Tseh is a rare condition described in medical literature. Epidural hematoma edh is an easily treated form of head injury that is often associated with a good prognosis. Spontaneous and idiopathic chronic spinal epidural. Read about the symptoms, signs, causes, diagnosis, treatment, and prevention of hematomas. Spinal epidural hematoma is a collection of blood in the potential space between the dura and the bone, along the spinal canal. The traumatic epidural hematoma tedh volume is often used to assist in tedh treatment planning and outcome prediction. Spinal edh is most commonly spontaneous venous bleeds, often in the setting of coagulopathy or overanticoagulation. Associated mass effect is present with effacement of the cortical sulci. Epidural anaesthesia and spinal haematoma springerlink. Epidural hematoma edh, also known as extradural hematoma, is a hemorrhage into the space between the dura and the overlying calvarium. The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting. An epidural hematoma in an adolescent patient after cardiac surgery. However, it may be necessary when a resection vertebral plan in spine tumor is required.
We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into. The overlying calvarium has a defect which is better visualized on the ct at bone window settings. The hematoma is denser and homogenous so easily identified. It is usually found in the temporoparietal region where a skull fracture will cross the path of the middle meningeal artery or the dural branches.
Some people could require surgery to relieve the hematoma. To assess the differential diagnosis and clinical results. Spinal edh occurring spontaneously or after minimal trauma has been attributed most often to a venous source 5. Subdural hematoma sdh and epidural hematoma edh are characterized by bleeding into the spaces surrounding the brain or spinal cord. Posttraumatic acute epidural hematoma edh is generally visible on the ct scan done immediately after admission. Lumbar epidural hematoma following lumbar puncture. In one study, muscle weakness was the first complaint in 46% of the. Spontaneous spinal epidural hematoma edh is a rare condition requiring urgent diagnosis 1. To determine the mr and ct findings that characterize acute spinal subdural hema toma assh. Epidural anaesthesia and spinal haematoma hinnerk wulf md purpose. Previous studies have proposed different variations of abc2. A spinal mri is the choice for diagnosis test and epidural hematoma is the main differential diagnosis of sih, specially when there are significant degenerative changes distorting the anatomy of the intraspinal compartments 8. Rosen da, hawkinberry dw, rosen kr, gustafson ra, hogg j, broadman lm.
Epidural hematoma free download as powerpoint presentation. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Spontaneous spinal epidural hematoma sseh is a very rare condition, so there were few studies assessing the management criteria of sseh. Spinal epidural hematoma seh represents the most frequent entity of acute or chronic spinal bleeding. Spinal epidural hematoma seh is an uncommon condition usually characterized by acute back pain. In rare instances, such hemorrhages can be spontaneous. An occipital hematoma may be either subdural or epidural. We report a case of a 79yearold female who underwent a surgical evacuation of a spontaneous scsh one year after diagnosis. Acute spontaneous spinal epidural hematomas american.
Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. The hematoma could press on the nerves, leading to serious complications. Spontaneous epidural hematomas sehs can be classified into two categories. Intracranial hematomas injuries and poisoning msd manual. They may cause pressure on the spinal cord or cauda equina, which may present as pain. Spontaneous spinal epidural hematoma sseh represents 0. An epidural hematoma forms when the head impact is of sufficient force to either pull the meninges away from the inner table of the skull or cause a skull fracture. Spinal epidural hematoma seh is a relatively rare but disabling disease that was described for the first time by jackson34 in 1869. A spinal epidural hematoma was removed at surgery with complete recovery. An epidural hematoma is a condition characterized by arterial bleeding developing in the potential space between the dura and the skull.
The bleeding is from an injury to a vein or a branch of the posterior meningeal. Nov 02, 2015 epidural haematoma it is a collection of blood between the potential space that exists between the inner table of skull and the dura periosteal layer. A case of acute spinal intradural hematoma due to spinal. Recovery after delayed surgery in a case of spinal. Spinal epidural hematoma seh is a rare clinical entity with a bleak out come. The aim of our study was to establish the value of mr findings in the.
Diagnose spinal epidural hematoma and spinal epidural abscess. This pocket of blood is called a subdural hematoma. This pocket of blood is called an epidural hematoma. The idiopathic forms are considered not to be attributed to any specific risk factors. Review the current literature regarding spontaneous spinal epidural hematomas ssehs and report on the known risk factors, evaluation, and. An epidural hematoma of the spine is an unusual injury but has the potential to be serious. Hematoma subdural hematoma rupak raj ghimire head trauma 1skull fractures. Advances in contemporary ct imaging have made confirmation of an edh diagnosis rapid and accurate.
