Delayed traumatic spinal epidural hematoma after mild traumatic brain injury successfully treated with minimally...

Concurrent traumatic cranial and spinal epidural hematomas (SEHs) are rare neurosurgical emergencies. Delayed presentation of traumatic SHE (TSEH) following mild traumatic brain injury (TBI) is particularly uncommon and may contribute to delayed diagnosis and progressive neurological deterioration. This report highlights the diagnostic challenge of delayed TSEH and describes the use of minimally invasive decompression in a delayed presentation.

A 48-year-old female presented with progressive paraplegia and urinary incontinence 1.5 months after a motor vehicle accident initially managed conservatively for mild TBI. Magnetic resonance imaging demonstrated a hyperacute-on-acute SEH extending from T11 to L5, causing severe spinal canal stenosis with compression of the spinal cord and cauda equina. The patient underwent minimally invasive unilateral laminotomy for bilateral decompression with evacuation of the epidural hematoma. Despite delayed presentation and 4 days of complete paraplegia, postoperative neurological improvement was observed, with recovery of motor, sensory, and bladder function.

This case emphasizes that TSEH may present with delayed and progressive neurological deterioration, particularly in patients with concomitant cranial injury and distracting trauma. Maintaining suspicion for spinal pathology and performing timely spinal imaging are essential in patients with evolving neurological deficits. In selected cases, minimally invasive decompression may provide adequate neural decompression while minimizing tissue disruption, although further evidence is required to clarify its role in delayed TSEH.