Spinal epidural hematoma
Updates to Article Attributes
Spinal epidural haematomas (spinal EDH) are a rare spinal pathology can result in serious morbidity with delayed or non-treatment. They are typically considered a surgical emergency.
Clinical presentation
The patient's symptoms and signs will depend on the location of the EDH, and degree of spinal cord / cauda equina compression, but invariably there will be a combination of severe pain and neurological deficit. See spinal cord injury and cauda equina syndrome for more information.
Pathology
Spinal EDH is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or over anticoagulation-anticoagulation.
Aetiology
- spontaneous (most common 4)
- especially in the context of a bleeding disorder or overanticoagulation
- trauma, e.g. vertebral fracture
- iatrogenic, e.g. lumbar puncture, epidural anaesthesia
- spinal arteriovenous malformations or other vascular anomalies
- spinal tumours
- pregnancy
Location
Spinal EDH can occur throughout the spine but is most common in the cervicothoracic region, usually posterior to the thecal sac over 2-4 vertebral levels 1,4.
Radiographic features
CT
- non-contrast: hyperdense (50-70 HU) extradural mass 4
MRI
Signal characteristics will vary on the age of the blood. Signal characteristics of acute spinal EDH 1,2,5:
- T1: isointense or hyperintense to spinal cord
- T2: heterogeneously hyperintense to spinal cord with hypointense foci
- T2*: blooming artifact
Differential diagnosis
Practical points
- assessment of spinal cord compression and spinal nerve roots should always be done
-<p><strong>Spinal epidural haematomas</strong> (<strong>spinal EDH</strong>) are a rare spinal pathology can result in serious morbidity with delayed or non-treatment. They are typically considered a surgical emergency. </p><h4>Clinical presentation</h4><p>The patient's symptoms and signs will depend on the location of the EDH, and degree of spinal cord / cauda equina compression, but invariably there will be a combination of severe pain and neurological deficit. </p><h4>Pathology</h4><p>Spinal EDH is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or over anticoagulation. </p><h5>Aetiology</h5><ul>- +<p><strong>Spinal epidural haematomas</strong> (<strong>spinal EDH</strong>) are a rare spinal pathology can result in serious morbidity with delayed or non-treatment. They are typically considered a surgical emergency. </p><h4>Clinical presentation</h4><p>The patient's symptoms and signs will depend on the location of the EDH, and degree of spinal cord / cauda equina compression, but invariably there will be a combination of severe pain and neurological deficit. See <a title="Spinal cord injuries" href="/articles/spinal-cord-injury">spinal cord injury</a> and <a title="Cauda equina syndrome" href="/articles/cauda-equina-syndrome">cauda equina syndrome</a> for more information. </p><h4>Pathology</h4><p>Spinal EDH is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or over-anticoagulation. </p><h5>Aetiology</h5><ul>
-</li></ul><h5>MRI</h5><p>Signal characteristics will vary on the <a href="/articles/ageing-blood-on-mri">age of the blood</a>. Signal characteristics of acute spinal EDH <sup>1,2,5</sup>:</p><ul>- +</li></ul><h5>MRI</h5><p>Signal characteristics will vary on the <a href="/articles/ageing-blood-on-mri">age of the blood</a>. Signal characteristics of <strong>acute</strong> spinal EDH <sup>1,2,5</sup>:</p><ul>
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