This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not recognized early can have catastrophic consequences. Spontaneous spinal epidural hematoma is a rare phenomenon that has no distinct etiology. An epidural hematoma edh is an extraaxial collection of blood within the potential space between the outer layer of the dura mater and the. A 60yearold female who underwent cervical spine surgery had negative intraoperative. Pdf epidural hematoma is an indication for emergency neurosurgical. In our study, pedh was defined as an appearance of new hematoma, or a 25% or more unequivocal increase in the size of hematoma during hospitalization. Spontaneous cervical epidural hematoma is an uncommon cause of acute spinal cord compression. 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. Morbidity and mortality associated with an sdh increases with age and exposure to anticoagulant and antiplatelet therapy. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. Intracranial epidural hematoma occurs in approximately 2% of patients with head injuries and 515% of patients with fatal head injuries. Conservative treatment of acute spontaneous spinal. Pediatric epidural hematomas edh represent a neurosurgical emergency.
An sdh is classified as acute, chronic, or subacute based on the timing of occurrence and brain imaging. The morbidity and mortality result from mass effect on the brain as the hematoma. Coagulopathy, vascular malformation, cavernous angioma, or tumor may cause it. Both surgical and conservative treatment can lead to a good clinical.
Spinal epidural hematoma and epidural analgesia article pdf available in canadian journal of anaesthesia 504. International surgery journal june 2017 vol 4 issue 6 page 2058. They may be associated with coagulopathies or arteriovenous. Similarly, we observed progressive epidural hematoma in 9.
Traumatic sehs are considered to occur secondary to spinal surgeries, lumbar puncture, vertebral fractures, and any spinal intervention. Subdural hematoma, bleeding into the space between the brain and its outermost protective covering, the dura. Spontaneous epidural hematomas sehs can be classified into two categories. Patients present with back pain and neurologic symptoms, with a typical onset time of several hours to days following surgery. Spinal epidural hematomas are a rare occurrence, accounting for less than 1% of all spinal canal spaceoccupying lesions 1,2. Chronic encapsulated epidural hematoma can occur at the level of the cauda equina, but this is even less common.
Twelve of these cases resulted from spinal surgery, seven from epidural catheters, four from vascular lesions, three from anticoagulation medications, two from trauma, and two from spontaneous causes. Abc2 is a wellaccepted volume estimation method that can be used for tedh volume estimation. Conservative treatment of acute spontaneous spinal epidural hematoma volume 25 issue 2 peter a. Idiopathic thoracic spontaneous spinal epidural hematoma. An epidural hematoma edh is bleeding between the inside of the skull and the outer covering of the brain called the dura. Recent advances in imaging modalities and treatment might affect its incidence and outcome. Sea often presents a diagnostic challenge, as the classic triad of fever, spinal pain, and neurological deficit is evident in only a minority of patients. Spontaneous spinal epidural hematoma during pregnancy. In a series of 171 patients suffering acute subdural haemorrhage sdh 111 patients or epidural haemorrhage edh 60 patients after closed head injury accumulated during the years 19781985 at the university hospital of graz, the mortality rate and the grade of clinical recovery were evaluated. Although it is a rare condition, it must be considered in. It usually results from tears in bridging veins that cross the subdural space subdural hematomas may cause an increase in the pressure inside the. We report on two cases of acute seh with unusual contrast enhancement patterns on mr images. Progressive epidural hematoma pedh after head injury is often observed on serial computerized tomography ct scans.
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. Contrast enhancement can be an mr finding of acute seh. A case report of spinal epidural hematoma complicated after open heart surgery. The practice guidelines for obstetric anesthesia published by the american society of anesthesiologists recommended epidural analgesia for labor pain.
An epidural hematoma occurs when a mass of blood forms in the space between your skull and the protective covering of your brain. Acute spontaneous sehs do not present with any underlying condition in almost half of the patients, although anticoagulant treatment. Advances in contemporary ct imaging have made confirmation of an edh diagnosis rapid and accurate. We present what we believe to be the fifth reported case of spontaneous spinal epidural hematoma associated with pregnancy in the english literature. Epidural hematoma is a lifethreatening complication encountered in neurosurgery practice.
Epidural hematoma edh is an easily treated form of head injury that is often associated with a good prognosis. Epidural hematoma an overview sciencedirect topics. If a prompt diagnosis is not made and decompression not undertaken shortly after the onset of symptoms, neurologic deficits are usually irreversible and death often ensues 1 6. Epidural hematoma edh, also known as extradural hematoma, is a hemorrhage into the space between the dura and the overlying calvarium. When diagnosis is delayed, irreversible neurological damage may ensue. Retroclival extradural hematoma is a magnetic resonance. Skull fractures occur in 8595% of adult cases, but they are much less common in children because of the plasticity of the immature calvaria. We report the conservative treatment of a spontaneous spinal epidural haematoma attending with acute extensive neurological deficits, which resolved spontaneously. J braun, b borovich, j n guilburd, m zaaroor, m feinsod and i grushkiewicz american journal of. Under assumption of an epidural hematoma caused by spinal anesthesia, lumbar decompression and removal of the hematoma was performed by laminectomy at l23 under general anesthesia. Mortality due to epidural hematoma is virtually restricted to patients who undergo surgery for that condition while in coma. In rare instances, such hemorrhages can be spontaneous. The expanding hemorrhage can increase the pressure inside the skull and compress the underlying brain tissue.
