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[Spontaneous spinal epidural hematoma: case report]

H Nakamura1, T Tominaga, S Satoh

  • 1Department of Neurosurgery, Tohoku University, School of Medicine.

No Shinkei Geka. Neurological Surgery
|April 1, 1997
PubMed
Summary

This study details a rare case of spontaneous spinal epidural hematoma in the upper thoracic region. The hematoma was linked to an unusual epidural vascular lesion, successfully treated with laminectomy and hematoma evacuation.

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Area of Science:

  • Neurology
  • Vascular Surgery
  • Spinal Surgery

Background:

  • Spontaneous spinal epidural hematoma (SSEH) is a rare condition often presenting with acute neurological deficits.
  • Etiologies of SSEH include vascular malformations, bleeding disorders, and trauma, but some cases remain idiopathic.

Observation:

  • A 62-year-old male presented with acute back pain, paraparesis, and sensory deficits.
  • MRI revealed a thoracic spinal epidural mass compressing the cord, associated with spondylosis and a thickened ligamentum flavum.
  • Surgical decompression and hematoma evacuation revealed an unusual epidural vascular lesion on the dura mater.

Findings:

  • Histological examination of the vascular lesion showed a cluster of dilated vessels with thin walls, lacking elastic and collagen fibers.

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  • The patient's neurological symptoms resolved completely within three weeks post-surgery.
  • The proposed etiology involves chronic venous hypertension from ligamentum flavum compression leading to vascular anomaly formation and subsequent bleeding.

    • Implications:

    • This case highlights a potential link between chronic spinal canal changes and the development of SSEH.
    • Understanding the pathogenesis of SSEH associated with vascular lesions is crucial for diagnosis and treatment.
    • Further research into the relationship between spinal venous plexopathy and SSEH may elucidate underlying mechanisms.