Spontaneous spinal epidural hematoma (EDH) is a relatively rare condition that requires urgent diagnosis and management. Such patients typically present with acute and severe back pain and spinal cord or caudaequina compression. Risk factors include coagulopathy, anticoagulation, vascular anomalies, inter vertebral disk herniation, Paget disease of bone, Valsalva maneuver and hypertension. Differential diagnosis includes an acute herniated inter vertebral disc, acute ischemia of the spinal cord, epidural tumor or abscess, spondylitis, transverse myelitis, or even a dissecting aortic aneurysm and acute myocardial infarction.An observational study was conducted in the Department of Radiodiagnosis, SKIMS Srinagar to study the clinical features, imaging features and treatment outcomes of spontaneous spinal epidural hematomas.This study shows that MR Imaging is a very sensitive and specific modality for diagnosis of spontaneous epidural hematomas. Also early management in the form of early decompressive laminectomy and hematoma evacuation is helpful in preventing permanent neuro deficit.

Keywords: Epidural hematoma, MRI, Spinal epidural space.

1. Holtas S, Heiling M, Lonntoft M. Spontaneous spinal epidural hematoma. Findings at MR imaging and clinical correlation. Radiology 1996;199:409–433
2. Foo D, Rossier A. Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas. SurgNeurol 1981;15:389–401
3. McQuarrie G. Recovery from paraplegia caused by spontaneous spinal epidural hematoma. Neurology 1978;28:224–228
4. Packer N, Cummins B. Spontaneous epidural hemorrhage. A surgical emergency. Lancet 1978;1:356–358
5. Groen R, Ponssen H. The spontaneous spinal epidural hematoma.A study of the etiology. J NeurolSci 1990;98:121–138
6. Groen RJ, Groenewegen HJ, van Alphen HA, Hoogland PV. Morphology of the human internal vertebral venous plexus.A cadaver study after intravenous Araldite CY 221 injection.Anat Rec 1997;249:285–294
7. Joseph AP, Vinen JD. Acute spinal epidural hematoma. J Emerg Med 1993;11:437–441
8. Lee K, McWhorter J, Angelo J. Spinal epidural hematoma associated with Paget’s disease. SurgNeurol 1988;30:131–134
9. Brawn L, Bergval U, Davies-Jones G. Spontaneous spinal epidural haematoma with spontaneous resolution. Postgrad Med J 1981;62:885–887
10. Gundry C, Heithoff K. Epidural hematoma of the lumbar spine. 18 surgically confirmed cases. Radiology 1993;187:427–431
11. Caldemeyer K, Mocharla R, Moran C, Smith R. Gadolinium enhancement in the center of a spinal epidural hematoma in a hemophiliac. J Comput Assist Tomogr 1993;17:321–323
12. Muhonen M, Piper J, Moore S, Menezes A. Cervical epidural hematoma secondary to an extradural vascular malformation in an infant. Case report. Neurosurgery 1995; 36:585–588
13. David S, Salluzzo RF, Bartfield JM, Dickinson ET. Spontaneous cervicothoracic epidural hematoma following prolonged Valsalva secondary to trumpet playing. Am J Emerg Med 1997;15: 73–75
14. Chan DT, Boet R, Poon WS, Yap F, Chan YL : Spinal shock in spontaneous cervical spinal epidural haematoma. ActaNeurochir (Wien) 146 : 161-1162; discussion 1162-1163, 2004
15. Guzel A, Simsek O, Karasalihoglu S, Kucukugurluoglu Y, Acunas B, Tosun A, et al : Spontaneous spinal epidural hematoma after seizure : a case report. ClinPediatr46 : 263-265, 2007
16. Poonai N, Rieder MJ, Ranger A : Spontaneous spinal epidural hematoma in an 11-month-old girl. PediatrNeurosurg43 : 121- 124, 2007
17. Tailor J, Dunn IF, Smith E : Conservative treatment of spontaneous spinal epidural hematoma associated with oral anticoagulant therapy in a child. Childs NervSyst22 : 1643-1645, 2006
18. Bisson EF, Dumont T, TranmerB : Spontaneous Spinal Epidural Hematoma in a Child with Hemophilia B. Can J NeurolSci34 : 488-490, 2007
19. Solheim O, Jorgensen JV, NygaardOP : Lumbar epidural hematoma after chiropractic manipulation for lower back pain : Case Report. Neurosurgery 61 : E170-171; discussion E171, 2007
