Spinal epidural hematoma related to intracranial hypotension

Abstract

A 45-year-old female patient visited the hospital complaining of severe sudden headache and posterior neck pain. The patient did not have any traumatic history or abnormal neurologic finding. The patient had sudden quadriplegia and sensory loss. Cervical spine MRI scan was taken, and the compatible findings to acute epidural hematoma were shown. The emergency operation was performed. After the operation, the patient recovered all motor and senses. As there was CSF leakage in the postoperative wound, this was confirmed by cervical spinal computed tomography (CT). Then lumbar drainage was thus performed. The opening pressure upon lumbar puncture was not measured as it was very low. As a result of continous CSF leakage, dural repair was performed. After the operation, the patient had been discharged without neurologic deficits. In this case, it is sensible to suspect intracranial hypotension as a possible cause of spinal EDH.

Keywords: Cerebrospinal fluid leakage; Headache; Neck pain; Spinal epidural hematoma.

Fig. 1

Cervical-spine MRI images: There is isointensity in the T1-weighted image, and hyperintensity in the T2-weighted image, from the C2 to the T2 epidural space of the ventral side of the spinal cord.

Fig. 2

Contrast-enhanced CT of cervical-spine: There is fluid collection in the dorsal area of the vertebral bodies from C3 to T3 at 6 day after 1^st surgery.

Fig. 3

Contrast-enhanced CT of cervical-spine: There is increased fluid collection in the dorsal area of the vertebral bodies from C2 to T3 at 24 day after 1^st surgery.