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Arai N, Abe H, Hiraoka T, Hanayama K. A Case of Spinal Cavernous Hemangioma with Rapidly Worsening Neurological Symptoms after COVID-19 Infection. Prog Rehabil Med 2024; 9:20240027. [PMID: 39211535 PMCID: PMC11350290 DOI: 10.2490/prm.20240027] [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: 07/08/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
Background : COVID-19 can cause respiratory symptoms, as well as various complications and sequelae. This report describes a patient with worsening neurological symptoms caused by a spinal cavernous hemangioma after infection with COVID-19. Cavernous hemangioma usually occurs in the upper part of the brain (70%-90%) and rarely occurs in the spinal cord (5%-7%). Approximately 65% of cases of intramedullary spinal cavernous hemangioma present with neurological symptoms, and more than half of these cases show a slow worsening of symptoms. This is a rare case of intramedullary spinal cavernous hemangioma with cysto-rectal involvement in which neurological symptoms rapidly worsened following COVID-19 infection. Case : A woman in her 30s was admitted to the hospital because of the sudden onset of muscle weakness in both lower limbs and cysto-rectal disturbances after COVID-19 infection. She was diagnosed with a hemorrhage from a spinal cord tumor and underwent emergency resection. The pathological diagnosis was a spinal cavernous hemangioma. At first, she had a spinal cord injury (third thoracic vertebrae; American Spinal Injury Association Impairment Scale, C; Frankel classification, B; with cysto-rectal impairment), but 2 months later, she started walking with knee-ankle-foot orthoses and parallel bars. After 3 months, she could move independently around the ward using a wheelchair. Upon discharge, the patient could walk with ankle-foot orthoses and Lofstrand crutches. Discussion : COVID-19 is associated with various extrapulmonary manifestations and may increase the risk of hemorrhage in cases of intramedullary spinal cavernous hemangioma.
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Affiliation(s)
- Nobuyuki Arai
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Kurashiki, Japan
| | - Hiromasa Abe
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Kurashiki, Japan
| | - Takashi Hiraoka
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Kurashiki, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Kurashiki, Japan
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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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Kim GE, Hong SJ, Kang SS, Ki HJ, Park JH. Epidural hematoma treated by aspiration after transforaminal epidural steroid injection - A case report. Anesth Pain Med (Seoul) 2021; 16:184-190. [PMID: 33845549 PMCID: PMC8107249 DOI: 10.17085/apm.20085] [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: 10/27/2020] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Spinal epidural hematoma is rare condition that can rapidly develop into severe neurologic deficits. The pathophysiology of this development remains unclear. There are several case reports of emergency hematoma evacuations after epidural steroid injection. Case We report on two patients who developed acute, large amounts of epidural hematoma without neurological deficits after transforaminal epidural steroid injection. After fluoroscopy guided aspiration for epidural hematoma was performed, neurological defects did not progress and the hematoma was shown to be absorbed on magnetic resonance imaging. Conclusions These reports are believed to be the first of treating epidural hematoma occurring after transforaminal epidural steroid injection through non-surgical hematoma aspiration. If large amounts of epidural hematoma are not causing neurological issues, it can be aspirated until it is absorbed.
