An 89-year-old woman admitted to the Emergency Care Department with reported back pain nine days earlier that started suddenly when sitting. This subsequently evolved into progressive paraparesis (Frankel D). An MRI of the lumbosacral spine revealed an extensive lumbar epidural hematoma (Figure). The patient underwent decompressive laminectomy of T12-L1.
Sagittal and axial sequence. Epidural hematoma T5-T6 to L1-L2, more importantly in the T9-T10 to L1-L2 segment, which shows the compressive effect on the roots of the cauda equina, the thoracic spine and medullary conus. Bottom right: Intraoperative photograph showing the epidural hematoma after laminectomy (white arrow).
Spontaneous epidural hematoma is a rare disease, most often involving the thoracolumbar region, followed by the cervical region11. Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience. J Neurosurg Spine. 2009;11(4):480-6. doi:10.3171/2009.4.SPINE08904
https://doi.org/10.3171/2009.4.SPINE0890...
. Non-traumatic causes include hypertension, coagulopathies, use of anticoagulants, arteriovenous abnormalities, tumors of the backbone and lumbar puncture. In approximately 40% of cases, the etiology cannot be determined. Typically, pain is the root of the acute onset, accompanied by neurological deficit11. Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience. J Neurosurg Spine. 2009;11(4):480-6. doi:10.3171/2009.4.SPINE08904
https://doi.org/10.3171/2009.4.SPINE0890...
,22. Ferreira ROMF, Rocha FJ, Barros JA, Fonseca AVB, Paiva PR. [Spontaneous epidural hematoma of the lumbar region: report of two cases]. Arq Neuropsiquiatr. 1980;38(3):313-6. Portuguese. doi:10.1590/S0004-282X1980000300014
https://doi.org/10.1590/S0004-282X198000...
.
References
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1Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience. J Neurosurg Spine. 2009;11(4):480-6. doi:10.3171/2009.4.SPINE08904
» https://doi.org/10.3171/2009.4.SPINE08904 -
2Ferreira ROMF, Rocha FJ, Barros JA, Fonseca AVB, Paiva PR. [Spontaneous epidural hematoma of the lumbar region: report of two cases]. Arq Neuropsiquiatr. 1980;38(3):313-6. Portuguese. doi:10.1590/S0004-282X1980000300014
» https://doi.org/10.1590/S0004-282X1980000300014
Publication Dates
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Publication in this collection
Jan 2017
History
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Received
25 July 2016 -
Accepted
09 Sept 2016