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Spontaneous spinal epidural hematoma

Michelle Nguyen, Maria Raquel Kronen, Alex Nhan, Antonio Liu
Background: Spontaneous epidural hematoma (SEH) is a rare finding in pregnancy, especially since most pregnant women do not have risk factors for developing SEH. The presence of epidural anesthesia can delay the diagnosis of SEH in pregnant patients. Immediate surgical decompression is the current standard of care for treating SEH. Case Presentation: We present the case of a 37-year-old pregnant woman with preeclampsia with severe features who developed neurological deficits that were initially attributed to her epidural anesthesia...
2018: Case Reports in Obstetrics and Gynecology
Samir Kashyap, Gohar Majeed, Shokry Lawandy
Background: Brown-Sequard syndrome (BSS) is a well-known entity that is most commonly caused by a penetrating injury to the spinal cord (e.g., stab wound or gunshot wound). It is characterized by an ipsilateral weakness (damage to corticospinal tracts) and contralateral loss of pain and temperature two levels below the lesion (damage to lateral spinothalamic tracts). Although, rarely non-penetrating injuries, tumors, disc herniations, infections, autoimmune diseases, and epidural hematomas (non-penetrating trauma and spontaneous) have contributed to BSS syndromes, there are only four cases of BSS in the literature attributed to traumatic spinal epidural hematomas...
2018: Surgical Neurology International
Aya Kondo, Hiroshi Yamaguchi, Yusuke Ishida, Daisaku Toyoshima, Mai Azumi, Nobuyuki Akutsu, Junji Koyama, Hiroshi Kurosawa, Atushi Kawamura, Azusa Maruyama
BACKGROUND: The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS. CASE REPORT: A previously healthy 6-year-old girl presented with a 2-day history of progressive pain in the lower extremities and an inability to walk. On initial evaluation, she was completely paraparetic in the lower extremities. Deep tendon reflexes were absent in the lower extremities, and Babinski reflexes were positive on both sides...
November 21, 2018: Brain & Development
Satyakam Baruah, Sudhir Dubey, Utkarsh Ghavgave, A N Jha
BACKGROUND: Neurological complications are increasingly being reported in dengue epidemics. Intra-spinal hematomas are rare and those associated with dengue fever are still rarer with only one being reported in literature. CASE DESCRIPTION: We report a case of dengue fever presenting with acute onset quadriparesis (upper limbs MRC 4/5 and lower limbs 0/5) and urinary incontinence. Patient was radiologically diagnosed with cervicodorsal acute to subacute anterior epidural hematoma...
November 4, 2018: World Neurosurgery
Eo Jin Kim, Joonghyun Ahn, Seung-Ju Kim
BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease, but it can lead to acute cord compression with disabling consequences. Identifiable reasons for spontaneous hemorrhage are vascular malformations and bleeding disorders. However, SSEH after taking herbal medicines has not been described yet. CASE PRESENTATION: A 60-year-old female experienced sudden back pain combined with numbness and weakness in the lower limbs for several hours with no trauma, drug use, family history or any disease history...
October 29, 2018: BMC Complementary and Alternative Medicine
Saleh Baeesa, Peter Jarzem, Mohammed Mansi, Rakan Bokhari, Mahdi Bassi
OBJECTIVE: Spontaneous spinal epidural hematomas (SSEH) are a rare and morbid entity whose prognosis is affected by delayed diagnosis and surgical intervention. Correlation with the time of intervention and neurological recovery is not clearly described in the literature. We present a retrospective study of SSEH, to determine the correlation between the timing of surgical intervention and changes in the spinal cord signal on MRI with the neurological outcome. METHODS: The records of 14 patients who underwent surgical decompression of SSEH over 10-year duration were reviewed...
October 15, 2018: World Neurosurgery
Firooz Salehpour, Farhad Mirzaei, Mohammad Kazemzadeh, Seyed Ahmad Naseri Alavi
Spontaneous cervical epidural hematoma is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not recognized early can have catastrophic consequences. Acute cervical epidural hematoma is definitely a condition of neurologic emergency. Although it is a rare condition, it must be considered in nontraumatic patients with sudden onset of neurologic deficits. Patients with spontaneous spinal epidural hematoma typically present with acute onset of severe back pain, and they rapidly develop signs of compression of the spinal cord or cauda equina...
