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. Epidural hematoma may be intracranial edh or spinal sedh. However, it has been reported to occur in all age groups, and it is a very rare clinical entity in children. 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 a rare disease that can lead to the acute onset of severe neurological deficits, 1 requiring early. Spinal epidural hemorrhage is usually associated with coagulopathy, arteriovenous malformation or neoplasia 2, 4, 6, 10. Spinal epidural hematomas are a rare occurrence, accounting for less than 1% of all spinal canal spaceoccupying lesions 1,2. Spontaneous spinal epidural hematoma of the thoracic spine. The syndrome of spontaneous spinal epidural hematoma in. 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. If left untreated, a person can face serious consequences, including death. Patients with mild symptoms may be managed conservatively after consultation with a.
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. 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. Spinal epidural hematoma after spinal cord stimulator trial. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 515% of patients with fatal head injuries. Ventral spontaneous spinal epidural hematoma sseh is rarer, with only two previous reports. Epidural hematoma an overview sciencedirect topics. Chronic encapsulated epidural hematoma can occur at the level of the cauda equina, but this is even less common. Acute spontaneous sehs do not present with any underlying condition in almost half of the patients, although. In the cervical spine, patients can present with neurological deficits ranging from focal cervical radiculopathy to complete quadriplegia. A 60yearold female experienced sudden back pain combined with numbness and weakness. 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 epidural hematomas edh are a rare spinal pathology which can result in serious morbidity with delayed or nontreatment.
Identifiable reasons for spontaneous hemorrhage are vascular malformations and bleeding disorders. Oct 29, 2018 spontaneous spinal epidural hematoma sseh is an uncommon disease, but it can lead to acute cord compression with disabling consequences. Epidural and subdural hematomas intermountain healthcare. Epidural and subdural hematomas hematomas are bruises that are caused by injuries to blood vessels underneath the skin, known as a bruise. Can spontaneous spinal epidural haematoma be managed. Idiopathic thoracic spontaneous spinal epidural hematoma. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Epidural analgesia is often used to supplement general anesthesia ga for surgical procedures in patients of all ages with moderatetosevere comorbid disease. Epidural hematoma after spinal anesthesia in a patient with. Since its introduction through safe motherhood initiative, little is known about its existence in. The causes of seh range from iatrogenic to idiopathic. Acute spinal epidural hematoma may occur spontaneously with no apparent or only trivial antecedent cause.
They are typically considered a surgical emergency. Spontaneous spinal epidural hematoma is rare in children. It is especially related to medication or disease associated with coagulopathy. Incidence of epidural hematoma could be calculated within goal precision 0.
Spinal epidural hematoma seh is a relatively rare but disabling disease that was described for the. This term refers to a hematoma between the lining of the spinal cord and the vertebrae. A spinal subdural or epidural hematoma is an accumulation of blood in the subdural or epidural space that can mechanically compress the spinal cord. Monitor patients frequently for signs and symptoms of neurological. Epidural hematomas are the direct result of physical trauma to the head.
At the time of diagnosis spontaneous recovery had started in each patient and therefore they were all treated conservatively. Iatrogenic causes have been outlined, namely surgical procedures, lumbar puncture and chronic anticoagulant therapy 1. Postoperatively, the back pain was resolved and the patient was discharged 6 days after the operation without further neurological problems or persisting pain. The patient presented had a presumed spinal cerebrospinal fluid leak with symptoms of intracranial hypotension. A 63yearold man presented to the emergency department with worsening interscapular. Spontaneous spinal epidural hematoma sseh manifests from blood accumulating in the epidural space. Spinal epidural hematoma is a collection of blood in the potential space between the dura and the bone, along the spinal canal. A metaanalysis of spinal hematomas showed that 75% are epidural in origin. Intracranial epidural hematoma is considered to be the most serious complication of. Spinal epidural haematoma should be included in the differential diagnosis of progressive spinal cord and nerve root compression in patients whom are receiving. A posterior epidural lesion appearing isointense on t1w, markedly hypointense on t2w images, and areas of blooming on gre images is seen.
