- Department of Neurosurgery, Zagazig University, Zagazig,
- Department of Neurosurgery, Al Mokatam Insurance Hospital, Cairo, Egypt.
Mahmoud M. Taha
Department of Neurosurgery, Zagazig University, Zagazig,
DOI:10.25259/SNI_543_2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Mahmoud M. Taha, Ahmad M. Elsharkawy, Hassan A. Al Menshawy, Amr AlBakry. Spontaneous cervical epidural hematoma: A case report and review of literature. 13-Dec-2019;10:247
How to cite this URL: Mahmoud M. Taha, Ahmad M. Elsharkawy, Hassan A. Al Menshawy, Amr AlBakry. Spontaneous cervical epidural hematoma: A case report and review of literature. 13-Dec-2019;10:247. Available from: https://surgicalneurologyint.com/surgicalint-articles/9800/
Background: Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not diagnosed early can lead to catastrophic consequences.
Case Description: Here, we report a 41-year-old male, diagnosed with SCEH, with a presenting chief complaint of cervical pain followed by progressive quadriparesis and urgency of micturition who was managed surgically, along with the review of literature.
Conclusion: SCEH is a rare pathologic entity. Due to the high risk of poor neurological outcome without treatment, SCEH should be a diagnostic possibility when the presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma and hemostasis leads to a favorable neurological outcome, whereas delay in treatment can be disastrous.
Keywords: Hemilaminectomy, Neurologic manifestations, Progressive, Spinal cord, Spontaneous cervical epidural hematoma
Spinal epidural hematoma (SEH) is a very rare cause of acute spinal cord compression and is estimated to occur in approximately 0.1% of 100,000 individuals.[
This 41-year-old male presented with a 6-day history of acute neck pain radiating into both upper extremities, accompanied by unsteady gait, progressive quadriparesis, and urinary urgency. Notably, the patient had a cardiac valve replaced 2 years ago and was on routine anticoagulation. On admission, he was quadriparetic with Grade 2/5 motor function in the right upper and both lower extremities and 3/5 left upper extremity strength. He also had a relative pin level from C5 downward. Laboratory studies showed an initial INR of 3.5, with a platelet count of 90.000/mm3 and hemoglobin of 12 mg/dl. The urgent cervical MRI, done within 2 h of admission, showed a right dorsolateral intraspinal mass lesion extending from C5 to T1; the lesion was hyperintense on T1WI (weighted image) and showed heterogeneous isointensity-hypointensity on the T2WI. These findings were consistent with a spontaneous, early, and subacute cervical epidural hematoma [
Evacuation of the hematoma was planned, and the patient preparation was started, 6 units of fresh frozen plasma, 36 units of platelets, 12 preoperative, 12 intraoperative, 12 postoperative, and 2 units of fresh blood were administered to the patient. Within 8 h after the initial MRI, utilizing C-arm guidance, a C5-T1 right hemilaminectomy was preformed allowing for complete hematoma evacuation [
SCEH is typically attributed to coagulopathies, anticoagulation, disc herniation, vascular malformations, neoplasms, and idiopathic causes.[
MRI of SEH
MRI is the diagnostic study of choice for SCEH.[
Although few cases of SCEH present with mild neurological symptoms, many exhibit frank quadriparesis/quadriplegia that should be rapidly diagnosed and treated to avoid permanent residual neurological deficits.[
SCEH is a rare disorder. Early diagnosis with MRI and hematoma evacuation within 24 h of symptom onset is critical to maximize recovery.
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