[A case of spontaneous spinal epidural hematoma with spontaneous remission before surgery]

A 61-year-old man was referred to our department with spontaneously remitting sensorimotor disturbance and bowel and bladder dysfunctions. He had no specific previous history and neither received any drug nor suffered from hypertension. On onset, complete flaccid paralysis of lower extremities, almost complete sensory disturbance of all modalities below the level of Th12, and bowel and bladder dysfunctions were observed. MRI and CT scan revealed an epidural hematoma in the posterior region of the spinal cord at Th11 level. Afterwards he continued to improve gradually both clinically and radiologically. Four days subsequent to onset, on admission to our department, he had slight sensorimotor disturbance, and bowel and bladder dysfunctions still existed. MRI demonstrated a shrinking and flattened hematoma. We performed laminectomy and evacuation of the hematoma. Grossly and histologically, no underlying lesion was revealed. Postoperative course was not eventful. He was discharged without residual deficits. In our case, surgery accomplished three goals: definitive diagnosis, secure decompression and prevention of recurrence. We believe, the possibility of spontaneous resolution of spontaneous spinal epidural hematomas (SSEDHs) with spontaneous remission may be high, but prompt surgical evacuation should be the treatment of choice for such cases, even if no underlying lesion is revealed by MRI, except in cases where operative morbidity and mortality rate is high and in cases with no neurological deficits other than pain. A review of the literature indicated that not all SSEDHs with spontaneous remission resolved spontaneously and completely.