2018 Volume 32 Issue 3 Pages 306-310
Background : Although spontaneous spinal epidural hematoma (SSEH) is a rare disease, its differentiation from stroke is difficult because of their similar clinical symptoms. This study aimed to clarify the clinical features and treatment of SSEH.
Methods : Seven patients (age : range, 47-79 years ; median, 76 years) with SSEH, including 5 women and 2 men, who were admitted in Shinsuma General Hospital between September 2009 and May 2017 were reviewed retrospectively.
Results : All the patients first experienced sudden onset of neck or back pain. Six patients subsequently had motor disorder with or without sensory impairment, and 1 patient had neck pain alone (Frankel classification A : 1 case ; B : 2 cases ; C : 3 cases ; and E : 1 case). All the patients were definitely diagnosed using magnetic resonance imaging (MRI) and computed tomography (CT) examinations, which were performed at the same time in 5 patients who also had hematomas in the spinal canals. The hematoma was located in the cervical spine in 6 patients and in the thoracolumbar spine in 1 patient. The patient who had neck pain alone was treated conservatively. Surgical treatment was performed in the other 6 patients with neurological symptoms (performed within 6 hours of onset in 3 patients and within 15 hours in the other 3 patients), resulting in clinical improvement in all the cases.
Conclusions : The sudden onset of neck or back pain followed by motor disorder seems to be an important clinical sign in differentiating SSEH from stroke, and spinal canal CT is also useful in diagnosing SSEH. As no criterion has been established for the operative indications for SSEH, the therapeutic options might be decided depending on the neurological severity in each case.
