Chronic spontaneous lumbar epidural hematoma

We report an exceptional case of cauda equina syndrome, caused by a chronic epidural hematoma of the lumbar spine, (L2-L3). A 53 year old man without history of trauma, lumbar punctures or antiagregant medication, suffered from progressive back pain and minor motor deficit in the legs. The etiology, MRI, intraoperative findings and microscopical study are presented and discussed. After surgery there was a complete resolution of the clinical picture.     

Spinal epidural hematoma due to a vertebro-epidural hemangioma

We present a patient with a spinal epidural hematoma (SEH), caused by a vertebro-epidural hemangioma (VEH). A VEH has been rarely reported as a cause for a SEH and it was remarkable that the VEH was located several vertebrae above the actual hematoma. This emphasises the need for extensive spinal angiography at different levels. The VEH was treated successfully with embolization.     

Spontaneous epidural hematoma due to skull metastasis of hepatocellular carcinoma

Although “spontaneous” epidural hematomas are rare, they can occur in patients with metastatic skull tumors. We describe a case caused by skull metastasis of hepatocellular carcinoma (HCC), and review the relevant literature. In patients with HCC, potential skull metastasis should be kept in mind, since skull metastases from HCC seem to often cause devastating epidural hematoma.     

Lumbar epidural hematoma following lumbar puncture: the role of high dose LMWH and late surgery. A case report

Spinal epidural hematoma (SEH) is a known complication of spinal surgery, but the incidence of post-surgical SEHs that result in neurologic deficits is extremely rare (0.1%). Patients that require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk of developing an epidural hematoma. The introduction of higher dose of low molecular weight heparin (LMWH) twice daily 30 mg regimen) increased the reported incidence of neuroaxial hematomas. Surgery performed within 8 hours makes good or partial recovery of neurologic function. Our patient was also started on higher dose of LMWH and developed neurological deficits due to a SEH following lumbar puncture. She underwent operation after six days and she had a mild recovery following the operation. Current administration of high doses of LMWH can cause SEH even after a lumbar puncture, which was performed without multiple attempts. Although surgery performed within 8 hours makes good or partial recovery of neurologic function, laminectomy and epidural hematoma evacuation performed after three days can also have successful results.     

Recovery from acute paraplegia due to spontaneous spinal,epidural hematoma under minimal-dose acetyl-salicylic acid

OBJECTIVE: Spontaneous spinal epidural hematoma (SEH) has not been reported under anti-thrombotic therapy with acetyl-salicylic acid (ASA) in a dosage of 50 mg/d. METHODS: Spinal MRI, emergency laminectomy. RESULTS: A 77-yo, HIV-negative female under longterm treatment over three years with ASA 50 mg/d for varicositas, prescribed by her general practitioner, experienced sudden onset back pain with radiation towards both knees after getting up in the morning. One-and-a-half hours later she also developed ascending hypesthesia and weakness originating from both distal lower limbs. Three hours after onset, hypesthesia had reached the T10-level bilaterally and she had become paraplegic. There was reduced intestinal motility, stool incontinence, and urinary hesitancy. MRI of the thoraco-lumbar spine demonstrated a SEH T9-L1 indenting the dural sack and compressing the myelon. Immediately after emergency laminectomy T10-12 with micro-surgical evacuation of the clot, 12 h after onset, she could move both legs again and was able to walk with support 7 days after surgery. CONCLUSIONS: This case shows that SEH occurs under a minimal dose of ASA and that such patients rapidly recover upon immediate surgical decompression and evacuation of the hematoma.     