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Affiliation(s)
- Go Eun Kim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Sung Jun Hong
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Sang Soo Kang
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Ho Joon Ki
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Jae Hyun Park
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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Ricart PA, Verma R, Fineberg SJ, Fink KY, Lucas PA, Lo Y, Asprinio DE, Amorosa LF. Post-traumatic cervical spine epidural hematoma: Incidence and risk factors. Injury 2017; 48:2529-2533. [PMID: 28935352 DOI: 10.1016/j.injury.2017.08.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/20/2017] [Accepted: 08/24/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence and risk factors for post-traumatic cervical epidural hematoma are not well described in the current literature. Our aim was to determine the incidence and associated risk factors for post-traumatic cervical spine epidural hematoma (SEH). METHODS We performed a retrospective review of our institution's prospectively collected data submitted to the state trauma registry, using ICD-9 codes, for all patients activated as a trauma with cervical spine injuries, between the years 2010 and 2014. Patients with MRI available were classified based on the presence of cervical epidural hematoma (CEH) or no hematoma (NEH). For our second analysis, we classified patients with cord compression associated with an epidural hematoma (CC) and no cord compression (NCC). Potential risk factors evaluated included: INR, PTT, albumin and platelets levels, radiographic findings of Ankylosing Spondylitis (AS), and ISS. No conflicts of interest exist and/or funding was used for this study. RESULTS 497 out of 1810 trauma activations met our inclusion criteria. 46 patients (2.5%) were found to have a post-traumatic cervical SEH (CEH). Of the CEH cohort, 76% were male, with 72% Caucasian, and a mean age of 55 years. 27 patients (5.4%) were found to have cervical cord compression at the level of the SEH. Of the CC arm, 78% were male, with 67% Caucasian, and a mean age of 56 years. A higher ISS and an elevated INR were found to be associated with epidural hematoma causing cord compression. CONCLUSIONS An incidence of 2.5% is reported for post-traumatic cervical spine epidural hematoma. Of these, 59% had associated spinal cord compression. Patients with a higher ISS and elevated INR levels are at a higher risk for developing this potentially devastating.
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Affiliation(s)
- Pedro A Ricart
- Department of Orthopaedic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
| | - Ravi Verma
- Department of Orthopaedic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Steven J Fineberg
- Department of Orthopaedic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Kyle Y Fink
- Department of Orthopaedic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Paul A Lucas
- Department of Orthopaedic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yungtai Lo
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - David E Asprinio
- Department of Orthopaedic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Louis F Amorosa
- Department of Orthopaedic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA; Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
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Hongo T, Iseda K, Tsuchiya M, Inaba M, Nozaki S, Takahashi K, Nakajima M, Fujiwara T. Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men. Acute Med Surg 2017; 5:181-184. [PMID: 29657732 PMCID: PMC5891113 DOI: 10.1002/ams2.317] [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: 06/12/2017] [Accepted: 09/18/2017] [Indexed: 12/26/2022] Open
Abstract
Cases Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease. Most SSEH cases involve back and/or neck pain. We report the cases of two men who experienced SSEH with dysstasia but without back or neck pain. Outcomes This study presents two cases involving elderly Japanese men who visited an emergency department because of sudden dysstasia without back or neck pain. The results of the neurological examinations revealed ataxic gait. Cervical spinal epidural hematomas were observed by computed tomography and magnetic resonance imaging. One patient underwent hematoma removal and decompression by corpectomy, whereas the other patient received conservative treatment and observation. The patients were discharged without sequelae. Conclusion Spinal epidural hematomas are difficult to diagnose, and a delayed diagnosis can adversely affect the patient's quality of life. These hematomas should be considered in the differential diagnosis of cerebrovascular diseases.
