Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Report
  • Published:

Spontaneous spinal epidural hematomas—Time is running out!

Abstract

Introduction

Spontaneous spinal epidural hematoma (SSEH) is the rarest cause of spinal cord compression, causing paraparesis or quadriparesis. They account for less than 1% (0.1 patients per 100,000 patients per year) of all spinal canal space-occupying lesions, thus resulting in a paucity of literature. Here, we report three cases of SSEH; all had a neurological deficit on presentation and were surgically managed with decompressive laminectomy and evacuation of the hematoma.

Case presentation

Of the three patients, one had a history of coronary artery disease and was on anticoagulants. In the remaining two, no cause could be identified. The hematoma was located at the thoracic region in 2 patients and at the cervical in one. Hematoma were located dorsal to cord in 2 patients and ventral in one. Two cases presented within 30 h of the onset of symptoms with the ASIA (American Spinal Injury Association) impairment scale (AIS) A and B neurology. Both showed a complete recovery during their latest follow-up. However, one case presented after 2 days with AIS A neurology and improved to AIS B post-operatively at 30 months follow-up.

Discussion

The myriad of symptoms and the need for an MRI for diagnosis have made SSEH difficult to diagnose clinically. Unlike other spinal pathologies where the severity of the preoperative neurological deficit is the best predictor of prognosis, in SSEH, time is the best predictor of prognosis. Our series highlights the fact that irrespective of the severity of the preoperative neurological deficit, timely diagnosis and early, adequate decompression surgery are essential for complete neurological recovery.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Case 1.
Fig. 2: Case 2.
Fig. 3: Case 3.

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. Holtås S, Heiling M, Lönntoft M. Spontaneous spinal epidural hematoma: findings at MR imaging and clinical correlation. Radiology. 1996;199:409–13.

    Article  PubMed  Google Scholar 

  2. Groen RJ, Ponssen H. The spontaneous spinal epidural hematoma. A study of the etiology. J Neurol Sci. 1990;98:121–38.

    Article  CAS  PubMed  Google Scholar 

  3. Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC. Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg. 2004;100:38–45.

    PubMed  Google Scholar 

  4. Foo D, Rossier AB. Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas. Surg Neurol. 1981;15:389–401.

    Article  CAS  PubMed  Google Scholar 

  5. Lefranc F, David P, Brotchi J, De Witte O. Traumatic epidural hematoma of the cervical spine: magnetic resonance imaging diagnosis and spontaneous resolution: case report. Neurosurgery. 1999;44:408–10.

    Article  CAS  PubMed  Google Scholar 

  6. Cullen DJ, Bogdanov E, Htut N. Spinal epidural hematoma occurrence in the absence of known risk factors: a case series. J Clin Anesth. 2004;16:376–81.

    Article  PubMed  Google Scholar 

  7. Fukui MB, Swarnkar AS, Williams RL. Acute spontaneous spinal epidural hematomas. AJNR Am J Neuroradiol. 1999;20:1365–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Wang M, Zhou P, Jiang S. Clinical features, management, and prognostic factors of spontaneous epidural spinal hematoma: analysis of 24 cases. World Neurosurg. 2017;102:360–9.

    Article  PubMed  Google Scholar 

  9. Lonjon MMC, Philippe P, Chanalet S, Grellier P. Nontraumatic spinal epidural hematoma: report of four cases and review of the literature. Neurosurgery. 1997;41:483–7.

    Article  CAS  PubMed  Google Scholar 

  10. Handbook of Clinical Neurology [Internet]. [cited 2023 Oct 8]. Available from: https://www.elsevier.com/books-and-journals/book-series/handbook-of-clinical-neurology.

  11. Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg. 1984;61:143–8.

    Article  CAS  PubMed  Google Scholar 

  12. Gopalkrishnan CV, Dhakoji A, Nair S. Spontaneous cervical epidural hematoma of idiopathic etiology: case report and review of literature. J Spinal Cord Med. 2012;35:113–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. Aycan A, Ozdemir S, Arslan H, Gonullu E, Bozkına C. Idiopathic thoracic spontaneous spinal epidural hematoma. Case Rep Surg. 2016;2016:5430708.

    PubMed  PubMed Central  Google Scholar 

  15. Clarke DB, Bertrand G, Tampieri D. Spontaneous spinal epidural hematoma causing paraplegia: resolution and recovery without surgical decompression. Neurosurgery. 1992;30:108–11.

    Article  CAS  PubMed  Google Scholar 

  16. Connolly ES, Winfree CJ, McCormick PC. Management of spinal epidural hematoma after tissue plasminogen activator. A case report. Spine. 1996;21:1694–8.

    Article  PubMed  Google Scholar 

  17. Groen RJM. Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases. Acta Neurochir. 2004;146:103–10.

    Article  CAS  PubMed  Google Scholar 

  18. Ainslie JP. Paraplegia due to spontaneous extradural or subdural haemorrhage. Br J Surg. 1958;45:565–7.

    Article  CAS  PubMed  Google Scholar 

  19. Correa AV, Beasley BA. Spontaneous cervical epidural hematoma with complete recovery. Surg Neurol. 1978;10:227–8.

    CAS  PubMed  Google Scholar 

  20. Groen RJ, van Alphen HA. Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery. 1996;39:494–508.

    CAS  PubMed  Google Scholar 

  21. McQuarrie IG. Recovery from paraplegia caused by spontaneous spinal epidural hematoma. Neurology. 1978;28:224–8.

    Article  CAS  PubMed  Google Scholar 

  22. Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA. Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 1995;83:1–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

SR and VTa helped in the conception or design of the work. GK, SK, VTh, AM, BRJ, and CM helped in the acquisition, analysis, or interpretation of data, drafted the work or revised it critically for important intellectual content, approved the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ganesh Kumar.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Ethics approval was waived by our institution’s Institutional Review Board. Consent to participate was obtained from all the patients.

Consent for publication

Consent to publish was obtained from all the patients.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Raju, S., Tandon, V., Kumar, G. et al. Spontaneous spinal epidural hematomas—Time is running out!. Spinal Cord Ser Cases 10, 78 (2024). https://doi.org/10.1038/s41394-024-00693-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41394-024-00693-8

Search

Quick links