20. Liu Z, Jiao Q, Xu J, Wang X, Li S, You C : Spontaneous spinal epidural hematoma: analysis of 23 cases. SurgNeurol69 : 253-260; discussion 260, 2008
21. Riaz S, Jiang H, Fox R, Lavoie M, MahoodJK : Spontaneous spinal epidural hematoma causing Brown-Sequard syndrome : case report and review of the literature. J Emerg Med 33 : 241-244, 2007
22. Shin JJ, Kuh SU, Cho YE : Surgical management of spontaneous spinal epidural hematoma. Eur spine J 15 : 998-1004, 2006
23. Hangping Y, Shunwu F, Huilin Y, Tiansi T, Feng Z, Xing Z : Early diagnosis and treatment of acute or subacute spinal epidural hematoma. Chin Med J 120 : 1303-1308, 2007
24. Bose S, Ali Z, Rath GP, PrabhakarH : Spontaneous spinal epidural hematoma : a rare cause of quadriplegia in the post-partum period. Br J Anaesth99 : 855-857, 2007
25. Park J, Lee JB, Park JY, Lim DJ, Kim SD, Chung YK : Spinal cord infarction after decompressive laminectomy for spontaneous spinal epidural hematoma. Neurol Med Chir (Tokyo) 47 : 325-327, 2007
26. Song KJ, Lee KB : The poor outcome of the delayed diagnosis of acute spontaneous spinal epidural hematoma : two cases report. J Korean Med Sci20 : 331-334, 2005
27. Ziyal IM, Aydin S, Inci S, Sahn A, OzagenT : Multilevel acute spinal epidural hematoma in a patient with chronic renal failure- case report. Neurol Med Chir (Tokyo) 43 : 409-412, 2003
28. Gundry CR, Heithoft KB. Epidural herna.toniıi Of the lunibar spine: 18 surgically confirmed cast’s. Radiology 1993; 187:427- 431.
29. D’Angebo, Bizzozero L, Tabamonti C, Ferrara M, Cobombo N. Value of magnetic resona 0CC imaging in spontaneous extradurab spinal hematoma due’ to vascular malformation (case report). SurgNe’urob 1990; 34:343-344.
30. Saito S, Katsuhe H, Kohayashi Y. Spinal e’pidurab hematoma with spontaneous recovery demonstrated by magnetic resonance’ imaging. Spine 1994;19:483-486.
31. Rothfus WE, Chedid MK, Deeb ZL, Abla AA, Maroon JC, Sherman RL. MR imaging in the diagnosis of spontaneous spinal epidurab hematomas.J Comput Assist Tomogr 1987; 11:851-854.
32. Donovan Post MJ, Becerra JL, Madsen PW, et ab. Acute spinal subdurab hematoma: MR and CT findings with pathologic correbates. AJNR 1994; 15:1895-1905.
33. Fujiwara H, Oki K, Momoshima S, Kuribayashi S : PROPELLER diffusion-weighted magnetic resonanace imaging of acute spinal epidural hematoma. ActaRadiol46 : 539-542, 2005
34. Avrahami E, Tadmor R, Ram Z, Feibel M, Itzhak Y. MR demonstration of spontaneous acute epidural hematoma of the thoracic spine. Neuroradiology 1989;31:89–92
35. Bernsen P, Haan J, Vielvoye G, Peerlinck K. Spinal epidural hematoma visualized by magnetic resonance imaging. Neuroradiology 1988;30:280
36. Crisi G, Sorgato P, Colombo A, Scarpa M, Falasca A, Angiari P. Gadolinium-DTPA-enhanced MR imaging in the diagnosis of spinal epidural haematoma. Report of a case. Neuroradiology 1990;32:64–66
37. Latham J, Dracopoulos G, Hall D. Cervical epidural haematoma following minor trauma. Aust NZ J Surg 1993;63:985–986
38. Melanie B. Fukui, Amar S. Swarnkar and Robert L. Williams. American Journal of Neuroradiology July 1999, 20 (7) 1365-1372;
39. Byung Suck Baek, M.D., Jin Woo Hur, M.D.,corresponding author Ki Young Kwon, M.D., and Hyun Koo Lee, M.D. J Korean Neurosurg Soc. 2008 Jul; 44(1): 40–42.
40. Matsumura A, Namikawa T, Hashimoto R, Okamoto T, Yanagida I, Hoshi M, et al : Clinical management for spontaneous epidural hematoma : diagnosis and treatment. Spine J 8 : 534-537, 2007
41. Harik S, Raichle M, Reis DJ. Spontaneously remitting spinal epidural hematoma in a patient on anticoagulants. N Engl J Med 1971;284:1355–1357
42. Hernandez D, Vinuela F, Feasby T. Recurrent paraplegia with total recovery from spontaneous spinal epidural hematoma. Ann Neurol 1982;11:623–624
43. Priest W. Epidural hemorrhage due to hemophilia. Lancet 1935; 2:1289–1291.

Obaid Ashraf

Department of Radiology, Sher‑I‑Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir

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