[Acute spinal epidural hematoma in MRI-CT, following continuous epidural anesthesia with spontaneous recovery]

We report a case of acute spinal epidural hematoma diagnosed by MRI-CT. A 76-year-old woman was admitted in our hospital for the purpose of the gastrectomy against her early cancer of stomach. Thoracic epidural anesthesia (Th8/9) was attempted for the operation and soft tube was continuously remained in the epidural space after successful gastrectomy. On the second day after operation, the tube was pulled out from the epidural space safely. However, the patient complained severe thoracic-back pain and complete paraplegia of legs with sensory loss beneath Th10 level of dermatoma. X-ray CT and MRI-CT showed spinal epidural hematoma, especially MRI-CT made clear the relationship between spine and hematoma and the level of longitudinal expansion. The hematoma was recognized in MRI-CT as high signal intensity spindle-shape area (spine echo Tr/Te 1800/100). The spinal epidural hematoma existed from 4th to 12th thoracic vertebra level on sagittal slice. Her symptom recovered completely about three hours and a half after the onset spontaneously, and there is no recurrence of paraplegia. The mechanism of spontaneous recovery from paraplegia is assumed that the spreading of the hematoma in epidural space up- and downwards to the rostro-caudal direction results in decompression. Acute spinal epidural hematoma occurred by continuous epidural anesthesia, and with spontaneous recovery is very rare. The hematoma disappeared in MRI-CT on the 26th day after the onset. MRI-CT is useful to detect spinal epidural hematoma safely and accurately for its diagnosis.