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Kina H, Kiraz M. Epidural hematoma: Bibliometric analysis of scientific trends and developments from 1980 to 2023. Medicine (Baltimore) 2025; 104:e41803. [PMID: 40101070 PMCID: PMC11922403 DOI: 10.1097/md.0000000000041803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 02/20/2025] [Indexed: 03/20/2025] Open
Abstract
The aim of this study is to identify research directions focused on epidural hematoma (EDHs) from past to present using bibliometric approaches, uncover current research trends through keyword analyses, delineate global productivity, and identify impactful studies through citation analyses. The study obtained 1785 articles related to EDH published between January 1, 1980, and December 31, 2023, from the Web of Science database, and comprehensive analyses were conducted using various bibliometric and statistical approaches. These analyses include citation and co-citation analyses, trend keyword analysis, multiple correspondence analysis, thematic evolution analysis, and various other bibliometric analyses. The bibliometric analyses were performed using Biblioshiny and VOSviewer. The top 3 journals contributing the most to the literature were Acta Neurochirurgica (n = 56, 3.1%), British Journal of Neurosurgery (48, 2.6%), and Neurosurgery (47, 2.6%). According to the h-index, the most influential top 3 journals were Neurosurgery (h = 27), Acta Neurochirurgica (h = 23), and Surgical Neurology (h = 21). Based on the m-index, the most influential top 3 journals were World Neurosurgery (m = 0.9), Medicine (m = 0.63), and Neurosurgery (m = 0.6). The most active country was the United States of America (n = 593), the most active author was Mahapatra AK (n = 10), and the most active institution was Harvard University (n = 25). Research interest in EDH has evolved over time, with notable increases in publication trends in 1968, 1982, and 1988, peaking in 1996 and 2004. Bibliometric analyses indicate that key topics such as spinal EDH, head injuries, magnetic resonance imaging, spontaneous spinal EDH, computed tomography, spine, complications, epidural, anticoagulants, pediatric cases, and trauma have stood out in EDH research. Trend analysis findings have shown an increasing focus on specific areas such as clinical management approaches, treatment methods, postoperative complications, risk factors, pediatric cases, as well as specific conditions like paralysis and cauda equina syndrome. Multiple correspondence analysis identified 6 core research dimensions, focusing on acute trauma management, surgical interventions, complications management, risk assessment, surgical outcomes, and incidence analysis.
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Affiliation(s)
- Hakan Kina
- Department of Neurosurgery, Istinye University Gaziosmanpasa Medical Park Hospital, Istanbul, Türkiye
| | - Murat Kiraz
- Department of Neurosurgery, Yuksek Ihtisas University, Ankara, Turkey
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Montalbetti A, Crobeddu E, Fornaro R, Emanuele L, Rampini AD, Bianco A, Magrassi L, Cossandi C. New oral anticoagulants-induced spinal epidural haematomas: case series and review of literature. Neurosurg Rev 2025; 48:241. [PMID: 39954096 DOI: 10.1007/s10143-025-03336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 10/15/2024] [Accepted: 02/01/2025] [Indexed: 02/17/2025]
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare cause of acute spinal cord compression. This condition is often associated with use of anticoagulant drugs, coumarins or new oral anticoagulants, such as direct factor Xa inhibitor and direct thrombin inhibitor. The manifestation of severe neurological deficits is common and can lead to catastrophic consequences if not diagnosed early. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Due to the rarity of this pathologic entity, only sporadic case reports and associated reviews are available. We report a case series of 4 patients diagnosed with spontaneous spinal epidural haematoma induced by new oral anticoagulants. Spontaneous spinal haematoma is a rare pathologic entity and therefore difficult to diagnose. For patients receiving long term anti-coagulant therapy, SSEH should be included in the differential diagnosis. Prompt surgical evacuation of the haematoma and haemostasis leads to favourable neurological outcome, whereas delay in treatment can be disastrous.
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Affiliation(s)
- Andrea Montalbetti
- Department of Neurosurgery, Moriggia Pelascini Hospital, Gravedona ed Uniti, Italy.
| | - Emanuela Crobeddu
- Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Riccardo Fornaro
- Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Luca Emanuele
- Department of Neurosurgery, Santa Corona Hospital, Pietra Ligure, Italy
| | | | - Andrea Bianco
- Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
| | - Lorenzo Magrassi
- Neurosurgical Training Program, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Christian Cossandi
- Department of Neurosurgery, Maggiore della Carità University Hospital, Novara, Italy
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Cheng J, Li B, Liu S, Liu Y, Zhao Y. Case report: a patient with spontaneous spinal epidural hematoma recovered after conservative treatment. Front Med (Lausanne) 2025; 12:1509903. [PMID: 39967594 PMCID: PMC11832481 DOI: 10.3389/fmed.2025.1509903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 01/21/2025] [Indexed: 02/20/2025] Open
Abstract
Spontaneous spinal epidural hematoma is a rare condition, akin to a stroke, which can manifest as hemiplegia. It cannot be diagnosed by head CT scan and is prone to misdiagnosis as a cerebral stroke, potentially leading to the activation of thrombolysis and exacerbation of the condition. This paper reports a case of a patient with this disease, a 68 years-old male who presented with sudden neck pain weakness, and numbness in the left limbs for 2 h. The symptoms were similar to those of a stroke. A head CT scan showed no significant abnormalities, but the clinical presentation of neck pain alerted the physician, who did not hastily administer thrombolysis. Instead, they quickly performed further examinations, including neck vessel ultrasound and neck CT/MRI, to rule out a cerebral stroke. The patient was ultimately diagnosed with spontaneous spinal epidural hematoma in the neck. The patient was transferred to the ICU for conservative treatment, and a follow-up neck MRI the next day revealed a significant reduction in the hematoma, with a corresponding improvement in clinical symptoms. This case report supports the diagnostic value of CT scans for spinal epidural hematoma and shares a conservative treatment plan for patients with high spinal cord lesions.
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Affiliation(s)
- Jingge Cheng
- Department of Emergency and Disaster Medicine, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bo Li
- Department of Emergency and Disaster Medicine, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Shuaiye Liu
- Department of Cardiology, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yiming Liu
- Department of Emergency and Disaster Medicine, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yipeng Zhao
- Department of Pathology, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Raju S, Tandon V, Kumar G, Kumar V N S, Thangamani V, Mohamed A, Jeyashankaran BR, Muthu C. Spontaneous spinal epidural hematomas-Time is running out! Spinal Cord Ser Cases 2024; 10:78. [PMID: 39648232 PMCID: PMC11625822 DOI: 10.1038/s41394-024-00693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 11/20/2024] [Accepted: 12/03/2024] [Indexed: 12/10/2024] Open
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is the rarest cause of spinal cord compression, causing paraparesis or quadriparesis. They account for less than 1% (0.1 patients per 100,000 patients per year) of all spinal canal space-occupying lesions, thus resulting in a paucity of literature. Here, we report three cases of SSEH; all had a neurological deficit on presentation and were surgically managed with decompressive laminectomy and evacuation of the hematoma. CASE PRESENTATION Of the three patients, one had a history of coronary artery disease and was on anticoagulants. In the remaining two, no cause could be identified. The hematoma was located at the thoracic region in 2 patients and at the cervical in one. Hematoma were located dorsal to cord in 2 patients and ventral in one. Two cases presented within 30 h of the onset of symptoms with the ASIA (American Spinal Injury Association) impairment scale (AIS) A and B neurology. Both showed a complete recovery during their latest follow-up. However, one case presented after 2 days with AIS A neurology and improved to AIS B post-operatively at 30 months follow-up. DISCUSSION The myriad of symptoms and the need for an MRI for diagnosis have made SSEH difficult to diagnose clinically. Unlike other spinal pathologies where the severity of the preoperative neurological deficit is the best predictor of prognosis, in SSEH, time is the best predictor of prognosis. Our series highlights the fact that irrespective of the severity of the preoperative neurological deficit, timely diagnosis and early, adequate decompression surgery are essential for complete neurological recovery.
