Skip to main content

Advertisement

SpringerLink
Log in

Spontaneous chronic epidural hematoma of the lumbar spine mimicking an extradural spine tumour

  • Case Report
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Spontaneous chronic epidural hematomas are extremely rare and can be extremely challenging to diagnose and differentiate. The clinical findings, computed tomographic scan and magnetic resonance imaging does not always enough to complete differentiate this condition. Our purpose is to report a case of a spontaneous chronic epidural hematoma presenting as an extradural mass leading to compressive radicular symptoms with images of bony scalloping which are sparsely reported in the literature.

Methods

We describe a 61-year-old woman who was evaluated after 18-month history of pain, disestesias and mild weakness in both lower extremities with significant radicular symptoms on the right side associated to neurogenic claudication.

Results

CT scans revealed a nodular image of soft tissue density located in the right anterolateral epidural space at the L4–L5 level demonstrating resorption of the bony margins. MRI studies revealed a round mass in the vertebral canal displacing the dural sac and scalloping the posterior wall of the L4 vertebral body. Diagnosis was established between a degenerative cyst versus an atypical neurinoma. Surgical findings demonstrated an isolated well-formed chronic hematoma.

Conclusion

Spontaneous chronic epidural hematomas are rare, even more when they produce scalloping of bony structures becoming a diagnostic challenge. Therefore they should be always considered as a differential diagnosis in patients with extradural chronic compressions taking into account that also chronic epidural hematomas can cause bone involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Cohen JE, Ginsberg HJ, Emery D, Schwartz ML (1998) Fatal spontaneous spinal epidural hematoma following thrombolysis for myocardial infarction. Surg Neurol 49:520–522

    Article  PubMed  CAS  Google Scholar 

  2. Johnston RA (1993) The management of acute spinal cord compression. J Neurol Neurosurg Psychiatry 56:1046–1054

    Article  PubMed  CAS  Google Scholar 

  3. Pear BL (1972) Spinal epidural hematoma. AJR 115:155–164

    Article  CAS  Google Scholar 

  4. Mayfield FH (1976) Complications of laminectomy. Clin Neurosurg 23:435–439

    PubMed  CAS  Google Scholar 

  5. Lawton MT, Porter RW, Heiserman JE (1995) Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg 83:1–7

    Article  PubMed  CAS  Google Scholar 

  6. Riffaud L, Morandi X, Chabert E, Brassier G (1999) Spontaneous chronic hematoma of the lumbar spine. J Neurorad 26:64–67

    CAS  Google Scholar 

  7. Boyd HR, Pear BL (1972) Chronic spontaneous spinal epidural hematoma. Report of two cases. J Neurosurg 36:239–242

    Article  PubMed  CAS  Google Scholar 

  8. Nehls DG, Shetter AG, Hodak JA, Waggener JD (1984) Chronic spinal epidural hematoma presenting as lumbar stenosis: clinical, myelographic, and computed tomographic features. A case report. Neurosurgery 14:230–233

    Article  PubMed  CAS  Google Scholar 

  9. Gurkanlar D, Acikbas C, Cengiz GK, Tuncer R (2007) Lumbar epidural hematoma following lumbar puncture: the role of high dose LMWH and late surgery. A case report. Neurocirugía 18:52–55

    PubMed  CAS  Google Scholar 

  10. Gundry CR, Heithoff KB (1993) Epidural hematoma of the lumbar spine: 18 surgically confirmed cases. Radiology 87:427–431

    Google Scholar 

  11. Batson OV (1957) The vertebral vein system. AJR 78:195–212

    CAS  Google Scholar 

  12. Groen RJM, Ponssen H (1990) The spontaneous spinal epidural hematoma. A study of aetiology. J Neurol Sci 98:121–138

    Article  PubMed  CAS  Google Scholar 

  13. Wiltse LL, Fonseca AS, Amster J, Dimartino P, Ravessoud FA (1993) Relationship of the dura, Hoffmann’s ligaments, Batson’s plexus, and a fibrovascular membrane lying on the posterior surface of the vertebral bodies and attaching to the deep layer of the posterior longitudinal ligament. An anatomical, radiologic, and clinical study. Spine 18:1030–1043

    Article  PubMed  CAS  Google Scholar 

  14. Delamarter RB, Sherman J, Carr JB (1995) Pathophysiology of spinal cord injury: recovery after immediate and delayed decompression. J Bone Jt Surg Am 77:1042–1049

    CAS  Google Scholar 

  15. Bruyn GW, Bosma NJ (1976) Spinal extradural hæmatoma. In: Vinken PJ, Bruyn GW (ed) Handbook of clinical neurology, vol 26. North-Holland, Amsterdam, pp 1–30

  16. Beatty RM, Winston KR (1984) Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 61:143–148

    Article  PubMed  CAS  Google Scholar 

  17. Graziani N, Bouillot P, Figarella-Branger D, Dufour H, Peragut JC, Grisoli F (1994) Cavernous angiomas and arteriovenous malformations of the spinal epidural space: report of 11 cases. Neurosurgery 35:856–864

    Article  PubMed  CAS  Google Scholar 

  18. Lunardi P, Mastronardi L, Lo Bianco F, Schettini G, Puzzilli F (1995) Chronic spontaneous spinal epidural haematoma simulating a lumbar stenosis. Eur Spine J 4:64–66

    Article  PubMed  CAS  Google Scholar 

  19. Toussaint P, Gosset JF, Le Gars D, Depriester C, Cordonnier C, Rosat P (1996) Non discal sciatica from non traumatic pesudocysts of the posterior longitudinal ligament: study of a series of 14 cases. Rachis 8:217–220 (Fr)

    Google Scholar 

  20. Cooper DW (1967) Spontaneous spinal epidural hematoma. J Neurosurg 26:343–345

    Article  PubMed  CAS  Google Scholar 

  21. Schwartz FT, Sartavi MA, Fox JL (1973) Unusual hematomas outside the spinal cord. J Neurosurg 39:249–251

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Spine Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Catalunya, Spain

    Salvador Fuster & Santiago Castañeda

  2. Department of Neurosurgery, Institut Clinic de Neurociencia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Catalunya, Spain

    Enrique Ferrer & Jose Poblete

  3. UCLA Comprehensive Spine Center, UCLA School of Medicine, Los Angeles, CA, USA

    Jeffrey Wang

Authors
  1. Salvador Fuster
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Santiago Castañeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Enrique Ferrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jose Poblete
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Santiago Castañeda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fuster, S., Castañeda, S., Ferrer, E. et al. Spontaneous chronic epidural hematoma of the lumbar spine mimicking an extradural spine tumour. Eur Spine J 22 (Suppl 3), 337–340 (2013). https://doi.org/10.1007/s00586-012-2402-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2402-0

Keywords

Search

Navigation