We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into. This is followed by the onset of progressive neurological symptoms. She presented with a severe paraparesis and showed a considerable improvement in. There were many cases of edh reported in the literature, sometimes of considerable size, with good. They may cause pressure on the spinal cord or cauda equina, which may present as pain. The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis such as non. Orthopedics educational objectives as a result of reading this article, physicians should be able to. Skull fractures occur in 8595% of adult cases, but they are much less common in children because of the plasticity of the immature calvaria. Diagnosis is by mri or, if not immediately available, by ct myelography. The bleeding is from an injury to a vein or a branch of the posterior meningeal. Patients with mild symptoms may be managed conservatively after consultation with a. Idiopathic thoracic spontaneous spinal epidural hematoma. Jul 20, 2008 a spinal epidural hematoma is a rare but significant neurological condition.
Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Here, we report our experience with an esophageal carcinoma surgical patient who developed an epidural hematoma almost immediately after catheter. Management of supratentorial epidural hematoma in children. Spinal epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. Posttraumatic acute epidural hematoma edh is generally visible on the ct scan done immediately after admission.
Spinal edh is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or overanticoagulation. Article acute spinal epidural hematoma applied radiology. The causes of seh range from iatrogenic to idiopathic. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 515% of patients with fatal head injuries. Spinal epidural hematoma is a collection of blood in the potential space between the dura and the bone, along the spinal canal. Acute spontaneous sehs do not present with any underlying condition in almost half of the patients, although anticoagulant treatment. Since the first description, the epidural hematoma was considered a neurosurgical emergency and an urgent evacuation was recommended, in order to prevent neurological sequelae or even death. Medicolegal cases for spinal epidural hematoma and spinal.
Tseh is a rare condition described in medical literature. Postoperative spinal epidural hematoma yonsei medical journal. A hematoma between the skull and the brains tissuelike covering, which is known as the dura. Hematoma, epidural, spinal definition of hematoma, epidural. An epidural hematoma occurs when a mass of blood forms in the space between your skull and the protective covering of your brain.
The occurrence of spinal epidural hematomas associated with the use of epidural catheters is relatively rare. Furthermore, it is unusual for hematomaassociated neurological symptoms to occur within 15 min of removing a catheter. Fiftyone confirmed spinal haematomas associated with epidural anaesthesia were found. A large biconvex epidural hematoma in the left frontotemporal region causing mass effect, midline shift and subfalcine herniation there is a linear fracture in the temporal and frontal bone in addition to a right blowout fracture of the orbit with fat herniation.
Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain dura mater and the skull. Jan 09, 2018 epidural hematoma ie, accumulation of blood in the potential space between dura and bone may be intracranial edh or spinal sedh see the image below. Previous studies have proposed different variations of abc2. There are several types of hematomas, and often are described by their location, for example, under the fingernail, in the liver, spine, and ear. The vascular structures mentioned above, especially the middle meningeal artery, can be compromised in this setting, leading to bleeding and hematoma formation. Patients with seh are treated at this institution with rapid evacuation of the hematoma and decompression of the spinal cord. Epidural hematoma an overview sciencedirect topics. Epidural hematoma has a double anatomopathological topography. Epidural hematoma is a rapidly accumulating mass of blood, usually clotted, or a swelling confined to the space between the skull and the dura mater. An epidural hematoma forms when the head impact is of sufficient force to either pull the meninges away from the inner table of the skull or cause a skull fracture.
Epidural hematoma definition and patient education. Diagnose spinal epidural hematoma and spinal epidural abscess. The hematoma is denser and homogenous so easily identified. The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting. The mechanisms responsible for the delayed appearance of the epidural hematoma a tamponade. A spinal subdural or epidural hematoma is an accumulation of blood in the subdural or epidural space that can mechanically compress the spinal cord. The overlying calvarium has a defect which is better visualized on the ct at bone window settings. Spinal chronic subdural hematoma scsh is a rare pathology usually associated with trauma or hematological alterations or is due to iatrogenic causes. Review the current literature regarding spontaneous spinal epidural hematomas ssehs and report on the known risk factors, evaluation, and. Abc2 is a wellaccepted volume estimation method that can be used for tedh volume estimation. Epidural hematoma is usually found on the same side of the brain that was impacted by the blow, but on very rare occasions it can be due to a contrecoup injury. Enoxaparin sodium is a low molecular weight heparin lmwh for use in preventing deep venous thrombosis in patients undergoing total hip arthroplasty and total knee arthroplasty. Spinal edh occurring spontaneously or after minimal trauma has been attributed most often to a venous source 5.