Based upon pathogenesis, seh can be classified as idiopathic, spontaneous, and secondary. Epidural hematoma is a rare complication of neuraxial techniques, with an incidence ranging from 1. Assessment of the accuracy of abc2 variations in traumatic. Spinalepidural hematomas when neuraxial anesthesia epiduralspinal anesthesia or spinal puncture is employed, patients. Spinal epidural hematoma seh is a rare emergency that transpires as a complication of several disorders, including trauma, diabetes, arteriovenous malformations, coagulopathies, and malignancy. The space occupied by epidural hematoma is limited by adherence of dura to the inner table of the skull, especially at the sutural lines, which contributes to the lenticular or biconvex appearance in the ct scan. Apr, 2016 epidural hematoma edh is an easily treated form of head injury that is often associated with a good prognosis. Since the first description, the epidural hematoma was considered a neurosurgical emergency and an urgent evacuation was recommended, in order to prevent neurological sequelae or even death. Supratentorial epidural hematoma in children paiva et al. Since the introduction of ct, the frequency of this occurrence has gone up from 6% to 30%.
Iatrogenic causes have been outlined, namely surgical procedures, lumbar puncture and chronic anticoagulant therapy 1. Spinal epidural hematoma with subarachnoid hemorrhage. Orthopedics educational objectives as a result of reading this article, physicians should be able to. It can result in a pocket of blood between the skull and the outer layer of tissue covering the brain. An epidural hematoma occurs when a mass of blood forms in the space between your skull and the protective covering of your brain. Postoperative spinal epidural hematoma yonsei medical journal. Trauma or other injury to your head can cause your brain to bounce. Although epidural hematomas are relatively uncommon approximately 2% of all. Spinal epidural hematoma with subarachnoid hemorrhage caused by acupuncture james r. Delayed traumatic spinal epidural hematoma with neurological deficits 479 to highlight that magnetic resonance angiography is not a gold standard to spine injuries. Diagnosis is by mri or, if not immediately available, by ct myelography. Extension of hematoma usually is limited by the suture lines owing to the light attachment of the dura at these locations continuation of periosteal layer of the dura with the pericranium. Epidural hematoma in emergency medicine differential diagnoses. Patients with mild symptoms may be managed conservatively after consultation with a.
Epidural abscess spinal epidural hematoma spinal evaluation. Epidural haematoma it is a collection of blood between the potential space that exists between the inner table of skull and the dura periosteal layer. Epidural hematoma an overview sciencedirect topics. The inciting event often is a focused blow to the head, such as that produced by a hammer or baseball bat. The vascular structures mentioned above, especially the middle meningeal artery, can be compromised in this setting, leading to bleeding and hematoma formation. Here, we report our experience with an esophageal carcinoma surgical patient who developed an epidural hematoma almost immediately after catheter. Hematoma, epidural, spinal definition of hematoma, epidural. The morbidity and mortality result from mass effect on the brain as the hematoma grows and strips the dura away from the skull.
Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Spinalepidural hematomas when neuraxial anesthesia epiduralspinal anesthesia or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low. The morbidity and mortality result from mass effect on the brain as the hematoma. Epidural hematoma has a double anatomopathological topography. They are anatomically located in what is known as the extradural neural axis compartment, located between the dura propria visceral layer and periosteum. This is followed by the onset of progressive neurological symptoms.
Spinal epidural hematoma radiology reference article. Ctm showing the posterolateral disc herniation which prevented filling of the nerve root. Sdhs form between the dura and the arachnoid membranes edhs arise in the potential space between the dura and the skull. Jul 20, 2008 a spinal epidural hematoma is a rare but significant neurological condition. Oct 25, 2017 epidural hematoma usually results from a brief linear contact force to the calvaria that cause separation of the periosteal dura from bone and disruption of interposed vessels due to shearing stress. Article acute spinal epidural hematoma applied radiology. Spinal epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option. Lumbar myelogram demonstrating abrupt termination of the right l5 root. A 33yearold male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. A hematoma between the skull and the brains tissuelike covering, which is known as the dura. Skull fractures were seen on ct in 30 patients 61%.
