2019 Research Forum

Applicant & Principal Investigator: Nosheen Hasan MD R2 Faculty Sponsor: Arash Heidari MD

A Case of Acute Spontaneous Spinal Epidural Hematoma

Nosheen Hasan MD R2, Arash Heidari MD, Katayoun Sabetian MD, Haris Rana MS III

INTRODUCTION Acute Spontaneous Spinal Epidural Hematoma is a rare condition (0.1/100,000) requiring early recognition and intervention as it is considered a neurosurgical emergency.

PURPOSE Spontaneous epidural hematomas are mostly associated with coagulopathies, vascular malformation, anticoagulation therapy, neoplasms and trauma. However, in half of the cases the etiology remains unclear. We are describing a case of spontaneous cervical spine epidural hematoma in a patient with underlying lupus. DISCUSSION A 26-year-old African American male with a diagnosis of Lupus in remission presented with sudden onset of burning pain at the left scapula with radiation to the right scapula. His symptoms were associated with bilateral arms numbness and weakness. He denied any preceding trauma or invasive procedures and initially presented to a local hospital. He was discharged with medications for pain and muscle spasm but they only provided minimal relief. Two days later his symptoms worsened to the extent that he had difficulty walking. He eventually developed paraplegia in addition to decreased sensation from abdomen to legs, and urinary retention.

Neurological assessment on admission indicated 3/5 left upper extremity strength, 2/5 left lower extremity strength, decreased sensation to light touch and pinprick in left upper and lower extremity, with Babinski positive. Within a few hours, his weakness and sensory defects had progressed to include the right lower extremities as well.

MRI of cervical spine indicated a large extradural mass in the posterior portion of cervical spine between C5-T2 with significant left lateral compression of the spinal cord. This patient was emergently taken for surgical intervention with a C6-T1 laminectomy for evacuation of what was found to be a spinal epidural hematoma. Postoperatively, this patient reported persistent numbness and tingling in his fingertips and lower extremities, however, reported regaining 85% motor function of right arm, 80% of the right leg, 75% of left arm, and 40% of left leg. CONCLUSION Diagnosis of Spontaneous spinal epidural hematoma should be suspected with sudden onset neurological deficits. MRI is the preferred diagnostic modality and emergent neurosurgical decompressive laminectomy should be performed to avoid permanent neurological deficits.

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