January 2018: International Journal of Spine Surgery
Hiroshi Uei, Yasuaki Tokuhashi, Masafumi Maseda, Masahiro Nakahashi, Hirokatsu Sawada, Hiroyuki Miyakata
Spontaneous spinal epidural hematoma (SSEH) very rarely develops in infants younger than 1 year old. To our knowledge, no previous case of delayed-onset paralysis induced by SSEH communicated with hematoma in the paraspinal muscle has been reported in the literature. The authors present the case of a 6-month-old girl with a tumor mass on her back who developed a paresis of her bilateral lower limbs. On spinal magnetic resonance imaging, the epidural mass appeared to be a dumbbell type and communicated with the mass in the paraspinal muscle through T12/L1 intervertebral foramen at the right side...
September 8, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Charlotte Goldfine, Catherine Glazer, Richard M Ratzan
Spontaneous spinal epidural hematoma (SSEH) is a rare diagnosis. One known risk factor is anti-coagulation medication. We present a case of SSEH in a 74-year-old male on rivaroxaban therapy who clinically presented with an intermittently resolving and then worsening neurological exam. Due to the extremely high morbidity and mortality associated with this diagnosis, it is important to be aware of the various presentations and adverse effects related to novel anticoagulation.
May 2018: Clinical practice and cases in emergency medicine
Min Chan Kim, Seok Won Kim
Objective: Acute hemiparesis is often an early presentation of acute ischemic stroke, though it can occur in various disorders. This study aimed to investigate the improper use of thrombolytic agents for patients with acute hemiparesis, following the misdiagnosis of acute ischemic stroke. Methods: We analyzed the clinical and radiological data of nine patients initially misdiagnosed with cerebral stroke in the emergency room from May 2013 to January 2017. All the patients were treated with tissue plasminogen activator (TPA) owing to the presence of acute hemiparesis...
April 2018: Korean Journal of Neurotrauma
Shubao Zhang, Fengyang Geng, Jiyue Wang, Zhiti Zhang, Chigang Du
BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a relatively uncommon yet potentially disabling neurologic emergency. The classical presentation includes a severe acute attack, sometimes radiating pain at the back, interscapular, or neck areas, followed by neurologic deficits. The main treatment is surgical, and self-healing cases are rare. CASE DESCRIPTION: A 17-year-old female was admitted to the neurosurgery department with neck pain, myasthenia of the limbs, and difficulty moving...
July 2018: World Neurosurgery
Wei Zhao, Long-Fei Shu, Sang Cai, Feng Zhang
Introduction: Spontaneous spinal epidural hematoma (SSEH) is a rare condition that can potentially cause paraplegia. SSEH has an increasing incidence rate and its cause remains unclear. Magnetic resonance imaging (MRI) results shows that SSEH presents a spinal epidural space-occupying lesion; therefore, emergency surgical treatment is required in some cases. MRI results of most SSEH cases showed that hematoma occurs in the dorsal or lateral side. By contrast, hematoma in the ventral side is very rarely shown...
December 2017: Anesthesiology and Pain Medicine
Takashi Hongo, Kenichi Iseda, Midori Tsuchiya, Mototaka Inaba, Satoshi Nozaki, Kenji Takahashi, Masaaki Nakajima, Toshifumi Fujiwara
Cases: Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease. Most SSEH cases involve back and/or neck pain. We report the cases of two men who experienced SSEH with dysstasia but without back or neck pain. Outcomes: This study presents two cases involving elderly Japanese men who visited an emergency department because of sudden dysstasia without back or neck pain. The results of the neurological examinations revealed ataxic gait. Cervical spinal epidural hematomas were observed by computed tomography and magnetic resonance imaging...
