Spontaneous spinal epidural hematomas:: review of 8 cases

Introduction: Spontaneous spinal epidural hematoma is a rarely occurring condition. The clinical importance of compressive spinal hematoma is due to its acute and progressive course that can lead to permanent and irreversible neurological deficits if not treated early. Clinical presentation is characterized by acute radicular pain followed by cord compression syndrome. Methods: We review eight cases of spontaneous spinal epidural hematomas diagnosed in our neurosurgical service in the last 16 years. Attention was focused on gender, age, medical history, level of the hematoma, preoperative neurological condition, operation interval and postoperative results. Results: The median age of patients was 63.5 years. A total of five patients were female and three male. The most frequently described symptoms before admission were acute vertebral pain followed by cord compression syndrome. In the MRI, six cases were isointense in T1-weighted images and hyperintense in T2-weighted images. In seven patients a laminectomy with clot removal was performed. Conclusions: The most important prognostic factors for recovery after spontaneous spinal epidural hematoma are the level of preoperative neurological deficit and the time to surgical operation.