Spontaneous spinal epidural hematoma: a case report and review of the literature

ABSTRACT

Spontaneous spinal epidural hematoma [SSEH] is a rare emergency with potentially serious sequel. We report a case of SSEH to emphasize the importance of early recognition and urgent surgery for this challenging emergency. A 10-year-old boy presented with gradual onset of neck and back pain, vomiting, and nuchal rigidity followed by rapidly progressive paraparesis, abdomen and lower extremities hyperesthesia and sphincter dysfunction. MR imaging demonstrated epidural hematoma of cervico-thoracic spinal segments [C7-T3]. Emergent decompressive laminectomy with hematoma evacuation was performed the third day after paraplegia onset. Neurological improvement was obvious but slow, and the patient was discharged walking with aid 10 days after surgery. Two months later he got full functional recovery. We conclude that SSEH is a rare but disabling or even fatal clinical challenge. Early diagnosis and prompt surgery improve the neurological and functional outcome. Initial nonspecific symptoms can lead to a delay in diagnosis, especially in younger children. Relevant physicians should pay attention to the symptoms of this rare entity and SSEH should be one of differential diagnoses of rapidly evolving spinal cord syndrome