2019 Research Forum

A Case of Acute Spontaneous Spinal Epidural Hematoma Nosheen Hasan MD R2, Arash Heidari MD, Katayoun Sabetian MD, Haris Rana MS III

Department of Internal Medicine, Kern Medical

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Introduction

Conclusions

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.

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.

Case Discussion 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. 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.

Patient with SSEH

Overall Neurological Examination MRI to Evaluate size and locationof Hematoma

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.

- Minimal symptoms and signs -No significant mass effect

-Significantneurologicaldeficits -SignificantMass Effect with SpinalCord Compression -Clinical ManifestationsWorsen

1. Conservative Management 2. Close observation in hospital

Surgical Treatment with Evacuation

References

1. Groen R, Ponssen H. The spontaneous spinal epidural hematoma: a study of the etiology. J Neurol Sci. 1990;98:121– 138. 2. Gopalkrishnan CV, Dhakoji A, Nair S. Spontaneous cervical epidural hematoma of idiopathic etiology: case report and review of literature. J Spinal Cord Med. 2012;35(2):113–117. 3. Fukui MB, Swarnkar AS, Williams RL, Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 1999;20:1365– 1372. 4. Baek BS, Hur JW, Kwon KY, Lee HK. Spontaneous spinal epidural hematoma. J Korean Neurosurg Soc. 2008;44(1):40–42. 5. Halim TA, Nigam V, Tandon V, Chhabra HS. Spontaneous cervical epidural hematoma: report of case managed conservatively. Indian J Orthop. 2008;42(3):357–359. 6. Lan T, Chen Y, Yang XJ, et al. Spontaneous spinal epidural hematoma. J Ortho Trans. 2015;3(3):152–156. 7. Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. J Neurosurg. 1984;61(1):143–148. 8. Gala FB, Aswani Y. Imaging in spinal posterior epidural space lesions: a pictorial essay. Indian J Radiol Imaging.2016;26(3):299–315. 9. Lee SC, Lui TG, Lee ST. Spontaneous cervical spinal epidural hematoma: a case report. Acta Neurol Taiwan.2003;12(1):34– 37.

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.

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