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Vertebral artery dissection as an extremely rare cause of spinal epidural hematoma: case report and review of the literature

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Abstract

Objective

To present a patient with a cervico-thoracic ventrally located epidural hematoma caused by dissection and subsequent bleeding of the cervical portion of the vertebral artery.

Summary and background data

Non traumatic epidural hematoma is a rare entity. The etiology usually is not clarified: a venous origin is usually suspected although an arterial source is also possible.

Clinical report

A 32-year-old woman presented with a ventrally located cervico-thoracic epidural hematoma caused by non traumatic dissection and dissecting aneurysm rupture of the cervical portion of the vertebral artery. The dissection was demonstrated by magnetic resonance imaging and digital subtraction angiography. The patient had no neurological symptoms and was treated by conservative methods. Follow up imaging showed healing of the vertebral artery and resorption of the epidural hematoma.

Conclusion

Dissection of the cervical portion of the vertebral artery with subsequent perivascular bleeding is not well recognized as a possible cause of a spinal epidural hematoma. Even though this entity and the underlying cause may be rare, we suggest a vigilant search for vertebral artery injury in cases of ventrally located cervical and upper thoracic epidural hematoma.

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Authors and Affiliations

  1. National Institute of Neurosurgery, Budapest, Hungary

    Zsolt Kulcsar, Zsolt Berentei, Miklos Marosfoi, Istvan Nyary & Istvan Szikora

  2. Klinik Hirslanden, Neurozentrum, Witellikerstrasse 40, 8032, Zurich, Switzerland

    Zsolt Kulcsar

Authors
  1. Zsolt Kulcsar
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  2. Zsolt Berentei
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  3. Miklos Marosfoi
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  4. Istvan Nyary
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  5. Istvan Szikora
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Corresponding author

Correspondence to Zsolt Kulcsar.

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Comment

The authors present an interesting case report, and a very surprising finding in a patient presenting with chest pain. However, this is not a new observation. Previous reports describe vertebral artery dissection presenting with chest or back pain in the absence of apparent trauma. The authors did well in re-creating the patient’s story and the chain of events. MRI and angiogram images depict the situation well. The literature agrees with nonoperative management in patients without neurological compromise. Although complete proof of cause and effect is not possible, it seems very probable that the spinal EDH is caused by vertebral artery dissection.

John Zhang

Jan Eckermann

USA

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Kulcsar, Z., Berentei, Z., Marosfoi, M. et al. Vertebral artery dissection as an extremely rare cause of spinal epidural hematoma: case report and review of the literature. Acta Neurochir 151, 1319–1323 (2009). https://doi.org/10.1007/s00701-009-0223-7

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  • DOI: https://doi.org/10.1007/s00701-009-0223-7

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