Spontaneous cervical epidural hematoma of idiopathic etiology: case report and review of literature

Abstract

Context: Spontaneous spinal epidural hematoma (SSEH) is a rare idiopathic condition that leads to acute onset of neurological deficits, which if not recognized early can have catastrophic consequences. The definition and pathophysiology of this condition remain controversial. High index of suspicion followed by T2-weighted gradient echo sequences are particularly useful in early diagnosis. Management consists of prompt surgical decompression of the hematoma though a recent trend is toward non-surgical treatment.

Findings: A 70-year-old man presented with acute onset neck pain with a radicular component and rapidly progressive quadriparesis. Magnetic resonance imaging revealed a posteriorly located cervical extradural hematoma with cord compression that was promptly evacuated. Functional recovery to near normal function occurred within 24 hours of surgery.

Conclusion: SSEH in its true idiopathic form is a rare pathologic entity. Because of the high risk of poor outcome without treatment, SSEH should be a diagnostic possibility when presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma leads to a favorable neurological outcome, whereas delay in treatment can be disastrous. The role of conservative management needs to be proven and should be tailored on an individual basis.

Figure 1

Axial T1W (A) and T2W (B) MR images showing the extradural hematoma compressing and displacing the spinal cord. Sagittal T1W (D) and T2W (C,E) images showing the clot situated dorsally at the level of C5–C7 vertebral bodies. Sagittal T2W gradient echo sequence (F) demonstrating blooming within the lesion.

Figure 2

Axial (A) and sagittal (B) T2W MRI showing postoperative changes in the form of laminectomy at C5–C7 levels. There is no evidence of any residual hematoma or cord displacement. On contrast study (C) there is no evidence of any pathological enhancement.