[Non-traumatic spinal epidural hematomas (2 cases): contribution of the CT scanner]

Two cases of non-traumatic epidural hematoma are reported. The first case, a 76 year old woman receiving anticoagulant treatment, presented with paralysis of both lower limbs and right upper limb. Myelography and CT scan showed a widespread hematoma from C4 to T2. The second patient, a 63 year old hypertensive woman, developed flaccid paraparesis with urinary retention, myelography and CT scan showed an epidural hematoma extending from T12 to L2. In both cases, surgical evacuation was followed by a fair motor recovery. The 190 published cases of non-traumatic spinal epidural hematoma include 14 of precise etiology, 69 idiopathic and 107 associated with or 2 predisposing factors. Three mechanisms are proposed to explain the spontaneous cases: alteration of peridural veins; rupture of dural vascular clusters; minimal arterial injury. CT scan imaging shows a biconvex, hyperdense epidural image and is the investigation of choice for acute, hyperalgesic myelo-radicular compression syndromes.