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Affiliation(s)
- Takashi Hongo
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Kenichi Iseda
- Department of Neurosurgery Okayama Saiseikai General Hospital Okayama Japan
| | - Midori Tsuchiya
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Mototaka Inaba
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Satoshi Nozaki
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Kenji Takahashi
- Department of Neurosurgery Okayama Saiseikai General Hospital Okayama Japan
| | - Masaaki Nakajima
- Department of Neurosurgery Okayama Saiseikai General Hospital Okayama Japan
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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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Imaging characteristics of cervical spine extra-arachnoid fluid collections managed conservatively. Skeletal Radiol 2016; 45:1285-9. [PMID: 27380319 DOI: 10.1007/s00256-016-2428-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/05/2016] [Accepted: 06/22/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Determine the MRI characteristics of large post-traumatic cervical spine extra-arachnoid collections managed conservatively in clinically stable patients and whether evidence of clinical or imaging deterioration materialized. MATERIALS AND METHODS Following IRB approval, we conducted a retrospective search for all patients (>16 years old) over a 17-months period who had an extra-arachnoid fluid collection reported on a post-traumatic cervical spine MRI. Patients were excluded if they had surgery for an unstable fracture (n = 21), emergent decompression (n = 1) or lacked a follow-up MRI within 15 days (n = 1). Two MSK radiologists recorded the size, morphology and MRI signal characteristics of the collections. RESULTS Eight patients (5 male, 3 female) met the inclusion criteria (mean age 40 years; range 19-78 years). Seven of the eight patients had fluid collections that demonstrated thin, tapered margins, extended >7 vertebral bodies and involved >180 degrees of the spinal canal. The signal characteristics of these collections varied: hyper-T1/iso-T2 (n = 1), iso-T1/T2 (n = 3), hyper-T1/hypo-T2 (n = 3) and mixed-T1/T2 (n = 1). Six of seven collections were ventral. Follow-up MRI demonstrated resolution/significant decrease in size (n = 4 between 1 and 12 days) or no change/slight decrease in size (n = 3; between 2 and 11 days). None of the seven fluid collections enlarged, no patient had abnormal cord signal, and no patient's neurologic symptoms worsened. One of eight patients had a dorsal "mass-like" collection that was slightly smaller 9 days later. CONCLUSION In stable patients with large, tapered post-traumatic cervical spine extra-arachnoid collections managed non-surgically, none developed (1) clinical worsening, (2) abnormal cord signal or (3) collection enlargement, regardless of the collection's signal characteristics.
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8
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Huh J, Kwak HY, Chung YN, Park SK, Choi YS. Acute Cervical Spontaneous Spinal Epidural Hematoma Presenting with Minimal Neurological Deficits: A Case Report. Anesth Pain Med 2016; 6:e40067. [PMID: 27853682 PMCID: PMC5106555 DOI: 10.5812/aapm.40067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/13/2016] [Accepted: 08/12/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction Spontaneous spinal epidural hematoma (SSEH) is an uncommon but potentially fatal condition. The increased bleeding tendency associated with anticoagulant medications has been proven to increase the risk of SSEH. The symptoms of SSEH usually begin with sudden severe neck or back pain and are followed by neurological deficits. However, some cases present with only axial pain or with radicular pain similar to herniated disc disorders. Case Presentation A 28-year-old healthy man developed a sudden onset of severe neck and right shoulder pain with mild arm weakness. The MRI revealed an SSEH that was compressing his spinal cord in the right posterolateral epidural space from C2-C6. On the second hospital day, his symptoms suddenly improved, and most of the hematoma had spontaneously resolved. Conclusions Currently, the incidence of SSEH is expected to increase. Pain physicians must include SSEH in their differential diagnosis for patients with axial pain or radicular symptoms alone, particularly when risk factors are present.
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Affiliation(s)
- Jisoon Huh
- Department of Neurosurgery, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea
| | - Ho-young Kwak
- Department of Computer engineering, College of engineering, Jeju National University, Jeju, South Korea
| | - You-Nam Chung
- Department of Neurosurgery, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea
| | - Yun Suk Choi
- Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea
- Corresponding author: Yun Suk Choi, 3Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea. Tel: +82-647172026, Fax: +82-647172042, E-mail:
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Effective Steroid Treatment in Traumatic Cervical Spinal Epidural Hematoma Presenting with Delayed Tetraparesis: Two Case Reports and Literature Review. World Neurosurg 2016; 91:673.e5-9. [DOI: 10.1016/j.wneu.2016.04.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 01/30/2023]
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Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma. Case Rep Surg 2016; 2016:5430708. [PMID: 27088028 PMCID: PMC4819082 DOI: 10.1155/2016/5430708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/01/2016] [Indexed: 01/30/2023] Open
Abstract
A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS). The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI) showed an image of a mass compressing the medulla.