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Affiliation(s)
- Sivakumar Raju
- Department of Spine Surgery, Preethi Multispeciality & Orthopedics Hospital, Madurai, Tamil Nadu, India
| | - Vikas Tandon
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | - Ganesh Kumar
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.
| | - Sudeep Kumar V N
- Department of Spine Surgery, Preethi Multispeciality & Orthopedics Hospital, Madurai, Tamil Nadu, India
| | - Vinoth Thangamani
- Department of Spine Surgery, Preethi Multispeciality & Orthopedics Hospital, Madurai, Tamil Nadu, India
| | - Azeem Mohamed
- Department of Neurosurgery, Preethi Multispeciality & Orthopedics Hospital, Madurai, Tamil Nadu, India
| | | | - Chidambaram Muthu
- Department of Spine Surgery, Preethi Multispeciality & Orthopedics Hospital, Madurai, Tamil Nadu, India
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Albrecht C, Boeckh-Behrens T, Schwarting J, Wostrack M, Meyer B, Joerger AK. Spontaneous spinal hematomas: A case series. Acta Neurochir (Wien) 2024; 166:353. [PMID: 39196426 PMCID: PMC11358243 DOI: 10.1007/s00701-024-06240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Spontaneous spinal hematoma (SSH), a rare neurological disorder, demands immediate diagnostic evaluation and intervention to prevent lasting deficits. This case series analyzes instances, particularly highlighting cases where vascular causes were identified despite inconclusive initial imaging. METHODS In a retrospective study of 20 patients treated for SSH at a Level I spine center from 01/01/2017 to 11/15/2023, we examined demographics, clinical presentation, imaging, and treatment details. Excluding traumatic cases, we present 4 instances of SSH associated with diverse vascular pathologies. RESULTS Patient ages ranged from 39 to 85 years, with a median age of 66 years. 45% were male, and 55% were female. Among 20 cases, 14 were epidural hematomas, 4 subdural, 1 combined epidural and subdural, and 1 subarachnoid hemorrhage. 85% presented with neurological deficits, while 3 solely had pain-related symptoms. 55% were under anticoagulant medication, and vascular anomalies were found in 25% of cases. The cause of SSH remained unclear in 20% of cases. MRI was performed for all patients, and DSA was conducted in 25% of cases. The 4 highlighted cases involved individuals with distinct vascular pathologies managed surgically. CONCLUSION Urgent attention is crucial for SSH due to possible lasting neurological consequences. The study emphasizes comprehensive diagnostics and surgical exploration, especially in cases with unclear etiology, to identify and address vascular causes, preventing hematoma progression or recurrence. Despite their rarity, vascular malformations contributing to spinal hematomas warrant particular attention.
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Affiliation(s)
- Carolin Albrecht
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Julian Schwarting
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Ann-Kathrin Joerger
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
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Soni TV, Patel SJ, Shah VK, Joshipura KM. Catastrophic spontaneous spinal epidural hematoma following thrombolysis: An intersection of neurosurgical and cardiological challenges - An institutional experience. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:371-374. [PMID: 39483830 PMCID: PMC11524568 DOI: 10.4103/jcvjs.jcvjs_62_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/01/2024] [Indexed: 11/03/2024] Open
Abstract
Catastrophic spontaneous spinal epidural hematoma (SSEH) following thrombolysis poses a complex intersection of neurosurgical and cardiological challenges. This case report presents the institutional experience of a 66-year-old female who developed rapid-onset compressive myelopathy after thrombolysis for inferior wall myocardial infarction with injection streptokinase. SSEH, although rare, demands prompt recognition due to its potential for permanent neurologic injury and mortality. The discussion highlights the clinical significance, anatomical considerations, and multidisciplinary approach requisite for accurate diagnosis and effective management of SSEH. The conclusion underscores the necessity for clinicians, particularly cardiologists administering thrombolytic therapies, to consider SSEH in postthrombolysis patients presenting with neurological deficits.
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Affiliation(s)
- Tushar V. Soni
- Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Shreyansh J. Patel
- Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Varshesh K. Shah
- Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Kavan M. Joshipura
- Department of Neurosurgery, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
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Jha VC, Alam S, Jha N. Spontaneous Cervicothoracic Extradural Hematoma with Rare Presentation in Pediatric Patient with Stroke-Like Features in Association with COVID-19, Presenting as Management Dillemma. Asian J Neurosurg 2023; 18:196-200. [PMID: 37056903 PMCID: PMC10089729 DOI: 10.1055/s-0043-1768249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
AbstractPresentation of cervico-thoracic extradural hematoma in pediatric age is rare with stroke-like features. Its association with COVID-19 in the active stage of the disease had not been reported and its management presents a management dilemma as COVID-19 with stroke-like features.A 14-year-old boy was referred to our institute with complaints of sudden-onset upper and middle back pain, associated with loss of sensation below the middle of the back, sudden progressive weakness of both lower limbs (power 0/5) and upper limbs (power grade-2/5), and incontinence of urine, following bouts of vomiting 12 days back. There was no history of trauma, bleeding diathesis, etc. Blood investigation was suggestive of leukocytosis, and RT-PCR test for COVID-19 was positive with raised D-dimer, serum ferritin, and C-reactive protein. MRI spine was suggestive of cervicothoracic extradural hematoma extending from C5-D3 level and compressing the spinal cord. The patient refused surgical decompression and was managed conservatively, following which he improved with power grade in limbs to 4/5.Surgical decompression is the treatment of choice but the patient can sometimes improve on medical management. Association of COVID-19 with spontaneous cervicothoracic extradural hematoma had not been reported earlier in the active stage, but its role in inducing vasculopathy and increased chances of bleeding at the uncommon site had been reported in the literature, and it may precipitate such cervical epidural hematoma.
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Muacevic A, Adler JR, Bairwa A, Pundir A. A Rare Life-Threatening Presentation of Shoulder Pain: Cervical Epidural Hematoma. Cureus 2023; 15:e33510. [PMID: 36779100 PMCID: PMC9904511 DOI: 10.7759/cureus.33510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/09/2023] Open
Abstract
Shoulder pain is a common complaint of patients presenting to emergency department. Various conditions, intrinsic and extrinsic to the shoulder, can result in shoulder pain. Some of these extrinsic conditions can pose a threat to life. We present a case of a young, previously healthy male who initially had bilateral shoulder pain, later developed quadriparesis, and was ultimately diagnosed with a spontaneous cervical epidural hematoma. He underwent an emergency C7-T1 laminectomy with hematoma evacuation and had a full recovery. Cervical epidural hematoma is a rare surgical emergency where timely diagnosis and treatment are crucial.
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MISHIMA H, AYABE J, TAKADERA M, TSUCHIYA Y, KAWASAKI T, OKANO M, ISODA M, TANAKA Y. Spinal Epidural Hematoma Due to Venous Congestion Caused by Nutcracker Syndrome. NMC Case Rep J 2022; 9:209-212. [PMID: 35974955 PMCID: PMC9339261 DOI: 10.2176/jns-nmc.2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
The causes of spinal epidural hematoma (SEH) have been attributed to coagulopathy, trauma, vascular anomalies, and so forth. The incidence of vascular anomalies shown by digital subtraction angiography has been reported to be 15%, and most cases have been reported to be spinal epidural arteriovenous fistulae. SEH has rarely been caused by venous congestion. We report a case of SEH in a 78-year-old male who presented to our emergency department with sudden-onset back pain, followed by complete paraplegia with bladder and rectal disturbance. Magnetic resonance imaging revealed a dorsally placed extradural hematoma extending from T10 to L1. An urgent laminectomy from T11 to L2 was performed. Computed tomography angiography (CTA) performed 1 week after the operation showed compression of the left renal vein between the aorta and superior mesenteric artery with dilation of the surrounding veins, including the spinal epidural venous plexus, at the same level as the hematoma. This was diagnosed as Nutcracker syndrome (NCS), which was consistent as a cause of SEH. The patient's symptoms gradually improved, and after 6 months, he regained normal strength in his lower extremities, but bladder and rectal disturbance remained and required intermittent self-catheterization. We chose conservative treatment for NCS, and SEH did not recur until the patient died of a cause unrelated to SEH or NCS. SEH could occur secondary to venous congestion including NCS. We emphasize the importance of investigating venous return to evaluate the etiology of SEH, which can be clearly visualized using CTA.
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Emergency surgical decompression for spontaneous spinal epidural hematoma in octogenarians: risk factors, clinical outcomes, and complications. Acta Neurochir (Wien) 2022; 165:905-913. [PMID: 36571626 PMCID: PMC10068654 DOI: 10.1007/s00701-022-05457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/10/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Spontaneous spinal epidural hematoma (SSEH) is a rare but disabling disease. Although several cases have been reported in the literature, their treatment remains unclear, especially in patients with advanced age. We, therefore, aimed to describe the clinical outcomes of cervical SSEH in octogenarians with an acute onset of neurological illness undergoing laminectomy. METHODS Electronic medical records from a single institution between September 2005 and December 2020 were retrieved. Data on patient demographics, neurological conditions, functional status, surgical characteristics, complications, hospital course, and 90-day mortality were also collected. RESULTS Twenty-two patients aged ≥ 80 years with SSEH undergoing laminectomy were enrolled in this study. The mean Charlson comorbidity index was 9.1 ± 2.0, indicating a poor baseline reserve. Ten individuals (45.5%) were taking anticoagulant agents with a pathologic partial thromboplastin time (PTT) of 46.5 ± 3.4 s. Progressive neurological decline, as defined by the motor score (MS), was observed on admission (63.8 ± 14.0). The in-hospital and 90-day mortality were 4.5% and 9.1%, respectively. Notably, the MS (93.6 ± 8.3) improved significantly after surgery (p < 0.05). Revision surgery was necessary in 5 cases due to recurrent hematoma. Anticoagulant agents and pathological PTT are significant risk factors for its occurrence. Motor weakness and comorbidities were unique risk factors for loss of ambulation. CONCLUSIONS Laminectomy and evacuation of the hematoma in octogenarians with progressive neurological decline induce clinical benefits. Emergent surgery seems to be the "state of the art" treatment for SSEH. However, potential complications associated with adverse prognostic factors, such as the use of anticoagulants, should be considered.
