[Transient Brown-Séquard syndrome due to spontaneous spinal epidural hematoma]

Abstract

Spinal epidural hematoma (SEH) is a low incidence injury. When the cause of bleeding is unknown, which occurs in 50% of the cases, we refer to it as spontaneous SEH. The clinical presentation is characterized by acute radicular pain followed by cord compression syndrome. Brown-Séquard syndrome is exceptional as a result of a SEH. Although standard treatment is prompt surgical evacuation of the hematoma, spontaneous resolution has also been reported. We present a case of spontaneous SEH in a 69 year-old man. An MRI revealed an hematoma in the right posterior epidural space extending from C6 to T2. The hematoma was manifested as a paresis of the right limbs and sensory loss of the left side below C7 level. During the first hours the neurological deficit was improved without treatment and consequently a conservative management was continued. After 72 h, the patient was completely recovered. We have reviewed the 14 cases of spinal epidural hematoma and Brown- Séquard syndrome previously reported, only 2 of them were resolved by conservative management. We conclude that when SEH presents as Brown-Séquard syndrome it usually has a more benign course and that in some cases a conservative management can be considered.