[CT findings in acute spinal epidural hematoma caused by a ruptured cavernous angioma]

A case of acute spinal epidural hematoma due to the rupture of cavernous angioma is reported. A 68-year-old man was admitted to our hospital with a complaint of hematoemesis. After the successful treatment of bleeding from a gastric ulcer by using endoscopical method, he noticed severe motor weakness in his lower extremities. Complete paraparesis of his lower limbs, total sensory loss below the level of fifth thoracic vertebrae, and bladder disturbance were revealed on neurological examination. A metrizamide myelogram showed complete block at the level of fourth thoracic vertebrae. A computed tomography (CT) scan disclosed a dorsolateral heterogeneous high density area (92 Hounsfield Unit) on the right with displacement of the spinal cord to the left, extending from the level of second to fifth thoracic vertebrae. He was operated thirty hours after the onset. After the laminectomy, an epidural hematoma covering over the dural sac was recognized. Following the removal of the hematoma, a hemorrhagic mass was disclosed and removed successfully. A pathological examination revealed cavernous angioma. His symptoms improved partially in three months after the operation. There have been thirteen cases of non-traumatic spinal epidural hematoma which had been diagnosed by CT scan, as far as we are aware. Although only four cases out of 13 were diagnosed without using any contrast materials, we stress that the spinal epidural hematoma can be diagnosed only by plain CT scan because of its characteristic clinical feature, attenuation coefficient, and mass effect to the spinal cord.