Spontaneous Intracranial Epidural Hematoma Originating from Dural Metastasis of Hepatocellular Carcinoma

Spontaneous intracranial epidural hematoma (EDH) due to dural metastasis of hepatocellular carcinoma is very rare. A 53-year-old male patient with hepatocellular carcinoma, who was admitted to the department of oncology, was referred to department of neurosurgery because of sudden mental deterioration to semicoma with papillary anisocoria and decerebrate rigidity after transarterial chemoembolization for hepatoma. Brain computed tomography (CT) revealed large amount of acute EDH with severe midline shifting. An emergent craniotomy and evacuation of EDH was performed. Active bleeding from middle cranial fossa floor was identified. There showed osteolytic change on the middle fossa floor with friable mass-like lesion spreading on the overlying dura suggesting metastasis. Pathological examination revealed anaplastic cells with sinusoidal arrangement which probably led to spontaneous hemorrhage and formation of EDH. As a rare cause of spontaneous EDH, dural metastasis from malignancy should be considered.

Spontaneous Epidural Hematoma of the Lumbo-Sacral Region

Spontaneous epidural hematoma in the spinal canal is an uncommon entity and has usually caused progressive neurological deficits and surgical decompression should be required. A 27-year old patient suffered from acutely developed back pain, associated with a wrenching movement of the back. Several hours later, the symptoms were exaggerated with severely radiating pain to the posterior thigh and calf. The diagnosis was made on CT scan. The patient's clinical manifestations improved completely over a few days with surgical intervention. We reviewed the literatures and discussed the etiological factors of spinal epidural hematoma and the utility of CT scan in differentiating other cause of back pain.

A Case of Spontaneous Cervical Spinal Epidural Hematoma: Case Report

Spontaneous spinal epidural hematoma is a rare cause of spinal cord compression. Recently, at our hospital, the author et al had the opportunity of observing case with spontaneous cervical epidural hematoma in a 28 years old woman who had suddenly felt a strong pain in interscapular area. Rapidly after she noticed weakness in her legs and one day later she was completely paraplegia. The MRI of spine was done. There show tubular like low signal intensity at posterior epidural space of C7 level and ghigh signal intensity of cord at C7 level due to cord compression effect. In this article, we are adding one more rare case of spontaneous cervical spinal epidural hematoma confirmed by MRI.