Magnetic resonance imaging—monitored conservative management of traumatic spinal epidural hematomas

Report of four cases

Restricted access

✓ Spinal epidural hematomas (SEHs) are uncommon complications of traumatic injury to the spine. Emergency surgical evacuation is the standard treatment. Although it is recognized in the literature, the possibility of nonsurgical treatment of traumatic SEH is far from being codified. The authors report excellent outcomes in four conservatively managed patients who had sustained a severe spine injury with fracture of the lumbar vertebral body and in whom traumatic SEHs were diagnosed by magnetic resonance imaging. Although in the authors' experience a good spontaneous outcome in this subgroup of minimally symptomatic patients harboring moderate-sized SEHs has been achieved, further studies are necessary to understand the real spectrum of nonsurgical treatment of such lesions.

Article Information

Address reprint requests to: Domenico d'Avella, M.D., Neurosurgical Clinic, Policlinico Universitario, via Consolare Valeria 1, 98100 Messina, Italy. email: davellan@pharma.unime.it.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 3. Magnetic resonance imaging studies. Upper: Sagittal T1-weighted images obtained on the day of hospital admission demonstrating an isointense SEH that extends from T-11 to L-2 and is anterior to the spinal cord, producing compression of the sac. This is the largest-sized hematoma in our series. Lower: A T1-weighted MR image obtained on Day 10 after injury revealing resolution of the SEH.

  • View in gallery

    Case 4. Magnetic resonance imaging studies. Upper Left: Gradient echo two-dimensional T2-weighted MR image, sagittal view, obtained 3 hours after injury revealing an anterolateral SEH that extends from L-2 to L-4 (length 6.5 cm, thickness 1.0 cm) with an inhomogeneous signal intensity.

    Upper Center: Transverse (spin—echo T1-weighted) image obtained 3 hours postinjury demonstrating the anterolateral right position of the lesion, which shows an isointense signal. Upper Right: Sagittal view obtained on Day 3 postinjury demonstrating a slight reduction in the hematoma size (length 5.7 cm, thickness 0.8 cm) with diffuse hypointense signal. Lower Left: Transverse image obtained on Day 3 after injury demonstrating that the lesion has a slightly hyperintense signal compared with the spinal cord. Lower Right: Gradient echo two-dimensional T2-weighted image, sagittal view, obtained on Day 10 postinjury demonstrating the spontaneous disappearance of the hematoma.

References

  • 1.

    Beatty RMWinston KR: Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 61:143148; 1984Beatty RM Winston KR: Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 61:143–148; 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Bruyn GWBosma NJ: Spinal extradural haematoma in Vinken PJBruyn GW (eds): Injuries of the Spine and Spinal Cord Part II Handbook of Clinical Neurology Vol 26Amsterdam: North-Holland1976 pp 130Bruyn GW Bosma NJ: Spinal extradural haematoma in Vinken PJ Bruyn GW (eds): Injuries of the Spine and Spinal Cord Part II Handbook of Clinical Neurology Vol 26 Amsterdam: North-Holland 1976 pp 1–30

    • Search Google Scholar
    • Export Citation
  • 3.

    Clarke DBBertrand GTampieri D: Spontaneous spinal epidural hematoma causing paraplegia: resolution and recovery without surgical decompression. Neurosurgery 30:1081111992Clarke DB Bertrand G Tampieri D: Spontaneous spinal epidural hematoma causing paraplegia: resolution and recovery without surgical decompression. Neurosurgery 30:108–111 1992

    • Search Google Scholar
    • Export Citation
  • 4.

    Crabbe DCMendelow ADPharoh Pet al: Cervical spinal extradural haematoma causing a transient Brown-Sequard syndrome. J Neurol Neurosurg Psychiatry 55:2391992Crabbe DC Mendelow AD Pharoh P et al: Cervical spinal extradural haematoma causing a transient Brown-Sequard syndrome. J Neurol Neurosurg Psychiatry 55:239 1992

    • Search Google Scholar
    • Export Citation
  • 5.

    Egido Herrero JASaldana CJimenez Aet al: Spontaneous cervical epidural hematoma with Brown-Sequard syndrome and spontaneous resolution. J Neurosurg Sci 36:1171191992Egido Herrero JA Saldana C Jimenez A et al: Spontaneous cervical epidural hematoma with Brown-Sequard syndrome and spontaneous resolution. J Neurosurg Sci 36:117–119 1992

    • Search Google Scholar
    • Export Citation
  • 6.

    Farias JPLima JAAntunes JL: Subacute cervical epidural hematomas. Surg Neurol 42:4144161994Farias JP Lima JA Antunes JL: Subacute cervical epidural hematomas. Surg Neurol 42:414–416 1994

    • Search Google Scholar
    • Export Citation
  • 7.

    Foo DRossier AB: Post-traumatic spinal epidural hematoma. Neurosurgery 11:25321982Foo D Rossier AB: Post-traumatic spinal epidural hematoma. Neurosurgery 11:25–32 1982

    • Search Google Scholar
    • Export Citation
  • 8.

    Foo DRossier AB: Preoperative neurological status in predicting surgical outcome of spinal epidural hematoma. Surg Neurol 15:3894011981Foo D Rossier AB: Preoperative neurological status in predicting surgical outcome of spinal epidural hematoma. Surg Neurol 15:389–401 1981

    • Search Google Scholar
    • Export Citation
  • 9.