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Spalteholz M, Rödel L. [Spontaneous spinal epidural hematoma as cause of incomplete spinal cord injury]. DER ORTHOPADE 2013; 42:971-4. [PMID: 23999927 DOI: 10.1007/s00132-013-2185-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Spontaneous spinal epidural hematomas are rare but are of differential diagnostic importance due to the potentially dramatic progression through to irreversible neurological deficits. At the beginning the clinical symptoms are non-specific and the development of neurological deficits leads to the diagnosis. We present the case of a 73-year-old female patient who initially reported uncharacteristic neck pain and developed incomplete quadriplegia during the next day as well as the case of a 78-year-old male patient, who complained of acute back pain and developed paraplegia a short time afterwards. Early microsurgery and spinal canal evacuation led to complete remission of the neurological deficits in both cases.
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Affiliation(s)
- M Spalteholz
- Traumazentrum, Klinik für Unfallchirurgie und Orthopädie, Klinikum St. Georg Leipzig, Leipzig, Deutschland,
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Kang MS, Shin YH, Lee CD, Lee SH. Delayed neurological deficits induced by an epidural hematoma associated with a thoracic osteoporotic compression fracture. Neurol Med Chir (Tokyo) 2013; 52:633-6. [PMID: 23006874 DOI: 10.2176/nmc.52.633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 79-year-old woman developed neurological deficits 6 weeks after the onset of a thoracic osteoporotic compression fracture. Magnetic resonance (MR) imaging of the thoracic spine revealed an epidural hematoma at the T10-L2 levels. Acute decompressive laminectomy and percutaneous vertebroplasty were performed. Following the surgery, the patient's neurologic deficits improved and follow-up MR imaging showed complete resolution of the hematoma. Spinal epidural hematomas are rare and associated delayed neurological deficits are extremely rare. Conservative treatment may be effective for epidural hematomas in neurologically intact patients, but epidural hematomas can be a cause of neural compression and symptomatic deterioration resulting in delayed neurological deficits during the follow-up period.
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Affiliation(s)
- Min-Soo Kang
- Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea
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13
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Rodrigues LMR, Abreu F, Fujiki EN, Milani C. Delayed traumatic spinal epidural hematoma with neurological deficits. EINSTEIN-SAO PAULO 2010; 8:477-9. [PMID: 26760333 DOI: 10.1590/s1679-45082010rc1748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED To describe the mechanism that causes spinal epidural hematoma with neurologic deficit and review the literature. We report a case of a 62-year-old man with post-traumatic epidural hematoma in the cervicothoracic spine, who developed progressive neurological deficit which eventually resulted in complete paralysis below T1. During surgical evacuation significant spine compression due to an organizing hematoma was observed. After surgery, the patient's motor function improved and there was a complete recovery of the neurologic deficit after a rehabilitation program. CONCLUSION Epidural hematoma can happen after delayed traumatic event leading to a variable degree of neurologic damage.