April 2018: Acute Medicine & Surgery
Yong-Xing Yao, Ming-Xia Li, Lian-Juan Sun
RATIONALE: Epidural hematomas can develop following intrathecal puncture, spinal vascular malformation, or spontaneous hemorrhage. Prompt recognition of symptoms and referral to neurosurgical services are crucial for recovery. We report a rare case of delayed removal of an epidural hematoma that resulted in good patient outcomes. PATIENT CONCERNS: A 69-year-old woman weighing 58 kg presented with back pain that had persisted for 12 years. Her medical history was notable for hypertension...
April 2018: Medicine (Baltimore)
Shuan-Chi Wang, Fang-Fang Wang, Shou-Chao Zheng
No abstract text is available yet for this article.
January 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Maria Isabel Bento Ayres Pereira Harry Leite, Sérgio Azevedo Ferreira Alves, Rui Paulo Vicente Reinas, Marta Gomes Rodrigues, Ana Sofia Martins das Neves Garrido, Otília Peixoto da Cunha, Joana Sofia Oliveira Rodrigues, Maria de Fátima Oliveira Santos Poças, Mário António Leite Resende Martins
A previously healthy 13-year-old girl presented with a 9-day history of acute onset severe neck pain associated with limited range of movement. Medical evaluation at day 2 was suggestive of muscle contracture, and she was discharged home with diazepam, antiinflammatory agents, and rest; however, she returned because of progressive clinical worsening with left arm distal paresthesia and paralysis since day 3. There was no history of trauma or other systemic complaints, and her familial medical history was unremarkable...
February 28, 2018: Pediatric Emergency Care
Michael Kim, Jessa Hoffman, Anubhav Amin, Manish Purohit, Avinash Mohan
A spontaneous spinal epidural hematoma is a collection of blood in the spinal epidural space that occurs in the absence of trauma. They most commonly present in the fourth to fifth decade in life with acute onset neck or back pain with delayed neurologic deficit. However, this presentation is often complicated in children because of the limitations in the pediatric neurologic exam. Magnetic resonance imaging is the imaging modality of choice for diagnosis. Here is a rare case of an infant spontaneous spinal epidural hematoma whose diagnosis was delayed because of a recent history of fever and viral pharyngitis before his development of neurologic deficits...
February 28, 2018: Pediatric Emergency Care
Quentin Mathais, Pierre Esnault, Maximilien Cruc, Cedric Bernard, Bertrand Prunet, Pierre Emmanuel Gaillard
BACKGROUND: While spontaneous spinal epidural hematomas are rare, 1 of the identified risk factors is vitamin K antagonist therapy. CASE DESCRIPTION: We present a case of a spontaneous spinal epidural hematoma occurring in a patient under treatment with dabigatran, a non-vitamin K oral anticoagulant. The initial hemiparesis symptom was misleading and was retrospectively identified as Brown-Séquard syndrome. Immediate dabigatran antagonism with idarucizumab followed by posterior cervical laminectomy permitted a complete neurologic recovery at day 4...
April 2018: World Neurosurgery
Toshiyuki Okazaki, Hiroshi Nakagawa, Hitoshi Hayase, Shinsuke Irie, Toru Inagaki, Osamu Saito, Motoshige Yamashina, Shinji Nagahiro, Koji Saito
Spontaneous and chronic epidural hematoma (SSEH) in the lumbar spine is rare, and idiopathic and chronic SSEH in the lumbar spine is extremely rare disease. Most of lumbar SSEH were acute and secondary with trauma, hematologic disorders, drug, and surgical procedure. Only 20 cases of chronic SSEH in the lumbar spine have been reported and 14 cases among them were considered to be idiopathic. Definitive guidelines for management of this condition are not clear and surgical total evacuation was performed in most of the cases...
March 15, 2018: Neurologia Medico-chirurgica
Kyle Raasck, Jason Khoury, Ahmed Aoude, Fahad Abduljabbar, Peter Jarzem
RATIONALE: Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord, and leading to acute neurological deficits. The disease's cloudy etiology and rarity contribute to dangerously suboptimal therapeutic principles. These neural deficits can be permanent, even fatal, if the SSEH is not treated in a timely and appropriate manner. Standard therapy is decompressive laminectomy, though nonsurgical management is a viable course of action for patients who meet a criterion that is continuously being refined...
December 2017: Medicine (Baltimore)
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