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Vastani A, Baig Mirza A, Khoja AK, Bartram J, Shaheen S, Rajkumar S, China M, Lavrador JP, Bleil C, Bell D, Thomas N, Malik I, Grahovac G. Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis. Neurosurg Rev 2022; 46:21. [PMID: 36538111 DOI: 10.1007/s10143-022-01914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare disease defined as blood accumulation within the vertebral epidural space without a cause identified, which can lead to severe neurological deficits. We aim to provide a comprehensive understanding of the prognostic factors affecting surgical outcomes in true SSEH and propose a critical time frame for operative management. A systematic literature search was performed and registered, using OVID Medline and EMBASE, in line with the PRISMA guidelines. Relevant demographic, clinical, surgical, and outcome data were extracted. The ASIA scale was uniformly used throughout our systematic review. Statistical analysis was performed via logistic regression. Of the 1179 articles examined, we included 181 studies involving 295 adult patients surgically treated for SSEH. SSEH were most commonly found in the cervicothoracic spine, with 2-4 spinal segments most commonly involved. Multivariable logistic regression model showed that the following factors were statistically significant in the post-operative outcome: operation type (P = 0.024), pre-operative neurologic status (P < 0.001), use of warfarin (P = 0.039), and operative interval (P = 0.006). Our retrospective analysis confirms the reversibility of severe neurological deficits after surgical intervention, with a prognosis of post-operative outcomes determined by the use of warfarin, pre-operative ASIA grade, and above all surgical evacuation within 12 h.
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Affiliation(s)
- Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Abbas Khizar Khoja
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Safwan Shaheen
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Shivani Rajkumar
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Musa China
- Division of Medicine, University College London (UCL), London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Cristina Bleil
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - David Bell
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Irfan Malik
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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Jiang W, Tan XY, Li JA, Dong M. Spontaneous Spinal Epidural Hematoma Complicated by Pulmonary Embolism During Pregnancy: A Case Report. Front Med (Lausanne) 2022; 9:832693. [PMID: 35402434 PMCID: PMC8990125 DOI: 10.3389/fmed.2022.832693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Spontaneous spinal epidural hematoma, without discernable underlying conditions, is considered a neurological emergency, and is rare during pregnancy. Case Presentation We report the case of a 24-year-old patient at 37 weeks of gestation. She had back pain that progressed to paraplegia of both lower limbs within 2 days. Thoracic magnetic resonance imaging revealed a lesion behind the spinal cord at the T5–T6 level, suggestive of spontaneous spinal epidural hematoma. Due to the rapid recovery of muscle strength in her lower limbs after an emergency cesarean section, we used methylprednisolone therapy to reduce spinal edema rather than decompression of the spinal canal. We incidentally found that the patient’s left pulmonary artery was occluded. In consideration of spontaneous spinal epidural hematoma as relative contraindication to anticoagulation, and in the absence of pulmonary embolism symptoms, including good partial oxygen pressure, we did not administer anticoagulant therapy. The patient’s condition improved rapidly in the following week. Conclusion Spontaneous spinal epidural hematoma concomitant with pulmonary artery embolism is an extremely rare manifestation during pregnancy. As exemplified by our case, desirable treatment outcomes are possible under such cases.
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Affiliation(s)
- Wei Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Xuan-Yu Tan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jia-Ai Li
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Ming Dong
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Ming Dong,
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Spinal epidural hematoma in antiphospholipid syndrome: case report and review of the literature. Spinal Cord Ser Cases 2022; 8:11. [PMID: 35042850 PMCID: PMC8766459 DOI: 10.1038/s41394-022-00476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Spinal epidural hematomas are a surgical emergency, the delay in diagnosis can develop devastating sequelae due to its acute and progressive course. If not treated properly, it may lead to death or permanent neurological deficit. It is a rare condition that can occur in patients with hematologic pathology. CASE PRESENTATION We report a case report and literature review of a patient with antiphospholipid syndrome, who undergoes a diagnostic lumbar puncture for probable fungal meningitis. Developed a spinal acute epidural hematoma with neurological involvement that is evidenced in MRI. Urgent surgical decompression was performed with good results. DISCUSSION Despite the low incidence of an epidural hematoma in patients who undergo lumbar puncture, it is important to perform a thorough evaluation in any patient with coagulation abnormalities prior and after a lumbar puncture, by reason of the inherent possibility of developing an epidural hematoma at the site of the procedure. In the same way, early diagnosis and aggressive treatment is necessary in patients who develop progressive neurological symptoms to limit the damage and improve the prognosis for neurological recovery.
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El-azrak M, Noumairi M, Oulalite MA, El Mir S, Kachmar S, Bkiyar H, El Ouafi N, El Oumri AA, Bazid Z, Housni B. Spontaneous spinal epidural hematoma in a patient on acenocoumarol for valvular atrial fibrillation: A rare case report. Ann Med Surg (Lond) 2021; 72:103076. [PMID: 34876979 PMCID: PMC8632830 DOI: 10.1016/j.amsu.2021.103076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare finding, but one with serious clinical implications. Oral anticoagulant drugs are known to be associated with the SSEH onset, particularly when combined with drugs increasing the bleeding risk. CASE PRESENTATION We present the case of a 62-year-old female on acencoumarol for her atrial fibrillation complicating severe mitral stenosis with a history of Ketoprofen use for the onset of her first symptoms. She presented to our emergency room with paraplegia and sphincter disturbance. Spinal magnetic resonance imaging (MRI) revealed a posterior SSEH extended from T10 to T12 requiring an urgent decompression of the spinal cord by laminectomy performed within 48 hours from the symptom's onset. After 3 months of rehabilitation, the patient improves partially her muscular strength with mostly unchanged sensitive and sphincteric levels. CLINICAL DISCUSSION Vitamin K antagonists (VKA) use appears to be a high suspicion index for SSEH diagnosis resulting in earlier surgery and improving neurological outcome. Also, it is important to pay attention to the concomitant use of VKA and non-steroidal anti-inflammatory drugs which increase the risk of bleeding and may worsen the neurological outcome. CONCLUSION SSEH is a rare and serious finding which should be especially searched when a history of oral anticoagulation is reported in presence of neurological symptoms. A prompt and suitable management may improve the patient outcomes.
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Affiliation(s)
- Mohammed El-azrak
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Mohammed Noumairi
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Mohammed Amine Oulalite
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Siham El Mir
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Safaa Kachmar
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Houssam Bkiyar
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Ahmed Amine El Oumri
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Brahim Housni
- Department of Anesthesiology and Reanimation, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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15
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Lee BJ. Letter to the Editor: Commentary on Recurrent Cervical Spontaneous Spinal Epidural Hematoma with Conservative Management: A Case Report ( Korean J Neurotrauma 2021;17:186-191). Korean J Neurotrauma 2021; 17:192. [PMID: 34760833 PMCID: PMC8558011 DOI: 10.13004/kjnt.2021.17.e32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, Goyang, Korea
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16
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Crumm CE, Crotty EE, Albert CM, Blair AB, Otjen JP, Feldman KW. Atraumatic Spinal Epidural Hematoma as Initial Presentation of Hemophilia A in an Infant. Pediatr Emerg Care 2021; 37:e772-e774. [PMID: 30870339 DOI: 10.1097/pec.0000000000001793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
ABSTRACT Hemophilia A is characterized by deficiency of factor VIII. We present a unique, illustrative case of an infant with a short history of neck pain and irritability without neurological deficits who was found to have a spinal epidural hematoma. The subsequent investigation for the etiology, including workup for nonaccidental trauma, led to a diagnosis of severe hemophilia A.
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17
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Liu H, Zhang T, Qu T, Yang CW, Li SK. Spinal epidural hematoma after spinal manipulation therapy: Report of three cases and a literature review. World J Clin Cases 2021; 9:6501-6509. [PMID: 34435018 PMCID: PMC8362556 DOI: 10.12998/wjcc.v9.i22.6501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal manipulation therapy (SMT) has been widely used worldwide to treat musculoskeletal diseases, but it can cause serious adverse events. Spinal epidural hematoma (SEH) caused by SMT is a rare emergency that can cause neurological dysfunction. We herein report three cases of SEH after SMT.
CASE SUMMARY The first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT. Her symptoms persisted after 3 d of conservative treatment, and she was admitted to our hospital. Magnetic resonance imaging (MRI) demonstrated an SEH, extending from C6 to C7. The second case was a 55-year-old man with sudden back pain 1 d after SMT, numbness in both lower limbs, an inability to stand or walk, and difficulty urinating. MRI revealed an SEH, extending from T1 to T3. The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT. He was unable to stand or walk and experienced mild back pain. MRI revealed an SEH, extending from T1 to T2. All three patients underwent surgery after failed conservative treatment. The three cases recovered to ASIA grade E on day 5, 1 wk, and day 10 after surgery, respectively. All patients returned to normal after 3 mo of follow-up.
