsulated epidural hematoma can occur at the level of the cauda equina, but this is even less common. Owing to a rich vascular supply, spinal epidural hematoma is the most common intraspinal hematoma but remains a rare condition, with an estimated incidence of 0. Spinal epidural hematoma seh is a relatively rare but disabling disease that was described for the. Twelve of these cases resulted from spinal surgery, seven from epidural catheters, four from vascular lesions, three from anticoagulation medications, two from trauma, and two from spontaneous causes. Spinal epidural hematoma after spinal anesthesia in a. Most cases of spinal epidural hematoma have been reported in patients who are receiving some kind of anticoagulation therapy or who have an otherwise compromised coagulation.
Spinal epidural hemorrhage is usually associated with coagulopathy, arteriovenous malformation or neoplasia 2, 4, 6, 10. In patients with established motor symptoms, surgical treatment within the first 24 hours seems to be the best option. This is followed by the onset of progressive neurological symptoms. Epidural and subdural hematomas intermountain healthcare. If left untreated, a person can face serious consequences, including death. Epidural hematoma has a double anatomopathological topography. Seh occurring without a trauma is called as spontaneous seh sseh and it is an uncommon neurosurgical emergency which can lead to acute cord compression with disabling. The search was performed using the keywords spinal epidural hematoma and was limited to articles discussing seh in humans and in the english, french, italian, german, or spanish languages. Spontaneous spinal epidural hematoma sseh is an uncommon disease, but it can lead to acute cord compression with disabling consequences. Spontaneous spinal epidural hematoma sseh is an uncommon cause of acute nontraumatic myelopathy. Spontaneous spinal epidural hematoma radiology case. Spinal epidural hematoma can occur with substantial trauma to a normal spine, particularly in a newborn after breech delivery, or with mild trauma to the spine in a patient with a bleeding diathesis, with a spinal epidural hemangioma, or. Spinal epidural hematoma seh comprises a heterogeneous group of disorders with the final common result of hemorrhage in the spinal epidural space. The spontaneous development of spinal epidural hematomas is most frequent after the fourth or fifth decade 5.
Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain and the skull. Spinal epidural hematoma seh is a rare emergency that transpires as a complication of several disorders, including trauma, diabetes, arteriovenous malformations, coagulopathies, and malignancy. Spinal epidural hematoma is a rare condition that usually presents with acute, severe pain at the location of the hemorrhage, with radiation to the extremities. Spinal hematoma is a haemorrhage in the spinal or epidural space that develops with forming a heterogeneous group of disorders. The causes of seh range from iatrogenic to idiopathic. A posterior epidural lesion appearing isointense on t1w, markedly hypointense on t2w images, and areas of blooming on gre images is seen. Pdf spinal epidural hematoma and epidural analgesia. When an injury happens to the head and brain, this trauma may be called epidural and subdural hematomas. A 63yearold man presented to the emergency department with worsening interscapular. Spontaneous spinal epidural hematomas sseh, defined as blood within the epidural space without known traumatic or iatrogenic cause, have an estimated incidence of 0.
In addition, a computeraided search of medline was conducted using pubmed to obtain literature published between 1869 and september 2012. Overall incidence approximately 1 per 1,000,000 people annually perron 20. Chronic spontaneous lumbar spinal epidural hematoma. In 40% of cases, the ailment occurs spontaneously 2 3. Abstract spontaneous spinal epidural hematoma sseh is a rare neurologic emergency with accumulation of blood in the spinal epidural space without trauma or iatrogenic cause. Review the current literature regarding spontaneous spinal epidural hematomas ssehs and report on the known risk factors, evaluation, and. Epidural hematoma after spinal anesthesia in a patient with.
Spontaneous spinal epidural hematoma sseh manifests from blood accumulating in the epidural space. Spinal epidural hematoma and epidural analgesia article pdf available in canadian journal of anaesthesia 504. What a radiologist needs to know spinal hematomas are a frequent indication for radiologic evaluation and can be a diagnostic dilemma for many radiologists and surgeons. A 33yearold male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. For the first time jackson in 1869 reported a case of sshe and after that it was declared as several hundred cases in literatures. Sep 19, 2019 spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. Intracranial epidural hematoma is considered to be the most serious complication of. Spinal epidural hematomas are a rare occurrence, accounting for less than 1% of all spinal canal spaceoccupying lesions 1,2.
Idiopathic thoracic spontaneous spinal epidural hematoma. When neuraxial anesthesia epidural spinal anesthesia or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low molecular weight heparins, heparinoids or fondaparinux sodium for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma which can result in long. Patients with spontaneous spinal edh typically present with acute onset of severe back pain and rapidly develop signs of compression of the spinal cord or cauda equina. Can spontaneous spinal epidural haematoma be managed. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, wellcircumscribed epidural mass with peripheral enhancement and signal intensities consistent with. Spontaneous spinal epidural hematoma edh is a rare condition requiring urgent diagnosis 1. Anticoagulant and antiplatelet management for spinal. Spontaneous spinal epidural hematoma published on mar 1967 by journal of neurosurgery publishing group. Thirty patients were treated surgically for spinal epidural hematoma seh. Epidural hematomas are the direct result of physical trauma to the head. Approximation of hematoma to inner margin of osseous spine. In each case follow up mri confirmed rapid reduction in the.
Spinal epidural hematoma can occur with substantial trauma to a normal spine, particularly in a newborn after breech delivery, or with mild trauma to the spine in a patient with a bleeding diathesis, with a spinal epidural hemangioma, or after multiple lumbar punctures. Identifiable reasons for spontaneous hemorrhage are vascular malformations and bleeding disorders. Spinal epidural haematoma should be included in the differential diagnosis of progressive spinal cord and nerve root compression in patients whom are receiving. Ventral spontaneous spinal epidural hematoma sseh is rarer, with only two previous reports. Diagnosis is by mri or, if not immediately available, by ct myelography. An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75yearold woman is reported. Significant bleeding can lead to spinal cord damage, causing neurological injury and deficit. A diagnosis of acute, cervical, spontaneous spinal epidural hematoma was made in two patients by combining clinical signs and myelographic findings. Paraplegia due to spinal epiduralhaematoma thelumbarlaminectomy l. Spontaneous spinal epidural hematoma sshe is a rare entity can have several reasons. At the time of diagnosis spontaneous recovery had started in each patient and therefore they were all treated conservatively. Epidural hematoma after spinal anesthesia in a patient. A spinal epidural hematoma is a rare spinal pathology which can result in morbidity with delayed treatment or nontreatment. B spinal epidural hematoma epidural or spinal hematomas have occurred in patients treated with xarelto who are receiving neuraxial anesthesia or undergoing spinal puncture.59 1404 186 687 879 1195 312 887 1578 1011 370 74 1188 1565 1354 57 1532 516 1047 1576 1189 73 1345 990 1225 616 730