[A case of acute spinal epidural hematoma with spontaneous resolution and its MRI]

A case of non-traumatic spinal epidural hematoma (SEH) with spontaneous resolution was reported. A 80-year-old woman was admitted to our hospital for her paraplegia of acute onset. She had had no specific previous history, and she did not either receive any drug or suffer from hypertension. On admission, general status was unremarkable. Flaccid paralysis of lower extremities and bilateral sensory disturbance of all modalities below the level of Th4 were observed. Deep tendon reflexes were normal in upper extremities, while absent in lower extremities. Babinski's sign was not elicited. From the findings of CT and metrizamide CT myelography, SEH of ventral type was presumed. MRI revealed hematoma compressing spinal cord over two vertebral segments, and widely spreading even to C7 rostrally and to Th10 caudally. Urgent surgical intervention was taken into consideration, but was not performed because of her rapid improvement: sensory disturbance alleviated from day to day, and she became able to walk within the 3rd day of hospitalization. Almost complete recovery from motor and sensory dysfunction was achieved in about 7 days after admission. Only 4 cases of spontaneous recovery of SEH have been reported so far, and this patient is the 5th such case. Although CT and metrizamide CT myelography are useful in diagnosing SEH, MRI is also proved to be an accurate and efficacious method for evaluation of its size, location and extent in the spinal canal.