Subacute spinal epidural hematoma

Case contributed by Emmanouil Kalioras

Presentation

5 days prior onset of syptoms : paraplegia, no history of trauma, receiving anticoangulant therapy, INR : 8

Patient Data

Age: 90 years
Gender: Female

T2 hypo- to isointense and T1 iso- to hyperintense fluid collection located in the epidural space starting at level of T8 and extending peripherally compressing the spinal cord, suggestive of epidural hematoma in the subacute phase.

Intramedullary T2 hyperintense signal starting at the level of T8 and extending peripherally, reflecting severe myelopathy.

Intrathecal-extramedullary T2 hypointense line at the level of T7, indicative of small subarachnoid hemorrhage.

No clear sign of contrast enhancement.

 

Case Discussion

Spontaneous spinal epidural hematoma is defined as blood within the epidural space with atramautic etiology. The exact pathophysiological mechanism is not fully understood, though suggested contributing factors such as neoplasms, AVMs and anticoagulant agents are considered.

Usually the therapy consists of decompressive laminectomy, although in this case no surgical procedure was performed.

Further followup for exclusion of an underlying cause couldn't be done, due to the fact that the patient passed away weeks later.

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