ReviewMRI findings in spinal subdural and epidural hematomas
Introduction
Signs of acute or progressive, painful paraparesis and/or paraparesis with sphincter dysfunction are well known indications for emergency MRI. Inflammatory [1], [2], infectious [3], [4] and metastatic lesions, as well as intraspinal hematomas are diagnostic considerations [5]. Intraspinal hematomas can be post-traumatic [6], [7], [8], post-procedural [9], [10], [11], due to anticoagulant therapy [12], [13], [14] or even spontaneous [13], [15], [16], [17], [18], [19].
Magnetic resonance imaging (MRI) is considered to be the technique of choice for diagnosis [20], [21]. Even though MRI is able to evaluate the location, extent, chemical state and compressive effects of hemorrhage, the diagnosis of hyperacute intraspinal hemorrhage may be difficult due to its imaging characteristics.
The purpose of this study is to review the literature and describe our experience in seven patients with spinal subdural and epidural hematoma.
Section snippets
Patients and methods
A retrospective study of clinical and MRI findings in patients with SSH or SEH was carried out from 2001 to 2005. Seven patients were identified who had spinal hematomas on MRI. Six of them were imaged between 10 h and 3 weeks after onset of symptoms. In one patient, the onset could not be clearly identified.
Imaging was performed on 1.5 T scanner (Signa CVi GE Medical Systems, Milwaukee, WI; Siemens Symphony, Erlangen, Germany) and consisted of sagittal and axial T1-weighted (450–600/10–20 [TR
Results
Three patients had a SSH. All patients were female, between 72 and 87 years. Initial symptoms, etiology, location and extent are summarized in Table 1.
MRI in the hyperacute phase demonstrated an isointense lesion on T1-weighted and hyperintense lesion on T2-weighted images (Fig. 1). MRI in the late subacute phase showed a hyperintense lesion on T1- and T2-weighted images (Fig. 2) (Table 2).
Spinal angiography was carried out in two patients and ruled out vascular malformations.
Surgery was
Discussion
The recent increase of publications of SSH and SEH may be explained by the introduction of MRI in daily medical practice. As a result, more patients with a mild clinical course caused by SSH and SEH are diagnosed. Previously those patients would have escaped medical attention [22]. In a large metaanalysis of 613 patients with spinal hematoma, the mean age at presentation was 63 years [23] with a male predominance (ratio, male:female, 1.7:1).
SSH and SEH normally present with signs of spinal cord
Conclusion
MRI is regarded as the imaging modality of choice to evaluate SSH and SHE. However, there are important considerations to take into account. Spontaneous SSH is a rare lesion that is difficult to diagnose in the hyperacute phase due to the lesion's imaging characteristics. T2-weighted gradient-echo images may be helpful to demonstrate a low-signal rim. In our study, T1-weighted fat suppressed images proved helpful in the subacute phase to differentiate epidural fat from hematoma. We recommend
References (43)
- et al.
Spinal subdural haematoma: a study of three cases
Clin Radiol
(2001) - et al.
Fatal spontaneous spinal epidural hematoma following thrombolysis for myocardial infarction
Surg Neurol
(1998) - et al.
Revisión de 22 casos de hematomas epidurales espinales. Factores pronósticos y manejo terapéutico
Neurocirugía
(2004) - et al.
Epidural spinal infection. Variability of clinical and magnetic resonance imaging findings
Spine
(1997) - et al.
MRI follow-up of herpes simplex virus (type 1) radiculomyelitis
Neurology
(1999) - et al.
Spinal epidural haematoma: report of 11 cases and review of the literature
Neuroradiology
(1994) - et al.
Hematomas extradurales espinales espontáneos: presentación de dos casos
Rev Neurol
(1997) - et al.
MRI of acute spinal epidural hematomas
J Comput Assist Tomogr
(1999) - et al.
Traumatic spinal subdural hematoma with spontaneous resolution
Spine
(2002) - et al.
Chronic spinal subdural haematoma associated with intracranial subdural haematoma: CT and MRI
Neuroradiology
(1999)
Wide-spread posttraumatic spinal subdural hematoma-imaging findings with spontaneous resolution: case report
J Trauma
Subacute subdural haematoma complicating lumbar microdiscectomy
J Bone Joint Surg Br
Serial magnetic resonance imaging findings for a spontaneously resolving spinal subdural haematoma: case report
Neurosurgery
Hyperacute spinal subdural haematoma as a complication of lumbar spinal anaesthesia: MRI
Neuroradiology
Nontraumatic acute subdural haematoma. Report of five cases and review of the literature
J Neurosurg (Spine 1)
Spinal and epidural hematoma and low-molecular weight heparin
N Engl J Med
Nontraumatic spinal subdural haematoma occurring in a postpartum period
Acta Neurochir (Wien)
Spinal subdural and epidural haematomas: Diagnostic and therapeutic aspects in acute and subacute cases
Acta Neurochir (Wien)
Acute spontaneous spinal subdural haematoma: MRI features
Neuroradiology
Spontaneous spinal subdural hematoma: case report and review of the literature
Neurosurgery
Spinal epidural hematoma with spontaneous recovery demonstrated by magnetic resonance imaging
Spine
Cited by (130)
Imaging review of the atypical spinal epidural space pathologies
2024, Current Problems in Diagnostic RadiologyParalysis of the lower limbs caused by spontaneous spinal epidural hematoma: A case report
2024, International Journal of Surgery Case ReportsUnexpected spot sign positivity on CT angiography and unenhanced MRI as the footprint of acute spinal hematoma
2022, Visual Journal of Emergency MedicineCitation Excerpt :Based on spinal canal compartment location, spinal hematomas are classified as epidural, subdural, subarachnoid, intramedullary, or a combination of these,1,2 with spinal epidural hematoma representing the most common type. The diagnostic tool of choice is magnetic resonance imaging (MRI), although the diagnose of the hyperacute phase can be challenging due to its imaging characteristics.3 On the other hand, in the hyperacute and acute scenario, computed tomography can help distinguish the generally hyperdense, crescent-shaped hyperacute hematoma from low-density fat and high-density osseous structures.3
Magnetic Resonance Imaging for Spine Emergencies
2022, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :Nontraumatic EDHs typically result from venous plexus hemorrhage in the setting of anticoagulation or coagulopathy.30 Acute hemorrhage in the epidural space characteristically presents as a T1 isointense or hyperintense and T2 hyperintense collection that subtends the dura30 (Fig. 12). The uplifted dura can be seen as a hypointense membrane containing the hematoma on T2W imaging (see Fig. 12).
Postoperative Epidural Hematoma
2022, Orthopedic Clinics of North America