A large biconvex epidural hematoma in the left frontotemporal region causing mass effect, midline shift and subfalcine herniation there is a linear fracture in the temporal and frontal bone in addition to a right blowout fracture of the orbit with fat herniation. Spinal subdural or epidural hematoma neurologic disorders. Spinal chronic subdural hematoma scsh is a rare pathology usually associated with trauma or hematological alterations or is due to iatrogenic causes. This patient had a spinal epidural hematoma, which is defined as a spontaneous collection of blood in the spinal epidural space. The occurrence of spinal epidural hematomas associated with the use of epidural catheters is relatively rare. Furthermore, it is unusual for hematomaassociated neurological symptoms to occur within 15 min of removing a catheter. There are several types of hematomas, and often are described by their location, for example, under the fingernail, in the liver, spine, and ear. The risk of these events is increased by the use of indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis such as non.
Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 515% of patients with fatal head injuries. A the regression line between the estimated traumatic epidural hematoma tedh volume values by a 1 b 1 c 0 and planimetry slope 0. Acute spontaneous sehs do not present with any underlying condition in almost half of the patients, although anticoagulant treatment. Medicolegal cases for spinal epidural hematoma and spinal. Spinal epidural hematoma after pain control procedure. Jan 09, 2018 epidural hematoma ie, accumulation of blood in the potential space between dura and bone may be intracranial edh or spinal sedh see the image below. The spontaneous development of spinal epidural hematomas is most frequent after the fourth or fifth decade 5. Consider bladder scanultrasound for bladder volume postvoid residual management general epidural compression syndrome management. In patients with established motor symptoms, surgical treatment within the first 24 hours seems to be the best option. Traumatic sehs are considered to occur secondary to spinal surgeries, lumbar puncture, vertebral fractures, and any spinal intervention. Idiopathic thoracic spontaneous spinal epidural hematoma. Sep 30, 2010 spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc.
There is a predominately high attenuation biconvex extraaxial fluid collection in the frontoparietal region. Pdf spinal epidural hematoma after pain control procedure. Patients with seh are treated at this institution with rapid evacuation of the hematoma and decompression of the spinal cord. Traumatic spinal epidural hematoma journal of emergency. There were many cases of edh reported in the literature, sometimes of considerable size, with good.
Significant bleeding can lead to spinal cord damage, causing neurological injury and deficit. Skull fractures occur in 8595% of adult cases, but they are much less common in children because of the plasticity of the immature calvaria. Hematomas are a collection of blood outside of a blood vessel. Treatment includes surgical decompression with a craniotomy.
In 40% of cases, the ailment occurs spontaneously 2 3. Spinal epidural hematoma is bleeding into the epidural space in the spine. Epidural bleeding has been described as a homogeneous lesion that is most frequently located posterior to the dural. Epidural hematoma is a rapidly accumulating mass of blood, usually clotted, or a swelling confined to the space between the skull and the dura mater. A hematoma collection of blood in the occipital region at the back of the head. However, it has been reported to occur in all age groups, and it is a very rare clinical entity in children. A spinal subdural or epidural hematoma is an accumulation of blood in the subdural or epidural space that can mechanically compress the spinal cord. Epidural hematoma is usually found on the same side of the brain that was impacted by the blow, but on very rare occasions it can be due to a contrecoup injury. Often there is loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again. Epidural hematoma is usually caused by a fullon blow to the head and is often associated with skull fracture.
Overall incidence approximately 1 per 1,000,000 people annually perron 20. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. In an occipital epidural hematoma, the bleeding occurs between the skull and the dura the brain cover. The morbidity and mortality result from mass effect on the brain as the hematoma expands and strips the dura away from the skull. Epidural hematoma epidural hematoma clinical presentation. Patients with spontaneous spinal edh typically present with acute onset of severe back pain and rapidly develop signs of compression of the spinal cord or cauda equina.
Epidural hematoma definition and patient education. Fiftyone confirmed spinal haematomas associated with epidural anaesthesia were found. Epidural hematoma is the accumulation of blood in the space between dura and bone in the cranial or spinal region. Spontaneous spinal epidural hematomas sseh are an extremely rare neurological emergency. Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain dura mater and the skull. Spinal epidural hematoma after epidural anesthesia in a. The patient was admitted to a private clinic with a threeday history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the guillainbarre syndrome gbs. Epidural hematoma usually associated with a skull fracture often occurs when a direct impact fractures the calvarium. The causes of seh range from iatrogenic to idiopathic. Abc2 is a wellaccepted volume estimation method that can be used for tedh volume estimation. She presented with a severe paraparesis and showed a considerable improvement in. If considering compression due to neoplasm obtain scan of entire spine.
1123 1552 733 190 648 779 57 1151 795 509 525 546 191 1149 1241 1105 189 1041 365 306 670 455 585 477 969 946 1465