International Clinical Neuroscience Journal

Vol. 8 No. 4 (2021)

Spontaneous spinal epidural hematoma: Two cases report and the literature review

International Clinical Neuroscience Journal, Vol. 8 No. 4 (2021), 30 October 2021 , Page 198-204

Abstract

Spontaneous spinal epidural hematoma (SSEH) is a rare disease but may lead to life-threatening consequences if not timely diagnosed and managed. Emergent hematoma evacuation is indicated before neurological deficits become irreversible. We report two cases. The first case was a 45-year-old man brought to hospital because of an acute onset of quadriparesis and urinary incontinence. His cervical magnetic resonance imaging (MRI) showed an epidural hematoma at the C5-C6 level with severe spinal cord compression. He underwent an emergency C5-C6 right hemi-laminotomy to remove the clot and decompress the cord. Postoperatively, his left-sided deficits immediately resolved. His urinary function returned to normal two weeks after the surgery. He could independently walk two months later. The second case was a 57-year-old man admitted to the hospital because of severe neck pain and paresthesia in both arms. He had been using an antiplatelet for two months. His MRI revealed an epidural hematoma from C2 to C4 with spinal cord compression on the right. This patient was successfully treated with conservative treatment. If SSEH is left undiagnosed and untreated, the neurological deficits may be permanent. Early emergent hematoma evacuation contributes to a favorable outcome. Conservative management is reasonable if neurological deficits are not severe.

Keywords:
  • Spinal epidural hematoma
  • Neurologic deficits
  • Myelopathy
  • Laminotomy

How to Cite

1.
Tri Tran DD, Nguyen QB, Truong VT, Truong TD, Phan DT, Nguyen TM. Spontaneous spinal epidural hematoma: Two cases report and the literature review. Int Clin Neurosci J [Internet]. 2021 Oct. 30 [cited 2026 Jul. 5];8(4):198-204. Available from: https://journals.sbmu.ac.ir/neuroscience/article/view/35465

References

Al-Mutair A, Bednar DA. Spinal epidural hematoma. J Am Acad Orthop Surg. 2010;18(8):494-502. doi: 10.5435/00124635-201008000-00006.

Bhat KJ, Kapoor S, Watali YZ, Sharma JR. Spontaneous epidural hematoma of spine associated with clopidogrel: a case study and review of the literature. Asian J Neurosurg. 2015;10(1):54. doi: 10.4103/1793-5482.151521.

Salehpour F, Mirzaei F, Kazemzadeh M, Naseri Alavi SA. Spontaneous epidural hematoma of cervical spine. Int J Spine Surg. 2018;12(1):26-9. doi: 10.14444/5005.

Figueroa J, DeVine JG. Spontaneous spinal epidural hematoma: literature review. J Spine Surg. 2017;3(1):58-63. doi: 10.21037/jss.2017.02.04.

Yu JX, Liu J, He C, Sun LY, Xiang SS, Ma YJ, et al. Spontaneous spinal epidural hematoma: a study of 55 cases focused on the etiology and treatment strategy. World Neurosurg. 2017;98:546-54. doi: 10.1016/j.wneu.2016.11.077.

Lan T, Chen Y, Yang XJ, Hu SY, Guo WZ, Ren K, et al. Spontaneous spinal epidural haematoma. J Orthop Translat. 2015;3(3):152-6. doi: 10.1016/j.jot.2015.03.001.

Baeesa S, Jarzem P, Mansi M, Bokhari R, Bassi M. Spontaneous spinal epidural hematoma: correlation of timing of surgical decompression and MRI findings with functional neurological outcome. World Neurosurg. 2019;122:e241-e7. doi: 10.1016/j.wneu.2018.09.224.

Gopalkrishnan CV, Dhakoji A, Nair S. Spontaneous cervical epidural hematoma of idiopathic etiology: case report and review of literature. J Spinal Cord Med. 2012;35(2):113-7. doi: 10.1179/2045772312y.0000000001.

Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA. Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 1995;83(1):1-7. doi: 10.3171/jns.1995.83.1.0001.

Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC. Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg. 2004;100(1 Suppl Spine):38-45. doi: 10.3171/spi.2004.100.1.0038.

Jackson R. Case of spinal apoplexy. Lancet. 1869;94(2392):5- 6. doi: 10.1016/s0140-6736(02)67624-x.

Bain W. A case of haematorrachis. Br Med J. 1897;2(1912):455. doi: 10.1136/bmj.2.1912.455.

Avrahami E, Tadmor R, Ram Z, Feibel M, Itzhak Y. MR demonstration of spontaneous acute epidural hematoma of the thoracic spine. Neuroradiology. 1989;31(1):89-92. doi: 10.1007/bf00342039.

Gala FB, Aswani Y. Imaging in spinal posterior epidural space lesions: a pictorial essay. Indian J Radiol Imaging. 2016;26(3):299-315. doi: 10.4103/0971-3026.190406.

Halim TA, Nigam V, Tandon V, Chhabra HS. Spontaneous cervical epidural hematoma: report of a case managed conservatively. Indian J Orthop. 2008;42(3):357-9. doi: 10.4103/0019-5413.41863.

Dziedzic T, Kunert P, Krych P, Marchel A. Management and neurological outcome of spontaneous spinal epidural hematoma. J Clin Neurosci. 2015;22(4):726-9. doi: 10.1016/j.jocn.2014.11.010.

Zhong W, Chen H, You C, Li J, Liu Y, Huang S. Spontaneous spinal epidural hematoma. J Clin Neurosci. 2011;18(11):1490-4. doi: 10.1016/j.jocn.2011.02.039.

Tawk C, El Hajj Moussa M, Zgheib R, Nohra G. Spontaneous epidural hematoma of the spine associated with oral anticoagulants: 3 case studies. Int J Surg Case Rep. 2015;13:8-11. doi: 10.1016/j.ijscr.2015.05.022.

Groen RJ. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir (Wien). 2004;146(2):103-10. doi: 10.1007/s00701-003-0160-9.

Shin JJ, Kuh SU, Cho YE. Surgical management of spontaneous spinal epidural hematoma. Eur Spine J. 2006;15(6):998-1004. doi: 10.1007/s00586-005-0965-8.

Rajz G, Cohen JE, Harnof S, Knoller N, Goren O, Shoshan Y, et al. Spontaneous spinal epidural hematoma: the importance of preoperative neurological status and rapid intervention. J Clin Neurosci. 2015;22(1):123-8. doi: 10.1016/j.jocn.2014.07.003.

  • Abstract Viewed: 316 times
  • PDF Downloaded: 340 times

Download Statastics