    Frankel HLHancock DOHyslop Get al: The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia 7:1791921969Frankel HL Hancock DO Hyslop G et al: The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia 7:179–192 1969

    • Search Google Scholar
    • Export Citation
  • 10.

    Groen RJvan Alphen HA: Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery 39:4945091996Groen RJ van Alphen HA: Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery 39:494–509 1996

    • Search Google Scholar
    • Export Citation
  • 11.

    Groen RJMPonssen H: Vascular anatomy of the spinal epidural space: considerations on the etiology of the spontaneous spinal epidural hematoma. Clin Anat 4:4134201991Groen RJM Ponssen H: Vascular anatomy of the spinal epidural space: considerations on the etiology of the spontaneous spinal epidural hematoma. Clin Anat 4:413–420 1991

    • Search Google Scholar
    • Export Citation
  • 12.

    Kingery WSSeibel MDate ESet al: The natural resolution of a lumbar spontaneous epidural hematoma and associated radiculopathy. Spine 19:67691994Kingery WS Seibel M Date ES et al: The natural resolution of a lumbar spontaneous epidural hematoma and associated radiculopathy. Spine 19:67–69 1994

    • Search Google Scholar
    • Export Citation
  • 13.

    Laissy JPMilon PFreger Pet al: Cervical epidural hematomas: CT diagnosis in two cases that resolved spontaneously. AJNR 11:3943961991Laissy JP Milon P Freger P et al: Cervical epidural hematomas: CT diagnosis in two cases that resolved spontaneously. AJNR 11:394–396 1991

    • Search Google Scholar
    • Export Citation
  • 14.

    Langmayr JJOrtler MDessl Aet al: Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression. J Neurol Neurosurg Psychiatry 59:4424471995Langmayr JJ Ortler M Dessl A et al: Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression. J Neurol Neurosurg Psychiatry 59:442–447 1995

    • Search Google Scholar
    • Export Citation
  • 15.

    Lawton MTPorter RWHeiserman JEet al: Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg 83:171995Lawton MT Porter RW Heiserman JE et al: Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg 83:1–7 1995

    • Search Google Scholar
    • Export Citation
  • 16.

    Lefranc FDavid PBrotchi Jet al: Traumatic epidural hematoma of the cervical spine: magnetic resonance imaging diagnosis and spontaneous resolution: case report. Neurosurgery 44:4084101999Lefranc F David P Brotchi J et al: Traumatic epidural hematoma of the cervical spine: magnetic resonance imaging diagnosis and spontaneous resolution: case report. Neurosurgery 44:408–410 1999

    • Search Google Scholar
    • Export Citation
  • 17.

    Lonjon MMPaquis PChanalet Set al: Nontraumatic spinal epidural hematoma: report of four cases and review of literature. Neurosurgery 41:4834861997Lonjon MM Paquis P Chanalet S et al: Nontraumatic spinal epidural hematoma: report of four cases and review of literature. Neurosurgery 41:483–486 1997

    • Search Google Scholar
    • Export Citation
  • 18.

    Miyagi YMiyazono MKamikaseda K: Spinal epidural vascular malformation presenting in association with a spontaneously resolved acute epidural hematoma. Case report. J Neurosurg 88:9099111998Miyagi Y Miyazono M Kamikaseda K: Spinal epidural vascular malformation presenting in association with a spontaneously resolved acute epidural hematoma. Case report. J Neurosurg 88:909–911 1998

    • Search Google Scholar
    • Export Citation
  • 19.

    Pahapill PALownie SP: Conservative treatment of acute spontaneous spinal epidural hematoma. Can J Neurol Sci 25:1591631998Pahapill PA Lownie SP: Conservative treatment of acute spontaneous spinal epidural hematoma. Can J Neurol Sci 25:159–163 1998

    • Search Google Scholar
    • Export Citation
  • 20.

    Pan GKulkarni MMacDougall DJet al: Traumatic epidural hematoma of the cervical spine: diagnosis with magnetic resonance imaging. Case report. J Neurosurg 68:7988011988Pan G Kulkarni M MacDougall DJ et al: Traumatic epidural hematoma of the cervical spine: diagnosis with magnetic resonance imaging. Case report. J Neurosurg 68:798–801 1988

    • Search Google Scholar
    • Export Citation
  • 21.

    Saito SKatsube HKobayashi Y: Spinal epidural hematoma with spontaneous recovery demonstrated by magnetic resonance imaging. Spine 19:4834861994Saito S Katsube H Kobayashi Y: Spinal epidural hematoma with spontaneous recovery demonstrated by magnetic resonance imaging. Spine 19:483–486 1994

    • Search Google Scholar
    • Export Citation
  • 22.

    Wagner SForsting MHacke W: Spontaneous resolution of a large spinal epidural hematoma: case report. Neurosurgery 38:8168181996Wagner S Forsting M Hacke W: Spontaneous resolution of a large spinal epidural hematoma: case report. Neurosurgery 38:816–818 1996

    • Search Google Scholar
    • Export Citation
  • 23.

    Zuccarello MScanarini Md'Avella Det al: Spontaneous spinal extradural hematoma during anticoagulant therapy. Surg Neurol 14:4114131980Zuccarello M Scanarini M d'Avella D et al: Spontaneous spinal extradural hematoma during anticoagulant therapy. Surg Neurol 14:411–413 1980

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 77 77 8
Full Text Views 46 44 0
PDF Downloads 42 29 0
EPUB Downloads 0 0 0

PubMed

Google Scholar