Clinical StudySpontaneous spinal epidural hematoma
Introduction
Spontaneous spinal epidural hematoma (SSEH), also known as idiopathic spinal epidural hematoma, is a rare neurosurgical emergency, where blood accumulates in the spinal epidural space spontaneously without obvious traumatic or iatrogenic cause.[1], [2] Although patients with SSEH may have spontaneous recovery, the typical outcomes include paraplegia, quadriplegia and even death. For most patients early diagnosis and decompression are recommended to prevent mortality and morbidity. Several factors have been associated with the outcomes, but controversy remains because of its rarity. We report 30 patients with SSEH, discuss their clinical characteristics and the contributing factors related to the preoperative neurological deficits and prognosis.
Section snippets
Methods and materials
The records of 30 patients diagnosed with SSEH between January 2002 and September 2010 were reviewed retrospectively. SSEH had been confirmed surgically or by MRI. Those patients with an intraspinal hematoma after an iatrogenic procedure or trauma were excluded. A total of 21 males and nine females were included (age range: 1–78 years; mean age: 35 years; eight <18 years). Their medical histories, clinical presentations, physical examination findings, radiological images, and surgical and
Results
Preoperative neurological deficit or outcome was not associated with sex or age. The extent of the hematoma ranged from one to nine vertebral segments (average: 3.8 segments). In 25 patients the hematomas were located in the dorsal, lateral or posterolateral spinal space, and in five, in the ventral spinal space. Hematoma distribution in the spine was: cervical region, eight; cervicothoracic, nine; thoracic, eight; thoracolumbar, two; and lumbar or lumbosacral, three. The extent and
Discussion
SSEH is a rare emergency in neurosurgery, accounting for 40% to 50% of all spinal epidural hematomas and less than 1% of all intraspinal lesions.4 The annual incidence is about 0.1 out of 100,000 persons,5 which has increased with the advent of CT scan and MRI. SSEH may affect every age, especially those in the fourth or fifth decades, but is rare in children.[6], [7] The sex ratio (male:female) is about 1.4:16 although a higher predominance of male and younger patients was found in our study
Conclusion
SSEH is an uncommon lesion with high morbidity and mortality. Patients usually experience sudden back or neck pain followed by rapidly progressive neurological deficit, within hours. Early surgical evacuation is the mainstream management in most SSEH patients while the conservative approach should be applied only to patients with mild or non-progressive neurologic deficit. Spinal cord edema or a shorter progression interval may predict serious preoperative neurological deficit. The prognosis is
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2021, Annals of Medicine and SurgeryCitation Excerpt :To be avoided, the anticoagulant intensity of VKA should be regularly assessed by International Normalized Ratio (INR), which depends on patient observance, acute medical conditions, comorbidities and medical drug interactions [15]. Nevertheless, no absolute ‘safe’ INR is to be considered because many published cases of SSEH were in the therapeutic range [16]. In our case, the patient used acenocoumarol; widely prescribed in our country, for the prevention of thromboembolic risk associated with AF complicating her severe mitral stenosis with an admission INR of 1.6.
A retrospective analysis of 30 patients with spontaneous spinal epidural hematoma
2021, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :However, in SSEH patients treated with anticoagulants, the theory of spontaneous resolution of SSEH might not apply, because of hematoma growth. SSEH is an urgent surgical condition, for which the most effective treatment is decompressive laminectomy and hematoma drainage [6,15], although conservative therapy can be applied when the neurological status is improving [25,29]. Some patients cannot undergo surgery because of their general condition or blood coagulation status [8,15].
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These authors contributed equally to the manuscript.