Spinal Epidural Hematoma

Spinal epidural hematoma (SEH) appears mostly in the fifth through the eighth decades and is reported more frequently in adult males. Although it is a rare condition, physicians should be aware of it. Unless promptly diagnosed and treated it results in severe, irreversible neurological sequelae. SEH develops when an epidural vein bleeds and a hematoma forms. The condition has been reported in patients with clotting disorders, in anticoagulated patients, during pregnancy, in patients with vascular malformations, and following simple trauma, interventional procedures, and multilevel spinal surgery. The hematoma forms in the epidural space and, when large enough, may compress the spinal cord. It may occur anywhere in the spine but tends to develop more in the C5-to-T2 region. In patients over 40 years of age the low thoracic and lumbar regions tend to be affected as well.

In most cases the hematoma forms on the dorsal-lateral surface of the cord and covers several spinal segments.

Clinical Presentation

The clinical presentation is rather dramatic. Patients may develop sudden, severe stabbing axial pain with a radicular component. Neurological deficits appear within a short period of time. Sensory loss and weakness may progress to paraparesis or quadriparesis, depending on the hematoma location. Lumbar hematoma may initially simulate a herniated disc, but within a short period of time more nerve roots may be affected and the symptoms spread bilaterally.

Imaging Studies

Plain films remain normal and are not helpful. CT may show a high-density epidural mass that is usually situated posterolaterally MRI is the diagnostic procedure of choice. The sagittal views provide

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