CONCLUSION SEH caused by SMT is very rare, and the condition of each patient should be evaluated in full detail before operation. SEH should be diagnosed immediately and actively treated by surgery.
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Affiliation(s)
- Hua Liu
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Tao Zhang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Tao Qu
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Cheng-Wei Yang
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Song-Kai Li
- Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
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18
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Ifuku T, Nishiguchi T. Spontaneous Spinal Epidural Hematoma in an Adult Patient with Complex Congenital Heart Disease. Int Heart J 2021; 62:935-937. [PMID: 34234072 DOI: 10.1536/ihj.20-721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spontaneous spinal epidural hematoma (SSEH) is considered to be a relatively rare disease that can result in serious neurological sequelae. The pathogenesis and risk factors of SSEH are still unknown, and its differential diagnosis varies widely. Misdiagnosis with more common conditions such as stroke or aortic syndromes can occur. We report the case of a 27-year-old man who developed sudden upper back pain with no specific precipitant. Five days later, he visited our emergency department complaining of weakness in both lower limbs and dysuria. He had a history of intracardiac repair and a Blalock-Park procedure for an interrupted aortic arch and ventricular septal defect in infancy. Additionally, he had undergone an aortic root dilatation and aortic valve replacement at the age of 10 because of progression of aortic and supra-aortic stenosis and had received chronic anticoagulation and antiplatelet therapy with warfarin and aspirin, respectively. An emergency spine magnetic resonance imaging scan indicated a mass at the Th3-Th5 level with severe compression of the dural sac and the spinal cord. Emergency excision showed a spinal epidural hematoma. Mild postoperative gait disturbance and dysuria persisted, requiring rehabilitation and intermittent self-urethral catheterization. As patients with adult congenital heart disease have an increased risk of bleeding, they may be at risk of developing SSEH. However, this is the first report to describe such an association.
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Affiliation(s)
- Toshinobu Ifuku
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital
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19
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Gandhi D, Chowdhary A, Kichloo A, Singh J, Patel L, Shah J. An unusual case of ventral spontaneous spinal epidural hematoma: Case report with review of literature. Radiol Case Rep 2021; 16:2207-2210. [PMID: 34178193 PMCID: PMC8213979 DOI: 10.1016/j.radcr.2021.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous spinal epidural hematoma is a rare predominantly idiopathic entity which can prompt acute neurologic symptoms and if not managed in time can lead to devastating outcomes. High index of suspicion is required for early diagnosis on MRI for a prompt management of patients showing sudden neurologic deficits. Our patient was 42-year-old female who presented with sudden onset of numbness followed by weakness in both lower limbs and urinary retention without any comorbidity or any medication. MRI whole spine done within 14 hours of symptom onset showed ventral epidural hematoma without any vascular malformation. Immediate decompressive laminectomy with evacuation of hematoma improved power in both lower limbs with regaining bowel and bladder function. The key here is timely surgical decompression of the hematoma for a favorable neurosurgical outcome. Although there is a recent development towards non–surgical treatment, it needs to be well established yet and require such approach on case-to-case basis.
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Affiliation(s)
- Darshan Gandhi
- Department of Diagnostic Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611, USA
| | - Anisa Chowdhary
- Department of Medicine, Maulana Azad Medical College 2, Bahadur Shah Zafar Marg, New Delhi, Delhi 110002, India
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University School of Medicine, 1280 East Campus Dr, Mt Pleasant, MI 48858, USA
| | - Jagmeet Singh
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA 18510, USA
| | - Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, 800 E 28th Street, Minneapolis, MN 55407, USA
| | - Jayun Shah
- Department of Neurosurgery, Sterling Hospitals, Memnagar, Ahmedabad, Gujarat 380052, India
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20
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Hines K, Hafazalla K, Bailey JW, Jallo J. Extruded disc causes acute cervical epidural hematoma and cord compression: a case report. Spinal Cord Ser Cases 2021; 7:39. [PMID: 34021115 DOI: 10.1038/s41394-021-00403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Cervical spontaneous epidural hematoma is a serious neurosurgical pathology that often requires prompt surgical intervention. While a variety of causes may contribute, the authors present the first case in the literature of cervical disc extrusion provoking epidural hemorrhage and acute neurological deterioration. CASE PRESENTATION A 65 year old male presented with six months of worsening signs and symptoms of cervical myelopathy. He had progressive deterioration over the course of two weeks leading to ambulatory dysfunction requiring a cane for assistance. While undergoing his medical workup in the emergency department, the patient became acutely plegic in the right lower extremity prompting emergent surgical decompression and stabilization. DISCUSSION Based on imaging, pathology, and intraoperative findings, it was concluded that the patient had an extruded disc segment that may have precipitated venous bleeding in the epidural space and findings of acute cervical cord compression. Cervical disc extrusion may lead to venous damage, epidural hematoma, and spinal cord compression. If this unique presentation is recognized and addressed in a timely manner, patient outcomes may still be largely positive as this case demonstrates.
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Affiliation(s)
- Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
| | - Karim Hafazalla
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - James W Bailey
- Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Institute at Rowan University, Stratford, NJ, USA
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
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21
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Verma K, Reavey-Cantwell J, Cameron BM. Apixaban-associated spontaneous thoracic intramedullary hemorrhage. Clin Neurol Neurosurg 2021; 202:106512. [PMID: 33508647 DOI: 10.1016/j.clineuro.2021.106512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Ketan Verma
- Virginia Commonwealth University, Department of Neurosurgery, United States.
| | | | - Brian M Cameron
- Virginia Commonwealth University, Department of Neurosurgery, United States
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22
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Morimoto D, Kim K, Kubota A, Kokubo R, Iwamoto N, Hattori Y, Morita A. Recurrent Cervical Spinal Epidural Hematoma: Case Report and Literature Review. NMC Case Rep J 2020; 7:157-160. [PMID: 33062561 PMCID: PMC7538460 DOI: 10.2176/nmccrj.cr.2019-0253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/28/2020] [Indexed: 12/04/2022] Open
Abstract
Spinal epidural hematoma (SEDH) is an uncommon pathology. Here, we report a case of SEDH with recurrences, along with a literature review of relevant cases to identify characteristics of SEDH recurrence. A 13-year-old girl experienced sudden-onset of back pain and bilateral leg weakness. She was diagnosed with a cervical idiopathic epidural hematoma, and the symptoms subsided with conservative management. Four months after the event, she again experienced back pain due to recurrence of the cervical epidural hematoma, but she was observed because no neurological deficits could be detected. Fifteen months after the initial SEDH, she experienced severe back pain and tetra-paresis due to recurrence. The SEDH was located in the left ventral and dorsal aspect at the C6–T1 level, with severe spinal cord compression. The hematoma was removed through left hemilaminectomy. Bleeding was noted from the epidural venous plexus along the left C6 spinal root, which had coagulated. After hematoma resection, her symptoms gradually improved, and she was discharged 3 weeks after surgery without any neurological deficits. No hematoma recurrence has since been experienced. Recurrent SEDH is relatively rare, with only 11 cases previously reported. Recurrent hematoma cases are more common in young, female patients, while SEDH, in general, is more common in males in their late forties. The recurrence interval is shorter in non-surgical cases than those requiring surgery. Knowledge of these characteristics may be useful in the future management of SEDH.
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Affiliation(s)
- Daijiro Morimoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Kyongsong Kim
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Rinko Kokubo
- Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan
| | - Naotaka Iwamoto
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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23
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Teles P, Correia JP, Pappamikail L, Lourenço A, Romero C, Lopes F, Almeida GN, Abreu P. A spontaneous cervical epidural hematoma mimicking a stroke - A case report. Surg Neurol Int 2020; 11:157. [PMID: 32637210 PMCID: PMC7332487 DOI: 10.25259/sni_161_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/27/2020] [Indexed: 01/30/2023] Open
Abstract
Background: A spontaneous cervical epidural hematoma (SCEH) is a rare occurrence. It usually presents with quadriparesis, but it may present with hemiparesis or hemiplegia and can easily be misdiagnosed as stroke. We present a case of stroke mimicking SCEH with hemiparesis worsened after tissue plasminogen activator therapy (tPA) followed by emergency cervical decompression laminectomy. Case Description: A 63-year-old female presented to the emergency department with sudden onset of posterior neck and left shoulder pain with the right side hemiparesis. On neurological examination, the patient had motor power of the right upper and lower limb of 2/5 Medical Research Council, and her whole left extremities were intact. Her medical history was unremarkable for trauma, hemorrhagic diathesis, or anticoagulation therapy. A head computed tomography was ordered ruling out intracranial hemorrhage. Assuming an acute ischemic stroke as the most likely diagnosis, alteplase (tPA) was administered 3 h after symptoms onset, however without any improvement in patient symptoms. A cervical magnetic resonance was performed revealing a right paramedian epidural mass-like lesion between C3-C6. The patient underwent cervical laminectomy C3-C6 with evacuation of epidural hematoma with significant clinical status improvement after surgery. Conclusion: tPA treatment is frequently used as first-line therapy for acute ischemic stroke. Therefore, physicians should be aware of the potential for the SCEH in patients presenting with hemiparesis, as tPA administration may increase cervical hematoma leading to clinical deterioration. With this case, we intended to warn about SCEH as a rare but possible entity, since its early recognition and prompt clinical intervention may improve neurological outcomes.
