4回の再発をきたした特発性脊髄硬膜外血腫の1例

抄録

　　Spontaneous spinal epidural hematomas (SSEH) rarely reoccur, and repeated bleeding events are extremely rare. Here we report a case of SSEH, which caused hemorrhages four times at the same site during a 17 month period.

　　A 54 year-old man presented with sudden onset neck pain and right hemiparesis and was transferred to our emergency department. Magnetic resonance imaging (MRI) of his cervical spine showed a dorsal epidural hematoma from C5 to C6. Contrast-enhanced MRI and computed tomography did not reveal abnormal vessels, and he was diagnosed with SSEH. He was treated conservatively due to his symptoms improving rapidly. He had identical episodes eight and nine months subsequent to the primary occurrence. He underwent spinal digital subtraction angiography during the second episode, but abnormal vessels were not detected. Following the third episode, he was also treated conservatively but SSEH recurred at the same site three days later. During the fourth episode, his symptoms were identical to the previous occurrences. Surgery was conducted due to the short interval of recurrence, and the spinal epidural hematoma and the epidural venous plexus were resected. He was discharged without neurological deficits and has not had any reoccurrence for two years.

　　To the best of our knowledge, this is the first report of a patient with four relapses of recurrent SSEH. Only three cases of recurrent SSEH with three bleeding episodes have been reported previously. While it remains unclear when and if surgery is necessary in patients with recurrent SSEH with mild clinical symptoms, we believe that surgical treatment should be implemented for these patients as the relapsing time interval tends to decrease. Here, we have shown here that surgery can prevent recurrence for at least two years.