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Affiliation(s)
| | - Felipe Abreu
- Faculdade de Medicina do ABC - FMABC, Santo André, SP, BR
| | | | - Carlo Milani
- Faculdade de Medicina do ABC - FMABC, Santo André, SP, BR
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Lin HL, Kuo LC, Cheng YC, Lin JN, Lin SG, Lin TY, Lee WC. Traumatic cervical spinal epidural hematoma mimics brachial plexus injury. Am J Emerg Med 2010; 28:985.e3-5. [PMID: 20825847 DOI: 10.1016/j.ajem.2010.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 01/03/2010] [Indexed: 12/31/2022] Open
Affiliation(s)
- Hsing-Lin Lin
- Department of Trauma, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Spontaneous resolution of a traumatic cervicothoracic epidural hematoma presenting with transient paraplegia: a case report. Spine (Phila Pa 1976) 2010; 35:E564-7. [PMID: 20445476 DOI: 10.1097/brs.0b013e3181cd2de8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case description. OBJECTIVE To clinically and radiographically describe a traumatic spinal epidural hematoma (TSEH) without adjacent spinal column fracture or soft tissue injury that completely resolved, without surgical intervention. SUMMARY OF BACKGROUND DATA Symptomatic TSEH is an infrequent condition after spinal trauma, accounting for 0.5% to 1.7% of cases. It can result in permanent neurologic deficits if not treated in a timely and appropriate manner. METHODS A 50-year-old man presented with progressive lower motor weakness and sensory change at 2 days after blunt trauma to the upper back area. Neurologic examination revealed paraplegia and hypesthesia below the T4 sensory dermatome. Magnetic resonance imaging for cervicothoracic spine showed a space-occupying lesion in the dorsal spinal epidural space from C7 to T5. The lesion was consistent with acute stage hematoma of the spinal epidural space. RESULTS The patient was prepared for decompression surgery. However, the patient's neurologic symptoms began to improve (grade 4/5) at 2 hours after onset of paraplegia. Surgical intervention was delayed, and the patient was treated conservatively with close neurologic monitoring. Three days after onset of symptoms, the patient's neurologic symptoms recovered completely. The follow-up magnetic resonance imaging at 12 days after the event showed complete resolution of the epidural hematoma. CONCLUSION An unpredictable extensive epidural hematoma can occur after blunt trauma of the cervicothoracic spine in patients at low risk for hemorrhage. This case illustrates that immediate surgical intervention may not always be necessary in certain patients with TSEH. Conservative management with careful observation may play a role as a management option for patients initially presenting with severe neurologic dysfunction if neurologic recovery is early and sustained.
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Dimou J, Jithoo R, Bush S. A patient with delayed traumatic cervical spinal epidural haematoma presenting with hemiparesis. J Clin Neurosci 2010; 17:404-5. [DOI: 10.1016/j.jocn.2009.02.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 02/22/2009] [Indexed: 01/30/2023]
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17
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Dimou J, Jithoo R, Morokoff A. Spontaneous spinal epidural haematoma in a geriatric patient on aspirin. J Clin Neurosci 2010; 17:142-4. [DOI: 10.1016/j.jocn.2009.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 03/11/2009] [Indexed: 01/28/2023]
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Kim IY, Kim SH, Kim JH, Lee JK. Rapid spontaneous resolution of a traumatic cervical epidural haematoma. Br J Neurosurg 2009; 19:451-2. [PMID: 16455573 DOI: 10.1080/02688690500390524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- I Y Kim
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, South Korea
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19
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Aksay E, Kiyan S, Kitis O, Yuruktumen A. A rare diagnosis in emergency department. Am J Emerg Med 2008; 26:835.e3-5. [DOI: 10.1016/j.ajem.2008.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 01/02/2008] [Indexed: 02/06/2023] Open
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Delayed Onset Neurological Deterioration due to a Spinal Epidural Hematoma after a Spine Fracture. Asian Spine J 2007; 1:98-101. [PMID: 20411132 PMCID: PMC2857477 DOI: 10.4184/asj.2007.1.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are no reports of a 7-day delay in the onset of neurological deterioration because of a spinal epidural hematoma (SEH) after a spinal fracture. A hematoma was detected from the T12 to L2 area in a 36-year-old male patient with a T12 burst fracture. On the same day, the patient underwent in situ posterior pedicle instrumentation on T10-L3 with no additional laminectomy. On the seventh postoperative day, the patient suddenly developed weakness and sensory changes in both extremities, together with a sharp pain. A MRI showed that the hematoma had definitely increased in size. A partial laminectomy was performed 12 hours after the onset of symptoms. Two days after surgery, recovery of neurological function was noted. This case shows that spinal surgeons need to be aware of the possible occurrence of a delayed aggravated SEH and neurological deterioration after a spinal fracture.