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Affiliation(s)
- Pedro Teles
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Joaquim Pedro Correia
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Lia Pappamikail
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Artur Lourenço
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Clara Romero
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Fátima Lopes
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Gonçalo Neto Almeida
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
| | - Pedro Abreu
- Department of Neurosurgery, Centro Hospitalar Universitario do Algarve, Rua Leao Penedo, Faro, Portugal
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24
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Jaweed M, Ganesan D, Yasin MA, Liew BS, Bin Rosman AK. Acute Spontaneous Cervical Spinal Epidural Haematoma a Very Rare Presentation Mimicking of Carotid Dissection during Sleep. Asian J Neurosurg 2020; 15:455-457. [PMID: 32656153 PMCID: PMC7335142 DOI: 10.4103/ajns.ajns_318_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/13/2019] [Accepted: 02/20/2020] [Indexed: 11/04/2022] Open
Abstract
Acute spontaneous spinal epidural hematoma without any identified etiology is a rare phenomenon and an uncommon cause of acute spinal cord compression. We report a case of acute spontaneous cervical spinal epidural hematoma, with sudden onset of acute neck pain and left-side body weakness during sleep which resembling of cervicle carotid dissection. The pain commenced suddenly, early in the morning while the patient was asleep. He had no previous history of any relevant medical disorder. Cervical Spine MRI revealed a cervical epidural haematoma at C3/C4, mainly on the left side, with spinal cord compression. Therefore, an emergent C3/C6 hemilaminectomy and evacuation of hematoma were carried out within 24 h of presentation. The patient's neck pain resolved after surgery and he was able to walk, though he required bladder catheterization on discharge after 1 week. He has nearly intact motor neurological examination in the second month of the operation.
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Affiliation(s)
- Mohammad Jaweed
- Department of Neurosurgery, School of Medicine, Faculty of Health and Medical Sciences, Hospital Sungai Buloh, Taylor's University, Selangor, Malaysia
| | - D. Ganesan
- Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Boon Seng Liew
- Department of Neurosurgery, Hospital Sungai Buloh, Selangor, Malaysia
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25
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Taha MM, Elsharkawy AM, Al Menshawy HA, AlBakry A. Spontaneous cervical epidural hematoma: A case report and review of literature. Surg Neurol Int 2019; 10:247. [PMID: 31893148 PMCID: PMC6935966 DOI: 10.25259/sni_543_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not diagnosed early can lead to catastrophic consequences. CASE DESCRIPTION Here, we report a 41-year-old male, diagnosed with SCEH, with a presenting chief complaint of cervical pain followed by progressive quadriparesis and urgency of micturition who was managed surgically, along with the review of literature. CONCLUSION SCEH is a rare pathologic entity. Due to the high risk of poor neurological outcome without treatment, SCEH should be a diagnostic possibility when the presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma and hemostasis leads to a favorable neurological outcome, whereas delay in treatment can be disastrous.
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Affiliation(s)
| | | | | | - Amr AlBakry
- Department of Neurosurgery, Zagazig University, Zagazig
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26
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Lee HS, Ju CI, Kim SW. Traumatic Cervical Epidural Hematoma without Osseous Fracture Presenting as Hemiparesis. Korean J Neurotrauma 2019; 15:209-213. [PMID: 31720279 PMCID: PMC6826106 DOI: 10.13004/kjnt.2019.15.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022] Open
Abstract
Traumatic cervical epidural hematoma (EDH) with no osseous fracture or underlying hematological abnormalities is a rare disorder that sometimes requires emergent surgical decompressive therapy. A 47-year-old woman was admitted to our emergency room due to severe neck pain and rapid onset hemiparesis after a car accident. Plain cervical radiographs and computed tomography scan did not reveal any abnormality. However, magnetic resonance imaging (MRI) revealed a large posterior EDH compressing the spinal cord extensively from C3 to C5. Emergent hematoma removal was performed following laminectomy, and subsequently the patient showed substantial clinical improvement. Complete removal of the hematoma was confirmed by MRI at 10 days after surgery. Here, the authors present a discussion of the etiology, pathogenesis, and prognosis of this rare pathologic entity.
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Affiliation(s)
- Hak Soo Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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27
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Shi J, Ermann J, Weissman BN, Smith SE, Mandell JC. Thinking beyond pannus: a review of retro-odontoid pseudotumor due to rheumatoid and non-rheumatoid etiologies. Skeletal Radiol 2019; 48:1511-1523. [PMID: 30868232 DOI: 10.1007/s00256-019-03187-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
Retro-odontoid pseudotumor, or mass-like retro-odontoid soft tissue thickening, is an uncommon but important imaging finding that may be associated with rheumatoid arthritis, crystal deposition diseases, as well as non-inflammatory conditions such as cervical degenerative changes and mechanical alterations. Retro-odontoid pseudotumor is commonly associated with atlantoaxial microinstability or subluxation. MRI and CT have an important role in the detection and diagnosis of retro-odontoid pseudotumor. However, due to a wide range of imaging characteristics and ambiguous etiology, it is a frequently misunderstood entity. The purpose of this article is to review relevant anatomy of the craniocervical junction; describe various imaging appearances, pathophysiology and histology in both rheumatoid and non-rheumatoid etiologies; and discuss differential diagnosis of retro-odontoid pseudotumor in order to help guide clinical management.
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Affiliation(s)
- Junzi Shi
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Joerg Ermann
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Barbara N Weissman
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Unnithan AKA. A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0046-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pavlićević G, Lepić M, Lepić T, Jaćimović N, Radenović K, Novaković N, Rasulić L, Mandić-Rajčević S. A Spontaneous Cervical Epidural Hematoma Mimicking a Stroke: A Challenging Case. J Emerg Med 2019; 57:70-73. [PMID: 31060847 DOI: 10.1016/j.jemermed.2019.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 03/18/2019] [Accepted: 03/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND A spontaneous cervical epidural hematoma (SCEH) is a rare occurrence, with < 500 cases reported to date. Clinically, it usually presents with quadriparesis, but in extremely rare cases it can present with hemiparesis or hemiplegia, and can easily be misdiagnosed as stroke. The cervical epidural hematoma by itself is an urgent condition that requires a quick and accurate diagnosis and a prompt surgical treatment. CASE REPORT We present a case where an SCEH mimicked the much more frequent condition of a stroke, and discuss the importance of diagnostics procedures that help differentiate SCEH from acute cerebral infarction. The patient's history of neck pain and spondylosis render this case more challenging. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Considering that the emergency tissue plasminogen activator treatment for acute cerebral infarction can worsen the state of an SCEH patient, or even lead to permanent damage or death, it is of great importance to rapidly and accurately differentiate these two conditions.
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Affiliation(s)
- Goran Pavlićević
- Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Milan Lepić
- Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Toplica Lepić
- Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia; Department of Neurology, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Jaćimović
- Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Ksenija Radenović
- Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Nenad Novaković
- Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Lukas Rasulić
- School of Medicine, University of Belgrade, Belgrade, Serbia; Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- Innovation Centre of the Faculty of Technology and Metallurgy, University of Belgrade, Belgrade, Serbia
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Spinal Hematoma Following Coronary Angioplasty: An Uncommon Complication. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:3-5. [PMID: 30833211 DOI: 10.1016/j.carrev.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 11/22/2022]
Abstract
We report an unusual case of post-procedural spontaneous spinal epidural hematoma in a 65 year old man who presented with an acute coronary syndrome and underwent complex coronary intervention with adjunct use of a GPIIb/IIIa inhibitor. Although spontaneous spinal epidural hematoma (SSEH) following coronary intervention is extremely rare, clinicians should be aware of this unusual diagnosis. Prompt investigation with MRI and early referral for neurosurgical input are recommended to prevent potentially significant sequelae.
