Spinal epidural hematoma

Spinal Epidural Hematoma (SEH) is a rare but potentially life-threatening condition characterized by the accumulation of blood between the outer membrane of the spinal cord (the dura mater) and the bones of the vertebral column. This condition can lead to significant neurological deficits if not promptly diagnosed and treated. The etiology of SEH can be broadly classified into spontaneous and traumatic causes, with the latter being more common.

Etiology

Spinal Epidural Hematomas may occur spontaneously, often associated with coagulopathies, vascular malformations, or anticoagulant therapy. Traumatic causes include vertebral fractures, spinal surgery, and invasive procedures such as lumbar punctures or epidural catheterization.

Pathophysiology

The spinal epidural space is a potential space that can become real when filled with blood, leading to compression of the spinal cord or cauda equina. The extent of neurological impairment depends on the level of the spine involved and the rapidity of hematoma expansion. Acute compression can lead to ischemia of the spinal cord, necessitating prompt intervention.

Clinical Presentation

Patients with SEH typically present with acute back pain, which may be followed by neurological deficits such as muscle weakness, sensory loss, or bowel and bladder dysfunction. The onset of symptoms can be sudden or gradual, and the severity varies depending on the amount of spinal cord compression.

Diagnosis

Magnetic Resonance Imaging (MRI) is the diagnostic modality of choice for SEH, offering detailed visualization of the hematoma and its effects on the spinal cord. In cases where MRI is contraindicated, computed tomography (CT) myelography may be used as an alternative.

Treatment

The primary treatment for Spinal Epidural Hematoma is surgical decompression, typically performed via laminectomy to remove the hematoma and alleviate pressure on the spinal cord. In some cases, conservative management may be considered for patients with minimal symptoms or contraindications to surgery.

Prognosis

The prognosis for patients with SEH depends on the rapidity of diagnosis and treatment. Early surgical intervention is associated with better outcomes, including the potential for full recovery of neurological function. Delayed treatment may result in permanent neurological deficits.

Prevention

Preventive measures for SEH include careful monitoring of patients on anticoagulant therapy and cautious handling during spinal procedures. In patients with known risk factors, minimizing trauma and prompt evaluation of acute back pain can aid in early detection.