Spontaneous epidural hematoma of thoracic spine presenting as Brown-Séquard syndrome: report of a case with review of the literature

Abstract

Background: Spontaneous spinal epidural hematoma (SSEH) is an uncommon clinical entity. It produces a severe neurological deficit and prompt decompression is usually the first choice of treatment. Brown-Séquard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm, but rarely caused by SSEH.

Methods: Case report and literature review.

Findings: A previously healthy man presented with Brown-Séquard syndrome below T5-T6 cord segment secondary to spontaneous epidural hematoma. He opted for conservative treatment, which was followed by rapid resolution.

Conclusions: Although Brown-Séquard syndrome as a presenting feature of SSEH is rare, it does exist in exceptional case, which should be taken into consideration for differential diagnosis. Prompt surgical decompression is an absolute surgical indication widely accepted for patient with progressive neurological deficit. However, SSEH presenting with incomplete neurological insult such as Brown-Séquard syndrome might have a benign course. Successful non-operative management of this problem does not make it a standard of care, and surgical decompression remains the standard treatment for SSEH.

Figure 1

Sagittal (A) and transaxial (B) proton density images (3000 ms, TE 98 ms) 10 hours after the onset showed a hyperintense epidural mass at T3–T4 level. Hyperintense epidural mass extend through the T4/T5 intervertebral foramen (C, arrow).

Figure 2

MRI with contrast 11 days later. T1-weighted MRI (A) and proton density image (B) demonstrated the resolution of the extradural hematoma. No other identifiable etiologies such as neoplasia, arterioveous malformation were found.