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Ali SS, Shaw AE, Oselkin M, Bragin I. Iatrogenic Spinal Epidural Hematoma Associated with Intracranial Hypotension. Cureus 2019; 11:e4171. [PMID: 31093470 PMCID: PMC6502287 DOI: 10.7759/cureus.4171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Epidural steroid injections (ESIs) are one of the few modalities currently in use for treating chronic spinal pain. There are two approaches: interlaminar ESIs and transforaminal ESIs. Complications arising from either approach are rare, but one such complication is cerebrospinal fluid (CSF) leak leading to intracranial hypotension. Even rarer is the development of iatrogenic spinal epidural hematoma in the context of the injections. Interestingly, an association with intracranial hypotension and spinal epidural hematoma has yet to be established. Even the characteristics of an iatrogenic spinal epidural hematoma are not well defined as there are different theories of how this develops and whether we are dealing with arterial or venous blood. Our case is unique as it appears our patient had developed not one, but both clinical symptoms supportive of intracranial hypotension from a CSF leak induced iatrogenically from a cervical epidural injection and imaging demonstrated thoracic-level spinal epidural hematoma. It is unclear whether the injection directly led to the spinal leak causing the intracranial hypotension, which then brought on the formation of the hematoma or if the injection led to both intracranial hypotension and hematoma formation independent of each other. From a clinical practice standpoint, given our case suggests the hematoma was concomitantly associated with intracranial hypotension, and the possibility exists that the hematoma may have formed in the context of the intracranial hypotension, then targeted blood patches may need to be done with greater urgency to preventing hematoma formation. Further studies are needed involving clotting factors comparing arterial and venous blood. It is also puzzling why the epidural blood from the hematoma did not clot the leak. This concomitancy deserves further attention and may lead to changes in how we manage cervical epidural injection patients who are found to have CSF leak and a spinal epidural hematoma.
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Affiliation(s)
- Sameer S Ali
- Neurology, Veterans Affairs Connecticut Healthcare System, West Haven, USA
| | - Allison E Shaw
- Neurology, St. Luke's University Health Network, Bethlehem, USA
| | - Martin Oselkin
- Radiology, St. Luke's University Health Network, Bethlehem, USA
| | - Ilya Bragin
- Neurology, St. Lukes University Health Network, Bethlehem, USA
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Spontaneous resolution and complete recovery of spontaneous cervical epidural hematoma: Report of two cases and literature review. Neurochirurgie 2019; 65:27-31. [PMID: 30635115 DOI: 10.1016/j.neuchi.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/08/2018] [Accepted: 10/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present the natural course and treatment modalities of spontaneous cervical epidural hematoma (SCEH), by reporting two rare cases with spontaneous resolution in both clinical and radiologic findings without surgery. MATERIAL AND METHODS One patient presenting with acute right side hemiparesis and another showing pure cervical radiculopathy were diagnosed with SCEH on magnetic resonance imaging (MRI). Both were both treated non-operatively. We also conducted a literature review of 19 cases of spontaneous spinal epidural hematoma (SSEH). RESULTS These two patients achieved complete resolution in terms of both neurologic function and radiologic findings within 21 days after onset. In the literature review, 63.2% of cases experienced neurologic improvement in the first 24h, 78.9% achieved complete neurologic recovery within 1 month, and radiological images showed complete resolution of hematoma in the first month for 73.7% of patients. CONCLUSIONS Atypical cervical SSEH can mimic cerebral stroke or a ruptured cervical disc. A high index of clinical suspicion followed by MRI examination is critical for diagnosis. Prompt surgical decompression and evacuation of the hematoma is generally regarded as first-line treatment. However, for patients without or with only slight neurologic symptoms, or showing early and sustained neurologic improvement, non-surgical therapy with close observation is a viable alternative. Both neurologic and radiologic resolution can be expected within the first month following onset in most cases of spontaneous resolution of SSEH.
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Gomes PA, Cernadas E, Sá J, Brito H, Costa R. Spontaneous Spinal Haemorrhage as a Complication of Oral Anticoagulant Therapy: A Case Report and Literature Review. Eur J Case Rep Intern Med 2018; 5:000887. [PMID: 30755993 PMCID: PMC6346978 DOI: 10.12890/2018_000887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/09/2018] [Indexed: 01/30/2023] Open
Abstract
Spinal cord haematoma, or haematomyelia, is a rare condition caused by several unusual disease processes. Traumatic events, such as spinal cord injury and surgery or procedures involving the spinal cord, are the most important causes of spinal cord haematoma. Rarely, it is associated with anticoagulation therapy. Irrespective of cause, spinal cord haematoma is considered a neurosurgical emergency and must be treated promptly in order to prevent neurological sequelae. The authors describe the case of a 69-year-old patient taking warfarin in the therapeutic range for a mechanic mitral valve, who developed chest pain with cervical and dorsal radiation, and experienced sudden paraparesis of the limbs. A CT of the spine confirmed haematomyelia. A high index of suspicion, prompt recognition and immediate intervention are essential to prevent major morbidity and mortality from intraspinal haemorrhage. LEARNING POINTS This article reports an unusual presentation of spontaneous spinal haematoma, imposing the careful elaboration of differential diagnoses, which is very important in internal medicine.The description of this low-incidence case allows the scientific community to assist in approaching patients with similar symptoms.The lack of studies about the etiology and treatment of spontaneous spinal haematoma underlines the need for further studies and research in the area in order to increase the scientific evidence on the approach of these patients.
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Affiliation(s)
- Patrícia A Gomes
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Eduardo Cernadas
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Juliana Sá
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Helena Brito
- Internal Medicine Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Ricardo Costa
- Emergency Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal
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Zuo B, Zhang Y, Zhang J, Song J, Jiang S, Zhang X. Spontaneous Spinal Epidural Hematoma: A Case Report. CASE REPORTS IN ORTHOPEDIC RESEARCH 2018. [DOI: 10.1159/000490067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord and leading to acute neurological deficits. MRI provides the most valuable visualization of the location and hematoma mass as well as the presence of the spinal cord compression. SSEH can occur in any segments of the spinal cord but predominantly at the posterior cervicothoracic (C5–T2) and thoracolumbar (T10–L2) levels. The source of hemorrhage SSEH can be both vertebral venous plexus system or arterial source. Decompressive laminectomy and hematoma evacuation are the standard surgical procedures upon diagnosis of SSEH, although spontaneous recoveries have been reported. The degree of preoperative neural deficit is a major prognostic factor. Conservative management has proven effective, although feasible only if spontaneous recovery is manifested. Decompressive laminectomy should continue to remain readily available, given the inverse correlation between operative interval and recovery.
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Goldfine C, Glazer C, Ratzan RM. Spontaneous Spinal Epidural Hematoma from Rivaroxaban. Clin Pract Cases Emerg Med 2018; 2:151-154. [PMID: 29849242 PMCID: PMC5965116 DOI: 10.5811/cpcem.2018.2.37096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 12/20/2022] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is a rare diagnosis. One known risk factor is anti-coagulation medication. We present a case of SSEH in a 74-year-old male on rivaroxaban therapy who clinically presented with an intermittently resolving and then worsening neurological exam. Due to the extremely high morbidity and mortality associated with this diagnosis, it is important to be aware of the various presentations and adverse effects related to novel anticoagulation.
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Affiliation(s)
- Charlotte Goldfine
- University of Connecticut School of Medicine, Hartford Hospital, Department of Emergency Medicine, Hartford, Connecticut
| | - Catherine Glazer
- University of Connecticut School of Medicine, Hartford Hospital, Department of Emergency Medicine, Hartford, Connecticut
| | - Richard M Ratzan
- University of Connecticut School of Medicine, Hartford Hospital, Department of Emergency Medicine, Hartford, Connecticut
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Okazaki T, Nakagawa H, Hayase H, Irie S, Inagaki T, Saito O, Yamashina M, Nagahiro S, Saito K. Idiopathic and Chronic Epidural Hematoma in the Lumbar Spine: A Case Report and Review of Literatures. Neurol Med Chir (Tokyo) 2018; 58:138-144. [PMID: 29415912 PMCID: PMC5929923 DOI: 10.2176/nmc.cr.2017-0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Spontaneous and chronic epidural hematoma (SSEH) in the lumbar spine is rare, and idiopathic and chronic SSEH in the lumbar spine is extremely rare disease. Most of lumbar SSEH were acute and secondary with trauma, hematologic disorders, drug, and surgical procedure. Only 20 cases of chronic SSEH in the lumbar spine have been reported and 14 cases among them were considered to be idiopathic. Definitive guidelines for management of this condition are not clear and surgical total evacuation was performed in most of the cases. Some authors reported the epidural bleeding originates in the rupture of Batson’s plexus due to a rise in intra-abdominal pressure, but the mechanism is not clearly clarified. We report a surgical case of idiopathic and chronic SSEH. A 61-year-old woman suffered a sudden onset of severe lumbar pain during sleep. She had no history of trauma, spinal surgery, or hypertension. Magnetic resonance imaging revealed a lumbar chronic epidural hematoma which compressed the dural sac behind and extended from L2 to L5. This patient underwent the partial evacuation of the hematoma with partial hemilaminectomy on left at L2/3, resulting in immediate pain relief and resolution of symptoms and almost absorption of the hematoma within 1 week of the procedure. We presented this rare case and reviewed idiopathic and chronic epidural hematoma in the lumbar spine.
