2012 Volume 26 Issue 2 Pages 200-204
Objective : Spinal epidural hematoma (SEH) is an uncommon clinical entity. Herein, we have described our experiences with cervical SEH patients.
Patients and methods : Clinical data were obtained for 8 patients (6 men and 2 women) with cervical SEH and were reviewed retrospectively. The average age of the patients was 66.6 years (range, 26-79 years). We evaluated the initial symptoms, history of anticoagulant therapy, pre-and posttreatment neurological function using the American Spinal Injury Association (ASIA) Impairment Scale and Neurosurgical Cervical Spine Score (NCSS), extent of hematoma and time interval from the initial ictus to the treatment.
Results : Six patients experienced sudden-onset neck or upper back pain, and the other 2 patients experienced sudden motor weakness without pain as the initial attack. Four patients had received anticoagulation. One patient had received an analgesic, which may have contained acetylsalicylic acid, for 3 days before the attack, and one patient had coagulopathy due to an unknown cause. Six of the 8 patients presented with severe motor dysfunction or loss of motor function (ASIA grades A, B, and C). Neurological status in 6 patients improved by at least 1 grade after treatment. The hematoma extended to 2-5 vertebral segments, but there was no relationship between the extent of hematoma and severity of symptoms. All patients underwent surgical evacuation, and 4 of the 8 patients were treated within 8 h.
Conclusion : During diagnosis in the early stages, it should be noted that the sudden onset of pain during the initial attack does not necessarily occur in all patients with cervical SEH. Our experience with cervical SEH shows that the severity of pretreatment neurological deficits is a reliable predictor of the outcome.
