Spontaneous spinal epidural hematoma: literature review

Abstract

Review the current literature regarding spontaneous spinal epidural hematomas (SSEHs) and report on the known risk factors, evaluation, and treatment of this rare entity. A literature search was performed using PubMed and Ovid to identify articles pertaining to SSEHs. Due to the rarity of the pathologic entity, only scattered case reports and associated reviews are available. SSEHs are a rare yet potentially life-altering event. The underlying risk factors are poorly understood, and SSEHs present with minimal or no antecedent trauma. SSEHs warrant urgent surgical intervention given the associated risk of permanent neurologic sequelae. Given the potential for persistent neurologic deficits, physicians must entertain a clinical suspicion of SSEH when a patient presents with a history of back pain followed by neurologic deficits. Even without clear risk factors for hemorrhage, the appropriate evaluation to include advanced imaging studies should be obtained to allow for identification of this entity and urgent surgical management.

Keywords: Spine; hemorrhage; neurologic deficit; spontaneous epidural hematoma.

Figure 1

Magnetic resonance imaging (MRI) of the thoracic spine. (A) T1-weighted imaging revealing a hyperintense lesion in the ventral epidural space from T3–T11; (B) T2-weighted imaging revealing the lesion to be hypointense; (C) gadolinium contrasted imaging revealing no enhancement.