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Spontaneous spinal epidural hematoma during pregnancy
Michael E B Kelly1, R Cole Beavis, Suzanne Hattingh
1Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
Summary
Spontaneous spinal epidural hematoma (SSEH) in pregnancy is rare. Prompt surgical evacuation of the hematoma led to significant recovery of neurological function in a 32-week pregnant patient, highlighting the importance of timely intervention.
Area of Science:
- Neurology
- Obstetrics
- Neurosurgery
Background:
- Spontaneous spinal epidural hematoma (SSEH) is a rare condition with an unclear etiology.
- SSEH occurring during pregnancy is exceptionally rare, with only a few cases documented in medical literature.
Observation:
- A 31-year-old pregnant woman at 32 weeks gestation presented with sudden-onset paraplegia.
- MRI revealed an acute epidural hematoma compressing the thoracic spinal cord between T2 and T4 vertebrae.
Findings:
- The patient underwent a Cesarean section followed by laminectomy and hematoma evacuation.
- Post-surgery, she showed gradual recovery of lower extremity motor function and returned of bowel/bladder control within months.
- Follow-up angiography ruled out any underlying vascular malformations.
Implications:
- Pregnancy-associated SSEH, though rare, can present with severe neurological deficits.
- Prompt surgical decompression is crucial for favorable long-term recovery in these cases.
- Elevated venous pressure during pregnancy may be a contributing factor to SSEH development.