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Spontaneous spinal epidural hematoma: a case report.

Ooi Chin Sheng1, Ren-Chieh Wu2,3, I-Hsin Chang4

  • 1Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Tzu Chi University, Hualien, Taiwan.

International Journal of Emergency Medicine
|September 26, 2021
PubMed
Summary

This case report details a rare spontaneous spinal epidural hematoma in a woman presenting with sudden leg weakness. Prompt surgical decompression led to immediate symptom relief, highlighting the importance of considering this condition even without typical risk factors.

Keywords:
Back painLower limb weaknessSpinal epidural hematoma

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Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Spinal epidural hematomas (SEH) are uncommon, with spontaneous cases being exceedingly rare (~0.1 per 100,000).
  • The male-to-female ratio for SEH is approximately 1.4:1.
  • This report focuses on a unique instance of spontaneous SEH.

Purpose of the Study:

  • To present a rare case of spontaneous spinal epidural hematoma.
  • To emphasize the diagnostic and management considerations for spontaneous SEH.
  • To highlight the importance of prompt evaluation for bilateral lower limb weakness.

Main Methods:

  • A 63-year-old female patient with hypertension and anemia presented with acute bilateral lower limb weakness.
  • Magnetic resonance imaging (MRI) confirmed the presence of a spontaneous epidural hematoma.
  • Emergency surgical evacuation of the hematoma and laminectomy were performed for spinal cord decompression.

Main Results:

  • Immediate alleviation of bilateral lower limb weakness post-surgery.
  • Successful decompression of the spinal cord.
  • Confirmation of a spontaneous epidural hematoma as the cause of symptoms.

Conclusions:

  • Spontaneous spinal epidural hematoma should be considered in patients presenting with bilateral lower limb weakness, even in the absence of known risk factors.
  • Early diagnosis and surgical intervention are crucial for favorable outcomes.
  • Careful investigation is warranted for unexplained neurological deficits.