Abstract
Spinal epidural haematomas (SEH) are rare; most are caused by trauma, anticoagulant therapy, vascular anomalies, hypertension, blood dyscrasias, epidural anaesthesia or, rarely, spinal surgery. We report 11 cases and review the literature (16 cases). The clinical picture is that of acute spinal cord compression. MRI characteristics are quite specific. On sagittal sections, the SEH appears as a biconvex mass, dorsal to the thecal sac, clearly outlined and with tapering superior and inferior margins. The dura mater is seen as curvilinear low signal separating the haematoma from the cord. Within 24 h of onset, the haematoma is isointense with the cord on T1-weighted images and heterogeneous on T2-weighted images. Later, it gives high signal on both T1- and T2-weighted images. Differential diagnosis must include subdural haematoma, epidural neoplasm and abscess. Complete neurological recovery rapidly follows laminectomy and removal of the clot. In three of our cases, the haematoma resolved spontaneously. MRI is the best examination for diagnostic and follow-up.
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Bernsen PLJA, Haan J, Vielvoye GJ, Peerlinck KMJ (1988) Spinal epidural hematoma visualized by magnetic resonance imaging Neuroradiology 30: 280
Post MJD, Seminer DS, Quencer RM (1982) CT diagnosis of spinal epidural hematoma. AJNR 3: 189–192
Avrahami E, Tadmor R, Ram Z, Feibel M, Itzhak Y (1989) MR demonstration of spontaneous acute epidural hematoma of the thoracic spine. Neuroradiology 31: 89–92
Bollar Zabala A, Gelabert Gonzáles M, García Allut (1988) Spontaneous spinal epidural hematoma diagnosed by MRI. J Neurosurg Sci 32: 153–155
Crisi G, Sorgato P, Scarpa M, Falasca A, Angiari P (1990) Gadolinium-DTPA-enhanced MR imaging in the diagnosis of spinal epidural hematoma. Neuroradiology 32: 64–66
DÁngelo V, Bizzozero L, Talamonti G, Ferrara M, Colombo N (1990) Value of magnetic resonance imaging in spontaneous extradural spinal hematoma due to vascular malformation: case report. Surg Neurol 34: 343–344
Garza-Mercado R (1989) Traumatic extradural hematoma of the cervical spine. Neurosurgery 24: 410–414
Larsson EM, Holtås S, Cronqvist S (1988) Emergency magnetic resonance examination of patient with spinal cord symptoms. Acta Radiol 26: 69–75
Marmey G, Doyon D, David P (1990) Diagnostic IRM d'un hématome épidural cervical. A propos d'une observation. J Radiol 71: 549–553
Nagel MA, Taff IP, Cantos EL, Patel MP, Maytal J, Berman D (1989) Spontaneous spinal epidural hematoma in a 7-year-old girl. Clin Neurol Neurosurg 91–2: 157–160
Pan G, Kulkarni M, MacDougall DJ, Miner ME (1988) Traumatic epidural hematoma of the cervical spine: diagnosis with magnetic resonance imaging. J Neurosurg 68: 798–800
Rothfus WE, Chedid MK, Deeb ZL, Abla AA, Maroon JC, Sherman RL (1987) MR imaging in the diagnosis of spontaneous epidural hematomas. J Comput Assist Tomogr 11: 851–854
Serdavei F, Trevisan C, Bianchedi G, Padovani R (1987) Spontaneous dorsal epidural hematoma: usefulness of magnetic resonance imaging and importance of operative treatment even in case with complete paraplegia. Acta Neurochir 89: 137–139
Schwerdtfeger K, Caspar W, Allousi S, Strowiktzki M, Loew F (1990) Acute spinal intradural extramedullary hematoma: a nonsurgical approach for spinal cord compression. Neurosurgery 27: 321–324
Foo D, Rosier AB (1981) Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas. Surg Neurol 15: 389–401
Laissy JP, Milon P, Freger P, Hattab N, Creissard P, Thiébot J (1990) Cervical epidural hematomas: CT diagnosis in two cases that resolved spontaneously. AJNR 11: 394–396
Brawn LA, Bergval UEG, Davies-Jones GAB (1986) Spontaneous spinal epidural haematoma with spontaneous resolution. Postgrad Med J 62: 885–887
Emery DJ, Cochrane DD (1988) Spontaneous remission of paralysis due to spinal extradural hematoma: case report. Neurosurgery 23: 762–764
Harik SI, Raichle ME, Reis DJ (1971) Spontaneously remitting spinal epidural hematoma in a patient on anticoagulants. N Engl J Med 284: 1355–1357
Hernández D, Viñuela F, Feasby TE (1982) Reccurent paraplegia with total recovery from spontaneous spinal epidural hematoma. Ann Neurol 11: 623–624
Messer HD, Forshan VR, Brust JCM, Hogues JEO (1976) Transient paraplegia from hematoma after lumbar puncture. A consequence of anticoagulant therapy. JAMA 235: 529–530
Gabl M, Kostrum H (1988) Acute spinal subdural hematoma. Neurochirurgia 31: 99–100
Levy JM (1990) Spontaneous lumbar subdural hematoma. AJNR 11: 780–781
Metzger J, Bouayed N, Boukobza M, Feldman L, Arthuis F, Cervigon E, Zouaoui A (1986) Radiological evaluation of extradural spinal compression of metastatic origin. Myelography, CT-Scanner, MRI. Acta Radiol S369: 254–256
Boukobza M, Metzger J (1989) IRM et abcès épiduraux. Rachis 1: 359–364
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Boukobza, M., Guichard, J.P., Boissonet, M. et al. Spinal epidural haematoma: report of 11 cases and review of the literature. Neuroradiology 36, 456–459 (1994). https://doi.org/10.1007/BF00593683
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DOI: https://doi.org/10.1007/BF00593683