Epidural hematoma epidural hematoma clinical presentation. In one study, muscle weakness was the first complaint in 46% of the. However, it may be necessary when a resection vertebral plan in spine tumor is required. A spinal mri is the choice for diagnosis test and epidural hematoma is the main differential diagnosis of sih, specially when there are significant degenerative changes distorting the anatomy of the intraspinal compartments 8. Epidural hematomas definition of epidural hematomas by. Significant bleeding can lead to spinal cord damage, causing neurological injury and deficit. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option. They are anatomically located in what is known as the extradural neural axis compartment, located between the dura propria visceral layer and periosteum. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. In an occipital epidural hematoma, the bleeding occurs between the skull and the dura the brain cover. Overall incidence approximately 1 per 1,000,000 people annually perron 20.
There is a predominately high attenuation biconvex extraaxial fluid collection in the frontoparietal region. Some people could require surgery to relieve the hematoma. Associated mass effect is present with effacement of the cortical sulci. Traumatic spinal epidural hematoma journal of emergency. Or a pocket of blood may form between the outer and middle layers of tissue. The spontaneous development of spinal epidural hematomas is most frequent after the fourth or fifth decade 5. Epidural hematoma edh is an easily treated form of head injury that is often associated with a good prognosis. The morbidity and mortality result from mass effect on the brain as the hematoma. If considering compression due to neoplasm obtain scan of entire spine. Treatment includes surgical decompression with a craniotomy. Hematomas are a collection of blood outside of a blood vessel.
Spinal epidural hematoma radiology reference article. Spinal epidural hematoma seh is a rare clinical entity with a bleak out come. Spontaneous and idiopathic chronic spinal epidural. In patients with established motor symptoms, surgical treatment within the first 24 hours seems to be the best option. Epidural hematoma usually associated with a skull fracture often occurs when a direct impact fractures the calvarium. Trauma or other injury to your head can cause your brain to bounce. Read about the symptoms, signs, causes, diagnosis, treatment, and prevention of hematomas.
A hematoma collection of blood in the occipital region at the back of the head. Spinal epidural hematoma seh is a rare emergency that transpires as a complication of several disorders, including trauma, diabetes, arteriovenous malformations, coagulopathies, and malignancy. However, it has been reported to occur in all age groups, and it is a very rare clinical entity in children. This patient had a spinal epidural hematoma, which is defined as a spontaneous collection of blood in the spinal epidural space. Epidural hematoma edh is a traumatic accumulation of blood between the inner table of the skull and the strippedoff dural membrane.
Epidural abscess spinal epidural hematoma spinal evaluation. Spinal epidural hematoma after pain control procedure. Spontaneous spinal epidural hematoma sseh is a very rare condition, so there were few studies assessing the management criteria of sseh. A 33yearold male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. Epidural hematoma is the accumulation of blood in the space between dura and bone in the cranial or spinal region.
Hematoma subdural hematoma rupak raj ghimire head trauma 1skull fractures. Spontaneous spinal epidural hematomas sseh are an extremely rare neurological emergency. The space occupied by epidural hematoma is limited by adherence of dura to the inner table of the skull, especially at the sutural lines, which contributes to the lenticular or biconvex appearance in the ct scan. Spinal epidural hematoma with subarachnoid hemorrhage caused by acupuncture james r. The patient was admitted to a private clinic with a threeday history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the guillainbarre syndrome gbs. Iatrogenic causes have been outlined, namely surgical procedures, lumbar puncture and chronic anticoagulant therapy 1. Recovery after delayed surgery in a case of spinal. Epidural hematoma in emergency medicine differential diagnoses. Epidural hematoma is usually caused by a fullon blow to the head and is often associated with skull fracture. Pdf spinal epidural hematoma after pain control procedure. Sdhs form between the dura and the arachnoid membranes edhs arise in the potential space between the dura and the skull. Apr, 2016 epidural hematoma edh is an easily treated form of head injury that is often associated with a good prognosis.
Based upon pathogenesis, seh can be classified as idiopathic, spontaneous, and secondary. Skull fractures were seen on ct in 30 patients 61%. An epidural hematoma of the spine is an unusual injury but has the potential to be serious. Epidural haematoma it is a collection of blood between the potential space that exists between the inner table of skull and the dura periosteal layer. Spinal epidural hematoma after epidural anesthesia in a. Epidural hematoma free download as powerpoint presentation.
Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. Often there is loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again. Spontaneous spinal epidural hematoma edh is a rare condition requiring urgent diagnosis 1. Spinal epidural hematoma with subarachnoid hemorrhage. Consider bladder scanultrasound for bladder volume postvoid residual management general epidural compression syndrome management. Spinal epidural hematoma seh is an uncommon condition usually characterized by acute back pain. The hematoma could press on the nerves, leading to serious complications.
An occipital hematoma may be either subdural or epidural. An epidural hematoma in an adolescent patient after cardiac surgery. The aim of our study was to establish the value of mr findings in the. Spinalepidural hematomas when neuraxial anesthesia epiduralspinal anesthesia or spinal puncture is employed, patients. The morbidity and mortality result from mass effect on the brain as the hematoma grows and strips the dura away from the skull. Rapid development of a spinal epidural hematoma following. Epidural hematoma is a rare complication of neuraxial techniques, with an incidence ranging from 1. Advances in contemporary ct imaging have made confirmation of an edh diagnosis rapid and accurate. Lumbar myelogram demonstrating abrupt termination of the right l5 root. Spinal subdural or epidural hematoma neurologic disorders. Although epidural hematomas are relatively uncommon approximately 2% of all. Oct 25, 2017 epidural hematoma usually results from a brief linear contact force to the calvaria that cause separation of the periosteal dura from bone and disruption of interposed vessels due to shearing stress. In rare instances, such hemorrhages can be spontaneous. The idiopathic forms are considered not to be attributed to any specific risk factors.
Sep 30, 2010 spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. A the regression line between the estimated traumatic epidural hematoma tedh volume values by a 1 b 1 c 0 and planimetry slope 0. Rosen da, hawkinberry dw, rosen kr, gustafson ra, hogg j, broadman lm. An epidural hematoma is a condition characterized by arterial bleeding developing in the potential space between the dura and the skull. In 40% of cases, the ailment occurs spontaneously 2 3. The morbidity and mortality result from mass effect on the brain as the hematoma expands and strips the dura away from the skull. It is usually found in the temporoparietal region where a skull fracture will cross the path of the middle meningeal artery or the dural branches. A case of acute spinal intradural hematoma due to spinal. Supratentorial epidural hematoma in children paiva et al. Ctm showing the posterolateral disc herniation which prevented filling of the nerve root. Assessment of the accuracy of abc2 variations in traumatic.
Extension of hematoma usually is limited by the suture lines owing to the light attachment of the dura at these locations continuation of periosteal layer of the dura with the pericranium. Delayed traumatic spinal epidural hematoma with neurological deficits 479 to highlight that magnetic resonance angiography is not a gold standard to spine injuries. Spontaneous spinal epidural hematoma sseh represents 0. Nov 02, 2015 epidural haematoma it is a collection of blood between the potential space that exists between the inner table of skull and the dura periosteal layer. Epidural bleeding has been described as a homogeneous lesion that is most frequently located posterior to the dural. Traumatic sehs are considered to occur secondary to spinal surgeries, lumbar puncture, vertebral fractures, and any spinal intervention. Epidural hematoma edh, also known as extradural hematoma, is a hemorrhage into the space between the dura and the overlying calvarium. Spinal epidural hematoma seh is a relatively rare but disabling disease that was described for the first time by jackson34 in 1869. A spinal epidural hematoma was removed at surgery with complete recovery. The inciting event often is a focused blow to the head, such as that produced by a hammer or baseball bat. This pocket of blood is called an epidural hematoma.
Spinalepidural hematomas when neuraxial anesthesia epiduralspinal anesthesia or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low. This pocket of blood is called a subdural hematoma. Lumbar epidural hematoma following lumbar puncture. Epidural anaesthesia and spinal haematoma hinnerk wulf md purpose. Spinal epidural hematoma is bleeding into the epidural space in the spine. Since the introduction of ct, the frequency of this occurrence has gone up from 6% to 30%. To assess the differential diagnosis and clinical results. Patients with spontaneous spinal edh typically present with acute onset of severe back pain and rapidly develop signs of compression of the spinal cord or cauda equina. Intracranial hematomas injuries and poisoning msd manual. It can result in a pocket of blood between the skull and the outer layer of tissue covering the brain. Spontaneous epidural hematomas sehs can be classified into two categories.
Acute spontaneous spinal epidural hematomas american. To determine the mr and ct findings that characterize acute spinal subdural hema toma assh. The traumatic epidural hematoma tedh volume is often used to assist in tedh treatment planning and outcome prediction. Subdural hematoma sdh and epidural hematoma edh are characterized by bleeding into the spaces surrounding the brain or spinal cord. We report a case of a 79yearold female who underwent a surgical evacuation of a spontaneous scsh one year after diagnosis.
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