Spinal epidural hematoma

Case contributed by Dr Ammar Haouimi

Presentation

Weakness of the lower limbs following trauma to the upper thoracic region a few days ago.

Patient Data

Age: 35 years
Gender: Male
CT

There is a hyperdense posterior epidural mass at T2-T3 level, compressing the adjacent segment of the spinal cord. No vertebral fracture seen on the bone window.

MRI

The MRI sequences demonstrate a well-circumscribed posterior epidural mass at T2-T3 level measuring 35 x 20 x 10 mm. It elicits an isosignal to the spinal cord on T1 with a declive sediment of high signal, isosignal centrally and low signal peripherally on T2. No enhancement seen on postcontrast sequences ( the peripheral rim of enhancement corresponds to th dura). The adjacent spinal cord is compressed and displaced anteriorly.

Case Discussion

MRI features suggestive of a spinal epidural hematoma compressing the spinal cord.

Spinal epidural hematomas (EDH) are rare, most commonly due to spontaneous venous bleeds, often in the setting of coagulopathy or over-anticoagulation. Other etiologies include trauma, spinal vascular malformations, spinal tumors, and iatrogenic.

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