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Indira Devi B, Arivazhagan A, Sattur MG, Kolluri SVR. Concomitant post-traumatic craniospinal multicompartmental hematoma associated with posterior fossa extradural hematoma — Case report and review of literature. INDIAN JOURNAL OF NEUROTRAUMA 2007. [DOI: 10.1016/s0973-0508(07)80014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hsieh CT, Chiang YH, Tang CT, Sun JM, Ju DT. Delayed traumatic thoracic spinal epidural hematoma: a case report and literature review. Am J Emerg Med 2007; 25:69-71. [PMID: 17157687 DOI: 10.1016/j.ajem.2006.05.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 05/17/2006] [Indexed: 02/06/2023] Open
Abstract
Spinal epidural hematoma is a relatively uncommon disease, but an important cause leading to cord compression. Posttraumatic spinal epidural hematoma is a rare entity and remains a challenge for clinical physicians. Magnetic resonance imaging is the best choice for early diagnosis, and urgent surgical decompression with evacuation of hematoma could improve some neurologic deficits, especially vital cord functions. We presented a 77-year-old woman who sustained back pain after a fall 1 month before admission, complaining of progressive weakness and sensory loss in bilateral lower extremities since 2 weeks before admission. Radiography of the thoracic spine revealed decreased body height at T10 and compression fracture. Magnetic resonance imaging of the thoracic spine revealed epidural hematomas at the level of T11 to T12. An urgent decompressive laminectomy with evacuation of hematoma was performed immediately. Postoperatively, her previous neurologic deficits improved except for an underactive neurogenic bladder and fecal incontinence.
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Affiliation(s)
- Cheng-Ta Hsieh
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Horn EM, Bristol RE, Feiz-Erfan I, Beres EJ, Bambakidis NC, Theodore N. Spinal cord compression from traumatic anterior cervical pseudomeningoceles. J Neurosurg Spine 2006; 5:254-8. [PMID: 16961088 DOI: 10.3171/spi.2006.5.3.254] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
✓Pseudomeningoceles rarely develop after cervical trauma; in all reported cases the lesions have extended outside the spinal canal.
The authors report the first known cases of anterior cervical pseudomeningoceles contained entirely within the spinal canal and causing cord compression and neurological injury. The authors retrospectively reviewed the cases of three patients with traumatic cervical spine injuries and concomitant compressive anterior pseudomeningoceles. The lesion was recognized in the first case when the patient’s neurological status declined after he sustained a severe atlantoaxial injury; the pseudomeningocele was identified intraoperatively and decompressed. After the decompressive surgery, the patient’s severe tetraparesis partially resolved. In the other two patients diagnoses of similar pseudomeningoceles were established by magnetic resonance imaging. Both patients were treated conservatively, and their mild to moderate hemiparesis due to the pseudomeningocele-induced compression abated.
The high incidence of anterior cervical pseudomeningoceles seen at the authors’ institution within a relatively brief period suggests that this lesion is not rare. The authors believe that it is important to recognize the compressive nature of these lesions and their potential to cause devastating neurological injury.