Spinal epidural hematoma seh is a very rare cause of acute spinal cord compression and is estimated to occur in approximately 0. The usual clinical presentation of sseh is sudden neck or back pain that progresses toward paraparesis or quadriparesis, depending on the. Spinal epidural hematoma after spinal cord stimulator trial lead placement in a patient taking aspirin asokumar buvanendran, md, and adam c. Epidural hematoma epidural hematoma clinical presentation. Spontaneous spinal epidural hematomas sseh, defined as blood within the epidural space without known traumatic or iatrogenic cause, have an estimated incidence of 0.
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. Thus, the current study may overestimate epidural hematoma incidence after interlaminar injection. Traumatic sehs are considered to occur secondary to spinal surgeries, lumbar puncture, vertebral fractures, and any spinal intervention. Of note, this is the only epidural hematoma to result from spinal injection in the primary authors 21 years of practice. Spinal epidural hematoma after spinal anesthesia in a. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Etiopathogenesis of traumatic spinal epidural hematoma ncbi.
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. Clinical indications for epidural anesthesia and analgesia have expanded significantly over the past several decades. Spinal epidural hematoma after spinal cord stimulator. 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. Thirty patients were treated surgically for spinal epidural hematoma seh. 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.
A diagnosis of acute, cervical, spontaneous spinal epidural hematoma was made in two patients by combining clinical signs and myelographic findings. Diagnosis is by mri or, if not immediately available, by ct myelography. Some of the most likely causes of an epidural hematoma include. This patient had a spinal epidural hematoma, which is defined as a spontaneous collection of blood in the spinal epidural space. Spontaneous spinal epidural hematoma sseh is an uncommon cause of acute nontraumatic myelopathy. These hematomas may result in longterm or permanent paralysis 5. 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.
In each case follow up mri confirmed rapid reduction in the. Acute spinal epidural hematoma arrows in thoracic spine diagnosed by sharply demarcated focal areas of increased density of 104110 hounsfield units h. Spinal subdural or epidural hematoma neurologic disorders. 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. 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.
In addition, a computeraided search of medline was conducted using pubmed to obtain literature published between 1869 and september 2012. Quencer 1 an acute spinal epidural hematoma is a neurosurgical emergency. Spinal anesthesia was performed by an experienced staff anesthesiologist using a 22gauge sprotte needle. Epidural hematoma traumatic brain injury tbi causes. A 33yearold male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. Overall incidence approximately 1 per 1,000,000 people annually perron 20. Spontaneous spinal epidural hematoma radiology case. Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain and the skull. Epidural hematoma after spinal anesthesia in a patient.
Spinal epidural hematoma and epidural analgesia article pdf available in canadian journal of anaesthesia 504. Bleeding may also occur secondary to trauma, spinal surgery, angioma, vascular malformation or coagulopathies, most particularly anticoagulant therapy. Spinal epidural hematoma without significant trauma is a rare condition with potentially severe outcome. Acute spontaneous spinal epidural hematomas american. 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. Spontaneous spinal epidural hematoma sshe is a rare entity can have several reasons.
B spinal epidural hematoma epidural or spinal hematomas have occurred in patients treated with xarelto who are receiving neuraxial anesthesia or undergoing spinal puncture. The usual clinical presentation of sseh is sudden neck or back pain that progresses toward paraparesis. Spinalepidural hematoma following epidural anesthesia in. Spontaneous epidural hematomas sehs can be classified into two categories. Paraplegia due to spinal epiduralhaematoma thelumbarlaminectomy l. Spinal epidural hematoma seh is a rare emergency that transpires as a complication of several disorders, including trauma, diabetes, arteriovenous malformations, coagulopathies, and malignancy. This is followed by the onset of progressive neurological symptoms. Unusually the patient had both an intracranial subdural hygroma and rarely reported extensive spinal intradural extraarachnoid collection following a lumbar epidural, administered in labour. Anticoagulant and antiplatelet management for spinal. Spontaneous spinal epidural hematoma edh is a rare condition requiring urgent diagnosis 1. 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. Seh may be acute or chronic, spontaneous, posttraumatic, or iatrogenic. However, sseh after taking herbal medicines has not been described yet.
