Spinal epidural hematoma

Case contributed by Sarah AlJahdali


Trauma, bicyclist against car door

Patient Data

Age: 55 years
Gender: Male

Note: Last mobile segment is considered to be L5-S1.

Acute compression fractures of the L1 and L2 vertebral bodies are noted with approximately 20% height loss at L1 and 40% height loss at L2. Mild fragmentation and displacement is seen at the anterosuperior corner of L2. A superimposed schmorl's node is seen at the L1 superior endplate.  No retropulsion or posterior element extension noted. There is associated elongated, fusiform, hyperdense material in the anterior epidural space mostly from L1 to L3, casuing moderate central canal stenosis at the L2-L3 level, in keeping with an epidural hematoma. 

Diagnosis was confirmed on subsequent MRI and surgery.

Case Discussion

Spinal epidural hematomas most commonly occur spontaneously, with anti-coagulation/coagulopathy, disc hernia, vascular anomaly, Valsalva maneuver, and possibly hypertension.  Spinal epidural hematomas can also be post-traumatic (as in this case) or iatrogenic.

They typically extend over multiple levels and can be seen dorsal, ventral or circumferential to the thecal sac. These collections may be associated with neurological impairment from compression of the spinal cord or cauda equina, and necessitating surgical evacuation/decompression. 

Although best evaluated with MRI, spinal epidural hematomas should be sought for even on CT when spinal trauma is diagnosed. 

Case co-author: Rehana Jaffer, MD, FRCPC

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