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Affiliation(s)
- Eric M Horn
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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Miñambres E, Burón J, Suberviola B, Hernández MA, González-Castro A, González-Mandly A. Nonsurgical management of symptomatic posttraumatic thoracic epidural hematoma. Am J Emerg Med 2005; 24:134-6. [PMID: 16338526 DOI: 10.1016/j.ajem.2005.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Accepted: 08/21/2005] [Indexed: 11/29/2022] Open
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Buchowski JM, Riley LH. Epidural hematoma after immobilization of a "hangman's" fracture: case report and review of the literature. Spine J 2005; 5:332-5. [PMID: 15863089 DOI: 10.1016/j.spinee.2004.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 09/06/2004] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neurologic deterioration after immobilization of traumatic spondylolisthesis of the axis rarely occurs because of the decompressive nature of the injury itself and the large amount of space available for the cord in the upper cervical spine. PURPOSE To document neurologic deterioration after reduction (without the use of traction) and halo immobilization of a Type IIA traumatic spondylolisthesis of the axis (hangman's fracture) secondary to an epidural hematoma. STUDY DESIGN/SETTING Case report. PATIENT SAMPLE AND OUTCOME MEASURES: The patient population consisted of one patient; no outcome measures were used. METHODS The medical record and radiographic studies of a 27-year-old patient involved in a motor vehicle crash that resulted in a traumatic spondylolisthesis of the axis were retrospectively reviewed, and a review of the English literature was performed. RESULTS Upon evaluation, the patient was found to have, in addition to other injuries, a Type IIA hangman's fracture of the C2 vertebra, which was stabilized in a halo. Shortly thereafter, the patient developed a gradual progressive neurologic deficit. Magnetic resonance imaging revealed the presence of a large epidural hematoma with cord compression treated with posterior laminectomy and transdural decompression of an anterior hematoma. Postoperatively, the patient's neurologic examination improved and returned to normal within 6 months. CONCLUSION An epidural hematoma can occur after traumatic spondylolisthesis of the axis, but its symptoms may not present until after the spondylolisthesis is treated.
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Affiliation(s)
- Jacob M Buchowski
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, Maryland 21287, USA
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Dinsmore AJ, Leonard RB, Manthey D. Spontaneous spinal epidural hematoma: A case report. J Emerg Med 2005; 28:423-6. [PMID: 15837023 DOI: 10.1016/j.jemermed.2004.11.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Revised: 08/23/2004] [Accepted: 11/17/2004] [Indexed: 01/30/2023]
Abstract
A 59-year-old man presented to the emergency department (ED) the day after a minor motor vehicle crash for evaluation of bilateral shoulder pain. He underwent ED evaluation for his back pain two more times before it was found that he had a spontaneous spinal epidural hematoma (SSEH). On the third visit, the patient had waxing and waning neurologic symptoms including lower extremity weakness and urinary retention. The diagnosis was made by MRI, and the patient was successfully treated with cervical hemilaminectomy at the cervicothoracic junction for evacuation of the epidural hematoma 5 days after the onset of back pain.
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Affiliation(s)
- Amanda J Dinsmore
- Department of Emergency Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157-1089
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Ananthababu PS, Anbuselvam M, Radhakrishnan MK. Spontaneous spinal epidural haematoma: report of two cases and review of the literature. J Clin Neurosci 2005; 12:90-2. [PMID: 15639423 DOI: 10.1016/j.jocn.2004.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2003] [Accepted: 02/12/2004] [Indexed: 01/30/2023]
Abstract
The clinical presentation, investigation, management and outcome of two patients with spontaneous spinal epidural haematoma (SSEH) are presented. CT myelogram revealed an extradural compressive lesion in one patient and MRI confirmed extradural haemorrhage in the second. Both the cases were treated surgically. One patient made a complete recovery and the other made no neurological recovery. The clinical presentation, diagnosis, treatment and factors determining the outcome of SSEH are discussed and the literature reviewed.
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Affiliation(s)
- P S Ananthababu
- Department of Neurosurgery, RIPAS Hospital, Bandar Seri Begawan, Negara Brunei Darussalam.
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Bennett DL, George MJ, Ohashi K, El-Khoury GY, Lucas JJ, Peterson MC. Acute traumatic spinal epidural hematoma: imaging and neurologic outcome. Emerg Radiol 2004; 11:136-44. [PMID: 16028317 DOI: 10.1007/s10140-004-0371-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The purpose of this study was to present MRI characteristics of traumatic spinal epidural hematomas (TSEHs) and to evaluate their effect on neurologic outcome. A retrospective analysis was performed of all 74 cases in which patients underwent emergent spinal MRI in the setting of acute trauma at our institution's Emergency Department between June 2002 and January 2003. MRI studies were evaluated for the presence of a TSEH. CT studies were evaluated for the presence of osseous trauma. Patient data were collected from medical records on the initial neurologic status at admission and at 6 months after injury. Twenty-seven of 74 patients had a spinal fracture and a TSEH. Twenty-five of 74 patients had a spinal fracture with no TSEH. Twenty-two of 74 patients had normal imaging studies. Six-month follow-up of neurologic status demonstrated no statistically significant difference in neurologic outcome between patients with spinal fractures and TSEH and those with spinal fractures but no TSEH. If a spinal fracture and abnormal neurologic exam are present, the neurologic outcome at 6 months is not worsened by the presence of a TSEH.
