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. 2019 Nov;14(2):206-210.
doi: 10.2185/jrm.3005. Epub 2019 Nov 20.

Clinical features of spontaneous spinal epidural hematoma

Fumihiko Eto  1 , Masaki Tatsumura  1 , Sho Iwabuchi  1 , Takeshi Ogawa  1 , Takeo Mammoto  1 , Atsushi Hirano  1
Affiliations

Clinical features of spontaneous spinal epidural hematoma

Fumihiko Eto et al. J Rural Med. 2019 Nov.

Abstract

Objective: Spontaneous spinal epidural hematoma is rare and therefore difficult to diagnose. This study evaluated the clinical features of this condition in patients admitted to our hospital. Patients and Methods: We evaluated 12 patients with spontaneous spinal epidural hematoma who were treated at our hospital. We investigated the following variables in these patients: underlying diseases, medications used, initial symptoms, spinal level affected, whether transported to the hospital by ambulance, department where first evaluated, mass lesion on computed tomography with soft tissue window settings, time interval between symptom onset and diagnosis, treatment received, and Frankel classification on arrival and when last observed. Results: Five patients reported the use of antiplatelet or anticoagulant drugs. All patients in this study reported acute onset of severe pain as the initial symptom, and 10 patients reported some degree of paralysis accompanying the pain. With respect to the morbidity level, the cervical region was the most common site of involvement (n=7). Ten patients were transported to the hospital at night via ambulance. Five patients first visited the Department of Internal Medicine. Seven patients presented with a mass lesion on computed tomography with soft tissue window settings. The time interval between symptom onset and diagnosis ranged from 2 hours to 6 days. Three and 9 patients received conservative and surgical treatments, respectively. No patient showed worsening of Frankel classification. Conclusion: Acute onset of severe pain was the most characteristic clinical symptom. Spontaneous spinal epidural hematoma should be included in the differential diagnosis. Computed tomography with soft tissue window settings may rule out cerebrovascular disease and cardiovascular disease, and specifically detect a hematoma. Subsequent magnetic resonance imaging can diagnose a spontaneous spinal epidural hematoma at an early stage.

Keywords: acute onset of severe pain; computed tomography with soft tissue window settings; spontaneous spinal epidural hematoma.

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Figures

Figure 1
Figure 1
Case 7. (a) Computed tomography (CT) scan (sagittal view) showing a spindle-shaped mass lesion at the C4–C6 level (arrows). (b, c) Mixed intensity observed on T1- and T2-weighted magnetic resonance imaging (MRI) scans indicates a hematoma (arrows). (d, e) Axial CT and MRI scans showing an epidural hematoma at the left portion dorsal to the dural sac.
Figure 2
Figure 2
Case 9. (a, d) Computed tomography scan with soft tissue window settings showing a spindle-shaped mass lesion suspicious for hematoma at the C2–C6 level (arrows). (b, c, e) Spontaneous spinal epidural hematoma was diagnosed with magnetic resonance imaging, and surgical treatment was performed in the patient (arrows).
Figure 3
Figure 3
Comparison of computed tomography (CT) scans based on window settings (sagittal views). Epidural hematomas are easier to identify on CT scans with soft tissue window settings (b) rather than CT scans with bone window settings (a) (arrows).
See this image and copyright information in PMC

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