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Affiliation(s)
- Toshiyuki Okazaki
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital.,Department of Neurosurgery, Tokushima University
| | | | - Hitoshi Hayase
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | - Shinsuke Irie
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | - Toru Inagaki
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | - Osamu Saito
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | | | | | - Koji Saito
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
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Wilson C, Simonds E, Iwanaga J, Oskouian RJ, Tubbs RS. Pseudoaneurysm of Posterior Ascending Branch of Vertebral Artery: Previously Unreported Case. World Neurosurg 2018; 112:158-160. [PMID: 29391298 DOI: 10.1016/j.wneu.2018.01.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pseudoaneurysms are less common than true aneurysms. Herein, we present a rare case of a mass of the right posterior ascending artery. CASE DESCRIPTION This was identified during routine dissection of an adult female cadaver. Histology demonstrated that the mass was a pseudoaneurysm. The mass was located posterior to the right alar ligament superior to the right portion of the transverse ligament and measured 7.37 mm and 2.97 mm. CONCLUSIONS To our knowledge, such a case has not previously been reported. Epidural masses anterior to the cervical dura mater at the craniocervical junction should consider such a pathology in the differential diagnosis.
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Affiliation(s)
| | - Emily Simonds
- Seattle Science Foundation, Seattle, Washington, USA
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies
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Patel R, Kumar A, Nishizawa K, Kumar N. Hemiparesis in spontaneous spinal epidural haematoma: a potential stroke imitator. BMJ Case Rep 2018; 2018:bcr-2017-222686. [PMID: 29374642 DOI: 10.1136/bcr-2017-222686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare condition that requires urgent surgical intervention in order to prevent permanent neurological deficit. SSEH commonly presents as a paraparesis or tetraparesis. SSEH presenting as a hemiparesis is less common and in such situations, it can be mistaken for a cerebrovascular accident (CVA). Thrombolytic or anticoagulant treatment for CVA can potentially worsen the neurological deficit. We report one such case of SSEH misdiagnosed as a CVA. Treatment with tissue plasminogen activator led to worsening of his condition. On a subsequent cervical spine MRI, an epidural haematoma extending from C3 to C5 was detected and treated with laminectomy and evacuation. Surgical intervention led to significant improvement from American Spinal Injury Association Scale (ASIA) B to ASIA E. Presence of clinical features such as Horner's syndrome, Brown-Sequard syndrome and the absence of cranial nerve palsies in acute hemiparesis are indicative of SSEH rather than CVA.
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Affiliation(s)
- Ravish Patel
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Aravind Kumar
- Orthopaedic Surgery, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Kazuya Nishizawa
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Naresh Kumar
- Orthopaedic Surgery, National University Hospital, Singapore, Singapore
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Salehpour F, Mirzaei F, Kazemzadeh M, Alavi SAN. Spontaneous Epidural Hematoma of Cervical Spine. Int J Spine Surg 2018; 12:26-29. [PMID: 30280079 PMCID: PMC6162037 DOI: 10.14444/5005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Spontaneous cervical epidural hematoma is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not recognized early can have catastrophic consequences. Acute cervical epidural hematoma is definitely a condition of neurologic emergency. Although it is a rare condition, it must be considered in nontraumatic patients with sudden onset of neurologic deficits. Patients with spontaneous spinal epidural hematoma typically present with acute onset of severe back pain, and they rapidly develop signs of compression of the spinal cord or cauda equina. Here, we present a case of a 31-year-old man who presented with acute onset of neck pain with radicular component with progressive neurologic deficit. Emergent magnetic resonance imaging revealed cervical extradural hematoma with cord compression that was promptly evacuated. Functional recovery was achieved within 48 hours. The level of preoperative neurologic deficit and its severity, as well as operative interval, are important factors significantly affecting the postoperative outcome.
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Affiliation(s)
- Firooz Salehpour
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Mirzaei
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Kazemzadeh
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ahmad Naseri Alavi
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Wettstein RKRW, van der Kallen BFW, Moojen WA, Tewarie RN. Thoracic epidural haematoma due to a subclavian steal syndrome and secondary formed thoracic collateral circuits, coincidence or consequence: a case report. Acta Neurochir (Wien) 2018; 160:205-208. [PMID: 29167977 DOI: 10.1007/s00701-017-3402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022]
Abstract
Despite profound diagnostics, the aetiology of spinal epidural haematoma (SEH) often remains unknown. In this case, diagnostics revealed an SEH at the fifth and sixth thoracic levels due to a subclavian steal syndrome with a tortuous vascular loop between the sixth thoracic intercostal artery and the costocervical arteries deriving from the left subclavian artery with plump arteries in the epidural space. The patient underwent decompression surgery and a percutaneous transluminal angioplasty. The patient showed good recovery at follow-up. The SEH was a result of secondary formed thoracic collateral circuits with epidural involvement due to a subclavian steal syndrome.
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Affiliation(s)
- Ravian K R W Wettstein
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
| | | | - Wouter A Moojen
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rishi Nandoe Tewarie
- Department of Neurosurgery, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
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Anghelescu A, Rasina A. Acute spontaneous thoracic epidural hematoma, triggered by weight-lifting training, in a retired sportsman: case report and literature review. Spinal Cord Ser Cases 2017; 3:17090. [PMID: 29423296 PMCID: PMC5798928 DOI: 10.1038/s41394-017-0029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/08/2017] [Accepted: 10/13/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity, most often with acute symptomatic spinal cord compression and potentially permanent neurologic deficits. SSEH usually has surgical solutions and a good outcome after hematoma evacuation. CASE PRESENTATION A 61-year-old professional weight-lifting coach presented to the emergency department with sudden back pain, rapidly progressive paraparesis, and neurogenic bladder, after an intense training, 5 h previously. Magnetic resonance imaging revealed a ventral thoracic epidural hematoma with significant compression at Th3-Th6. Surgical procedure was performed within the first 12 h: decompressive laminectomy from Th3 to Th7 vertebral levels and near total epidural hematoma removal. The patient improved rapidly from Th5 AIS-C to Th7 AIS-D paraplegia with independent ambulation, after the intervention. The rehabilitation program led to further improvement of the neurologic deficits and a favorable outcome, to AIS-E. DISCUSSION Weightlifting has been reported as SSEH precipitating factor in young athletes. Our case is unique however, because the athlete was older. The underlying pathophysiological mechanism is represented by intravenous pressure changes and bleeding of the epidural venous plexus during a prolonged Valsalva maneuver, induced by strenuous, repeated efforts. Spondylosis, hypertension, and low doses of aspirin were incriminated as risk factors for SSEH. Prompt diagnosis, emergent decompressive intervention, early rehabilitation, and secondary prophylaxis were essential for a good outcome.
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Affiliation(s)
- Aurelian Anghelescu
- Neurorehabilitation Clinic, Teaching Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Alin Rasina
- Stereotactic and Functional Neurosurgery, Teaching Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania
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42
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Li C, He R, Li X, Zhong Y, Ling L, Li F. Spontaneous spinal epidural hematoma mimicking transient ischemic attack: A case report. Medicine (Baltimore) 2017; 96:e9007. [PMID: 29245281 PMCID: PMC5728896 DOI: 10.1097/md.0000000000009007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Spontaneous spinal epidural hematoma (SSEH) is a rare but highly disabling neurological emergency. The initial presentations are variable. Most patients of SSEH present with paraplegia or tetraplegia clinically, but recurrent hemiparesis with complete spontaneous recovery, mimicking transient ischemic attack (TIA), is a very rare initial presentation of SSEH. PATIENT CONCERNS A 71-year-old female presented to the emergency department with 2 episodes of transient right hemiparesis in 5 hours. Two days later, above symptom reappeared and progressed to quadriplegia, dyspnea, and uroschesis quickly. The neurological examination showed tetraplegia and hypalgesia below the C2 level, but neither facial palsy nor aphasia was found. DIAGNOSIS The patient was initially misdiagnosed as TIA and treated with antiplatelet therapy. But during the hospital day, the cervical magnetic resonance imaging showed a dorsal epidural hematoma extending from C2 to C6 level and she was diagnosed as SSEH. INTERVENTIONS She underwent surgical decompression and hematoma removal 1 week later. OUTCOMES One week after operation, the sensory deficit above C6 level improved, but there was no improvement in her muscle strength and dyspnea. Unfortunately, she died 1 month later. LESSONS Our case highlights recurrent hemiparesis with complete spontaneous recovery mimicking TIA is a rare initial presentation of SSEH. It is important to perform careful clinical assessments and neuroimaging investigations for correct diagnosis. Neck pain and hemiparesis sparing cranial nerve are important signs for distinction of SSEH from acute ischemic cerebrovascular diseases.
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Affiliation(s)
- Chuqiao Li
- Department of Neurology, The Affiliated Guangzhou Red Cross Hospital, Jinan University, Guangzhou
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Rui He
- Department of Neurology, The Affiliated Guangzhou Red Cross Hospital, Jinan University, Guangzhou
| | - Xiaoqiang Li
- Department of Neurology, Xiaolan Hospital of Southern Medical University, Zhongshan
| | - Yulan Zhong
- Department of Neurology, The Affiliated Guangzhou Red Cross Hospital, Jinan University, Guangzhou
| | - Li Ling
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Fangming Li
- Department of Neurology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
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Maddali P, Walker B, Fisahn C, Page J, Diaz V, Zwillman ME, Oskouian RJ, Tubbs RS, Moisi M. Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia. Cureus 2017; 9:e1032. [PMID: 28357164 PMCID: PMC5354393 DOI: 10.7759/cureus.1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.