Spinal epidural hematoma seh comprises a heterogeneous group of disorders with the final common result of hemorrhage in the spinal epidural space. The presentation, investigation, and management of four patients with spontaneous spinal epidural haematoma is presented. Paul rosman, in swaimans pediatric neurology sixth edition, 2017. We report a case of a 62yearold man with posttraumatic epidural hematoma in the cervicothoracic spine, who developed progressive neurological deficit which. Dec 07, 2017 an epidural hematoma is a potentially lifethreatening complication of a head injury. Jul 20, 2008 a spinal epidural hematoma is a rare but significant neurological condition. 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. In patients with established motor symptoms, surgical treatment within the first 24 hours seems to be the best option. A spinal epidural hematoma is a rare spinal pathology which can result in morbidity with delayed treatment or nontreatment.
An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75yearold woman is reported. Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. Spontaneous spinal epidural hematoma sseh is a relatively rare disease. Spinal hematoma is a haemorrhage in the spinal or epidural space that develops with forming a heterogeneous group of disorders. 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. Spontaneous spinal epidural hematoma published on mar 1967 by journal of neurosurgery publishing group. Epidural hematoma has a double anatomopathological topography.
We report a 14 yearold boy who had tetraplegia on awakening. Acute spinal subdural hematoma assh is an uncommonly recognized condition that if left untreated can result in severe irreversible neu rologic deficits 17. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries. 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. These hematomas are typically considered a surgical emergency.
Pdf spinal epidural hematoma and epidural analgesia. Approximation of hematoma to inner margin of osseous spine. Spinal epidural hematoma without significant trauma in. Spinal epidural hematoma seh is a rare cause of nerve root or cord compression. The source of bleeding in spontaneous hematomas has never been clear. 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. 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. 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. Significant bleeding can lead to spinal cord damage, causing neurological injury and deficit. Sep 19, 2019 spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy.
Peripheral contrast enhancement may be due to dural inflammation secondary to hematoma. When an injury happens to the head and brain, this trauma may be called epidural and subdural hematomas. Epidural hematoma is a rare complication of neuraxial techniques, with an incidence ranging from 1. 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. This term refers to a hematoma between the lining of the spinal. Spinal epidural hematoma due to anticoagulant therapy. Chronic spontaneous lumbar spinal epidural hematoma.
Spinal epidural hematoma is bleeding into the epidural space in the spine. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, wellcircumscribed epidural mass with peripheral enhancement and signal intensities consistent with. Chronic nontraumatic spinal epidural hematoma of the lumbar. Spinal epidural hematoma radiology reference article.
It is usually confined to the dorsal epidural space. For the first time jackson in 1869 reported a case of sshe and after that it was declared as several hundred cases in literatures. 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. In 40% of cases, the ailment occurs spontaneously 2 3. 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 seh is an uncommon condition usually characterized by acute back pain. Review the current literature regarding spontaneous spinal epidural hematomas ssehs and report on the known risk factors, evaluation, and. Spinal epidural hematoma is a rare, but potentially devastating, consequence of accessing the epidural space for anesthesia or interventional pain procedures. The patient presented with a 7month history of low back pain and bilateral sciatica. The spontaneous development of spinal epidural hematomas is most frequent after the fourth or fifth decade 5. 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. Haematoma can be acute, chronic, spontaneous, traumatic or iatrogenic. 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.
1291 12 800 1032 1436 1040 1080 946 1588 1539 867 5 158 1563 1021 1033 1466 1374 1529 647 122 215 1429 354 1215 1321 178 392 439 463 161 132 650 1009 763 917