Spontaneous spinal epidural hematoma

Spontaneous spinal epidural hematoma (SSEH) is a rare emergent condition. It may result in paraplegia, quadriplegia and even death. Prompt diagnosis and emergent decompressive surgical management have been recommended to prevent mortality and morbidity. Although several factors have been associated with prognosis, controversy remains, partly due to its rarity. Thus, the history, clinical presentation, physical examination findings, radiological images, and surgical and pathological records of 30 patients with SSEH (21 male, nine female [sex ratio of 2.3:1], average age of 35 years) treated between January 2002 and September 2010 have been reviewed. The association of age, sex, hypertension, vascular malformation, vertebral level, position and extension of the hematoma, progression interval, operative interval, spinal cord edema, and preoperative neurological condition with the prognosis is discussed. The outcome was better for patients with incomplete neurological deficit (p = 0.001), lesions extending <4 vertebral segments (p = 0.026), and lesions in the thoracolumbar and lumbar region. A shorter progression interval often led to a less favorable prognosis (p = 0.017). Patients with spinal cord edema experienced a worse preoperative neurological deficit (p = 0.005) and a worse outcome (p = 0.000). Patients with a progression interval ?12 hours presented with a worse preoperative neurological deficit (p = 0.026). Early surgical intervention to evacuate the hematoma remains the main treatment for most symptomatic patients. Conservative treatment may be used only for those in a good preoperative neurological condition. Prognosis is associated with the preoperative neurological condition, progression internal, spinal cord edema, and extension and vertebral level of the SSEH. Patients with SSEH in the cervical or cervicothoracic region with a complete preoperative motor deficit have a higher mortality rate.     

Subacute epidural hematoma]

Eleven patients are reported who had subacute epidural haematoma diagnosed by CT 48 hours after craniocerebral trauma. These haematomas, most frequently, were located outside the temporal region. In some cases capsule of the haematoma could be recognized. The indication to surgical treatment was increasing intensity of intracranial pressure and development or persistence of the signs of focal CNS injury. Effective conservative treatment was given to patients with good general condition in whom CT showed no shifting of midline structures over 5 mm, and the fissure of the fracture was not lying transversely to the course of middle meningeal artery branches.     

外伤性斜坡区硬膜外血肿

目的探讨外伤性斜坡区硬膜外血肿的临床特点、诊断及治疗。方法回顾性分析并总结4例外伤性斜坡区硬膜外血肿患者的临床资料,所有患者均行CT、MRI检查,予以保守治疗。结果患者治愈出院,无明显神经功能缺失症状,复查CT斜坡区血肿完全吸收。结论外伤性斜坡区硬膜外血肿在临床上少见,熟悉其临床表现、选择合适的影像学检查,有助于早期诊断治疗,减少误诊率。     

Lumbar epidural ewing sarcoma

Summary The clinicopathological findings in a child with extraskeletal Ewing sarcoma are described.The patient complained of pain in the lower back and difficulty walking. An extraskeletal, epidural, friable tumor, 2–3 cm long was removed from the epidural space. It had no relationship with the bone structures. Light and electron microscopic examination of the tumor led to the diagnosis of Ewing sarcoma. The morphological aspects of this neoplasia and the problem of the differential diagnosis with other small cell tumors of the epidural space are discussed.

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Zusammenfassung Es wird ein Ewing-Sarcom, welches sich außerhalb des Skelettes bei einem Kind entwickelte, geschildert. Klinisch manifestierte es sich als epidurale Masse. Bei der chirurgischen Exploration zeigte sich ein brüchiges Gewebe, welches 2–3 cm lang war und nicht vom Knochen ausging. Lichtmikroskopisch und elektronenmikroskopisch ließ sich die Diagnose eines Ewing-Sarcoms stellen.Es werden morphologische Aspekte und differentialdiagnostische Überlegungen in Zusammenhang mit Tumoren des Epiduralraumes diskutiert.

     

Traumatic epidural hematoma in children

The purpose of this study was to investigate the characteristics of childhood acute epidural hematoma and to report our experience in recent years. A series of 35 patients below the age of 15 years treated for acute epidural hematoma at our institution between June 1991 and December 2000 was analyzed in detail. Pediatric epidural hematoma presents both age-related and atypical features when compared with epidural hematoma in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Outcomes seem to be directly related to the patient's preoperative neurologic status and the presence of associated intracranial lesions.