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Affiliation(s)
- D Lee Bennett
- Department of Radiology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Cuenca PJ, Tulley EB, Devita D, Stone A. Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms. J Emerg Med 2004; 27:37-41. [PMID: 15219302 DOI: 10.1016/j.jemermed.2004.02.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2003] [Revised: 12/31/2003] [Accepted: 02/06/2004] [Indexed: 01/30/2023]
Abstract
Post-traumatic spinal epidural hematomas are uncommon, usually requiring emergent neurosurgical evacuation. We present a symptomatic delayed post-traumatic epidural hematoma of the T-spine that resolved within hours of administration of high dose steroids. A 22-year-old man presented 10 days after sustaining blunt trauma during a motor vehicle crash. He developed signs of acute cord compression with loss of sensation and motor function in bilateral lower extremities with priapism. Magnetic resonance imaging demonstrated a spinal epidural hematoma with 50% canal stenosis at the T4 level. His symptoms improved 1 h after the administration of high dose steroids. All symptoms resolved completely while the patient was in the Emergency Department and he was treated conservatively by Neurosurgery with no further sequelae. Thoracic spinal epidural hematoma is an uncommon condition that may present in delayed fashion after trauma with significant neurologic compromise. If neurologic symptoms improve with initial steroid therapy, patients with this condition may be treated conservatively with steroids and observation.
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Affiliation(s)
- Peter J Cuenca
- Emergency Medicine Residency Program, Madigan Army Medical Center/University of Washington, Madigan Army Medical Center, Fort Lewis, WA 98433, USA
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de Melo PMP, Kadri PADS, de Oliveira JG, Suriano IC, Cavalheiro S, Braga FM. Cervical epidural haematoma with clivus fracture: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:499-502. [PMID: 12894294 DOI: 10.1590/s0004-282x2003000300034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.
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Borges G, Bonilha L, Maldaum MV, Menezes JR, Zanardi V. Acute cervical epidural hematoma: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:726-30. [PMID: 10973117 DOI: 10.1590/s0004-282x2000000400021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT) scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH) is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.
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Affiliation(s)
- G Borges
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brasil.
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La Rosa G, d'Avella D, Conti A, Cardali S, La Torre D, Cacciola F, Longo M, Tomasello F. Magnetic resonance imaging-monitored conservative management of traumatic spinal epidural hematomas. Report of four cases. J Neurosurg 1999; 91:128-32. [PMID: 10419360 DOI: 10.3171/spi.1999.91.1.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spinal epidural hematomas (SEHs) are uncommon complications of traumatic injury to the spine. Emergency surgical evacuation is the standard treatment. Although it is recognized in the literature, the possibility of nonsurgical treatment of traumatic SEH is far from being codified. The authors report excellent outcomes in four conservatively managed patients who had sustained a severe spine injury with fracture of the lumbar vertebral body and in whom traumatic SEHs were diagnosed by magnetic resonance imaging. Although in the authors' experience a good spontaneous outcome in this subgroup of minimally symptomatic patients harboring moderate-sized SEHs has been achieved, further studies are necessary to understand the real spectrum of nonsurgical treatment of such lesions.
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Affiliation(s)
- G La Rosa
- Department of Neurosurgery, University of Messina School of Medicine, Italy
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