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Affiliation(s)
| | | | | | - Jeni Page
- Neurosurgery, Swedish Neuroscience Institute
| | - Vicki Diaz
- Neurological Surgery, Wayne State University
| | | | - Rod J Oskouian
- Neurosurgery, Complex Spine, Swedish Neuroscience Institute
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Raasck K, Habis AA, Aoude A, Simões L, Barros F, Reindl R, Jarzem P. Spontaneous spinal epidural hematoma management: a case series and literature review. Spinal Cord Ser Cases 2017; 3:16043. [PMID: 28382214 PMCID: PMC5289268 DOI: 10.1038/scsandc.2016.43] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/11/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord and leading to acute neurological deficits. Standard therapy is decompressive laminectomy, although spontaneous recoveries have been reported. Sub-optimal therapeutic principles contribute to SSEH's 5.7% mortality-which patient will benefit from surgery remains unclear. This study aims to investigate parameters that affect SSEH's progression, outlining a best-practice therapeutic approach. MATERIALS AND METHODS Literature review yielded 65 cases from 12 studies. Furthermore, 6 cases were presented from our institution. All data were analyzed under American Spinal Injury Association (ASIA) score guidelines. RESULTS Fifty percent of SSEH patients do not fully recover. In all, 30% of patients who presented with an ASIA score of A did not improve with surgery, although every SSEH patient who presented at C or D improved. Spontaneous recovery is rare-only 23% of patients were treated conservatively. Seventy-three percent of those made a full recovery, as opposed to the 48% improvement in patients managed surgically. Thirty-three percent of patients managed conservatively had an initial score of A or B, all improving to a score of D or E without surgery. Regardless, conservative management tends toward low-risk presentations. Patients managed conservatively were three times as likely to have an initial score of D than their surgically managed counterparts. DISCUSSION The degree of pre-operative neural deficit is a major prognostic factor. Conservative management has proven effective, although feasible only if spontaneous recovery is manifested. Decompressive laminectomy should continue to remain readily available, given the inverse correlation between operative interval and recovery.
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Affiliation(s)
- Kyle Raasck
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Ahmed A Habis
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Ahmed Aoude
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Leonardo Simões
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Fernando Barros
- Instituto de Ortopedia e Traumatologia, Oeste D'Or Hospital , Campo Grande, Rio de Janeiro, Brazil
| | - Rudy Reindl
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
| | - Peter Jarzem
- Division of Orthopaedic Surgery, McGill University , Montreal, Quebec, Canada
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Wu ZY, Zhu YJ, Chu L, Cheng CY, Chen CM, Hui-Ting H. Full-Endoscopic Transforaminal Approach for Removal of a Spontaneous Spinal Epidural Hematoma. World Neurosurg 2017; 98:883.e13-883.e20. [DOI: 10.1016/j.wneu.2016.07.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 01/30/2023]
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Spontaneously developed paraplegia in a patient with Factor V Leiden mutation. Spinal Cord Ser Cases 2017; 2:15039. [PMID: 28053741 DOI: 10.1038/scsandc.2015.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/30/2015] [Accepted: 12/09/2015] [Indexed: 11/09/2022] Open
Abstract
Factor V Leiden (FVL) mutation is the one-point mutation in G1691A in the tenth exon of the gene for Factor V, caused by the substitution of glutamine for arginine at codon 506. We present here a patient with a mutation of the Factor V gene and taking anticoagulant therapy, who became paraplegic following surgery for dural hematoma and spontaneous spinal intramedullary hematoma. His physical examination revealed T5 ASIA A, complete paraplegia. Our case is important in the literature, as being the first case with spinal intramedullary hematoma that developed due to anticoagulant use.
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Yamaguchi K, Mathew J, Lhi JM, Park DY. Acute and Rapid Development of Spontaneous Spinal Epidural Hematoma Associated with Combined Aspirin-Dipyridamole Therapy: A Case Report. JBJS Case Connect 2017; 7:e19. [PMID: 29244699 DOI: 10.2106/jbjs.cc.16.00134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE Spontaneous spinal epidural hematoma (SSEH) is a known, although rare, clinical entity that may be challenging to diagnose. This case report describes the rapid development of a large SSEH in an elderly patient on aspirin-dipyridamole combination therapy after she shifted her position in bed. Magnetic resonance imaging obtained 4 hours after the onset of symptoms demonstrated a large spinal epidural hematoma that extended from T4 to L1. CONCLUSION With early diagnosis, the patient was successfully treated with a laminectomy and evacuation of the hematoma, and there was full neurological recovery.
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Affiliation(s)
- Kent Yamaguchi
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
| | - Justin Mathew
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - James M Lhi
- University of Southern California School of Pharmacy, Los Angeles, California
| | - Don Young Park
- Department of Orthopaedic Surgery, University of California, Los Angeles, Santa Monica, California
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Lee DH, Oh TH, Lee JC, Lim KH. Delayed Posttraumatic Spinal Epidural Hematoma: Importance of Early Surgical Treatment for Neurologic Deficits. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.4.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Tak-Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jong-Chul Lee
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Kyoung Hoon Lim
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
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Yu JX, Liu J, He C, Sun LY, Xiang SS, Ma YJ, Bian LS, Hong T, Ren J, Tao PY, Li JW, Li GL, Ling F, Zhang HQ. Spontaneous Spinal Epidural Hematoma: A Study of 55 Cases Focused on the Etiology and Treatment Strategy. World Neurosurg 2016; 98:546-554. [PMID: 27890764 DOI: 10.1016/j.wneu.2016.11.077] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic emergency of the spinal cord. Its cause and treatment strategy remain controversial. This study aimed to evaluate a significant cause of SSEH and to discuss the treatment strategy according to the clinical outcomes of patients in 2 institutions. METHODS Fifty-five cases of SSEH treated at our institutions between February 2002 and February 2016 were retrospectively analyzed. RESULTS The mean age of the first SSEH onset was 31.8 years. The follow-up rate was 72.7%, with 28 patients (70%) showing satisfactory clinical outcomes. Forty patients received preoperative spinal digital subtraction angiography. Spinal epidural (extradural) arteriovenous fistula was detected in 6 patients (15%), 5 of whom showed 1 type of special slow-flow shunt. Nineteen patients (34.5%) suffered from multiple episodes until they underwent invasive treatments or last follow-up. Rebleeding was confirmed in 8 patients. None of the patients had a subsequent episode or rebleeding after invasive treatment. The risk factors for poor clinical outcome included advanced age at initial onset (P = 0.020), a short progression interval (P = 0.030), no symptom relief after admission (P = 0.011), hypesthesia (P = 0.017), complete spinal cord injury (P = 0.001), and hematoma below the T4 level (P = 0.014). CONCLUSIONS Spinal epidural (extradural) arteriovenous fistula is a significant cause of SSEH. Standard spinal digital subtraction angiography is necessary for patients with SSEH. Conservative treatment could not prevent occurrence of multiple episodes or rebleeding in patients. Microsurgery should be recommended as the preferred treatment strategy for SSEH. Endovascular embolization is also recommended if applicable.
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Affiliation(s)
- Jia-Xing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiang Liu
- Department of Neurosurgery, Beijing Haidian section of Peking University Third Hospital, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Li-Yong Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Si-Shi Xiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Yong-Jie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Li-Song Bian
- Department of Neurosurgery, Beijing Haidian section of Peking University Third Hospital, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng-Yu Tao
- Department of Neurosurgery, Beijing Haidian section of Peking University Third Hospital, Beijing, China
| | - Jing-Wei Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Gui-Lin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute (China-INI), Beijing, China.
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Lee CH, Song GS, Kim YH, Son DW, Lee SW. Spontaneous Spinal Epidural Hematoma Coexisting Guillan-Barré Syndrome in a Child: A Case Report. KOREAN JOURNAL OF SPINE 2016; 13:167-169. [PMID: 27800000 PMCID: PMC5086472 DOI: 10.14245/kjs.2016.13.3.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 12/16/2022]
Abstract
Spontaneous spinal epidural hematoma (SSEH) has been reported as a rare cause of spinal cord compression, especially in children. Clinical features are usually nonspecific, although cervicothoracic location of hematoma could be presented with progressive paraplegia. Guillian-Barré syndrome (GBS) is clinically defined as an acute peripheral neuropathy causing progressive limb weakness. Because SSEH and GBS have very similar signs and symptoms, SSEH could be misdiagnosed as GBS. Nevertheless, they can be presented together. We describe a rare case of SSEH coexisting with GBS.
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Affiliation(s)
- Chi Hyung Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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