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| Year : 1999 | Volume
: 47
| Issue : 2 | Page : 159 |
Spontaneous spinal extradural haematoma.
Tewari MK, Pandey AK
How to cite this article:
Tewari M K, Pandey A K. Spontaneous spinal extradural haematoma. Neurol India 1999;47:159 |
Spontaneous spinal extradural haematoma (SSEDH) is a rare condition, usually occurring in middle aged males. A progressive deterioration of motor and sensory functions along with bladder involvement following neck or back pain is the usual presentation. Early diagnosis and management produces complete recovery. Its aetiopathogenesis remains unclear.
A 30 year old healthy man, presented with sudden severe excruciating pain in the nape of neck and upper back, for the past 24 hours. The pain developed at night while sleeping. It was continuous, nonradiating, and got aggravated by movement of head. Few hours later he noticed slight weakness of both upper limbs, retention of urine and severe weakness of right lower limb followed by left lower limb. There was no history of recent trauma or anti-coagulation therapy. Examination revealed motor power of 3/5 in both arms distally. The grip was 50% of the normal. There was flaccid paralysis of both lower limbs and complete sensory loss below T4 level. X-ray of cervical spine was normal. His haematological and coagulation profiles were normal. MRI revealed a biconvex hyperintense signals in both T1 and T2 weighted images in the cervico dorsal region suggestive of epidural haematoma. C3 to D1 laminectomy within 12 hours of admission revealed epidural haematoma in the right gutter. The source of bleed, the epidural vein, was coagulated. Histopathological examination confirmed organizing haematoma. Motor power in upper and lower limbs and bladder function returned to normal within 15 days.
SSEDH is a rare condition with little over 250 cases reported in the world literature.[1] SSEDH can be caused by : i) Rupture of valveless veins in the internal vertebral plexus even by slightest change of posture during sleep, turning or coughing, or due to Valsalva's manoeuver, ii) bleeding from angiomas or arteriovenous malformations (AVM). iii) anticoagulant drug therapy or blood dyscrasias, iv) metabolic changes in pregnancy, v) acute infections including whooping cough.[2],[3] Though it is very unlikely for normal epidural vessels to bleed spontaneously at minimal movements, still many authors believe that venous bleeding leads to SSEDH.[4] Schwartz et al[5] concluded that in the absence of gross trauma or bleeding diathesis it is conceivable that this type of haematoma is related to an organised vascular abnormality or to transmission of increased intra-abdominal or intrathoracic pressure to the epidural plexus initiating bleeding. Foo and Rossier[6] found vascular malformation in 6 out of 158 cases of non-traumatic SSEDH. Diagnosis is confirmed by CT or MRI.
Spontaneous resolution of SSEDH resulting in clinical improvement is extremely uncommon.[7] Important factor is the time delay between onset of symptoms and surgery. Muller et at[8] feel that there is no relation between the degree of recovery and localization of haematoma, time lag in surgery or age of the patient. Tewari et al[4] found good recovery in three children, even though surgery was performed after a gap of 50-55 days.
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