Article pdf available in the canadian journal of neurological sciences. This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of cervical spine surgeries. To minimize morbidity, an appropriate level of suspicion and an understanding. Only five similar cases have been reported in the literature. Postoperatively, the back pain was resolved and the patient was discharged 6 days after the operation without further neurological problems or persisting pain. Spontaneous remission of spontaneous spinal epidural haematoma with severe neurological deficit is rare in the literature. Epidural hematoma, also called extradural hematoma, a type of head injury involving bleeding into the space between the skull and the dura mater, the outermost layer of the protective structures surrounding the brain. Epidural hematoma after spinal anesthesia in a patient. Prognosis after acute subdural or epidural haemorrhage. Spinal epidural hematomas sehs are a rare but serious complication associated with spinal surgery, with an incidence estimated to be as high as 3%.
Computed tomography of epidural hematomas sage journals. Posttraumatic acute epidural hematoma edh is generally visible on the ct scan done immediately after admission. The mr finding of an acute spinal epidural hematoma seh can mimic epidural neoplastic or inflammatory lesions, because acute seh appears hypointense on t1weighted images and hyperintense on t2weighted images. Neurosurgeons should be aware of the possibility of epidural hematoma following ventriculoperitoneal. Spinal epidural abscess sea is an uncommon and potentially catastrophic condition. Outcome from evacuation of hematoma after trepanation is affected by several risk factors, such as. Acute cervical epidural hematoma is definitely a condition of neurologic emergency. When no cause can be identified, it can be termed idiopathic. Open journal of modern neurosurgery, 2016, 6, 8997. Epidural hematoma definition and patient education. Progressive epidural hematoma in patients with head trauma ncbi. Acute subdural hematoma mimicking epidural hematoma on ct. The traumatic epidural hematoma tedh volume is often used to assist in tedh treatment planning and outcome prediction. Bleeding can also be due to an injury to internal organs.
Chronic spontaneous lumbar spinal epidural hematoma. An 80 year old man was admitted to our hospital presenting sciatica followed by rapid. An epidural hematoma edh occurs when blood accumulates between the skull and the dura mater, the thick membrane covering the brain. The patient was treated conservatively and recovered without neurological deficits. Epidural hematoma terjadi pada 1% trauma kepala, insiden tertinggi terjadi pada usia 2030 tahun, jarang terjadi pada usia dibawah 2 tahun atau lebih dari 60 tahun, disebabkan dura yang melekat erat pada tabula interna skull. Since bleeding is under artertial pressure, the hematoma may expand rapidly. Since the introduction of ct, the frequency of this occurrence has gone up from 6% to 30%. Stat computed tomography ct revealed a large, rightsided, acute epidural hematoma edh with masseffect and a severe midline shift. An epidural hematoma of the clivus is reported in a 16yearold boy after a motor vehicle accident.
Although early recog nition of this condition is possible with highreso lution computed tomography ct because the hematoma may be directly visuali. A subdural hematoma sdh is a type of bleeding in which a collection of bloodusually associated with a traumatic brain injurygathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. Previous studies have proposed different variations of abc2. Epidural hematoma epidural hematoma clinical presentation. The painless presentation coupled with the slow onset of symptoms serve to emphasize the. Anesthetic management of spontaneous cervical epidural. Spinal epidural hematoma occurring in the absence of any trauma or iatrogenic procedure is described as spontaneous spinal epidural hematoma sseh. Although epidural hematomas are relatively uncommon approximately 2% of all. The reported incidence of delayed epidural hematoma varies from 5. Contrast enhancement patterns of acute spinal epidural. Pdf spinal epidural hematoma and epidural analgesia.
The mechanisms responsible for the delayed appearance of the epidural hematoma a. The characteristic signs and symptoms, together with early myelographic demonstration of varying degrees of epidural block, will lead to appropriate diagnosis and prompt treatment. Information about epidural hematoma edh general information. Epidural hematoma following cervical spine surgery mayo. Progressive epidural hematoma in patients with head trauma. Registered users can save articles, searches, and manage email alerts. Epidural hematoma is a rare complication of neuraxial techniques, with an incidence ranging from 1. It can occur when a traumatic force applied to the head is sufficient to cause a deformity of the skull and damage to the underlying middle meningeal artery. Lownie skip to main content accessibility help we use cookies to distinguish you from other users and to provide you with a better experience on our websites. An edh is often caused by a skull fracture during childhood or adolescence. When to expect the worst volume 43 issue 1 mohammed. Definisi epidural hematoma adalah hematoma antara tengkorak dan duramater. Spinal epidural hematoma, although still considered to be a rare complication occurring at a previously reported rate of less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics in patients with normal coagulation status, is now suggested to occur in a rate as high as 1 in 3,000 in some patient populations 84, 85. The diagnosis was made by magnetic resonance imaging.
Traumatic brain injury, epidural hematoma, nonsurgical. An acute spinal epid ural hematoma is a neurosurgical emergency. The overall mortality in acute sdh was 57%, in acute edh 25%, the percentages of good. The potential for difficult airway management with the patient under general. The membrane covering the brain is not as closely attached to the skull as it is in older people and children younger than 2 years. Spontaneous spinal epidural hematomas sseh, defined as blood within the epidural space without known traumatic or iatrogenic cause, have an estimated incidence of 0. Trauma or other injury to your head can cause your brain to bounce. Spontaneous spinal epidural hematoma published on mar 1967 by journal of neurosurgery publishing group. Spontaneous spinal epidural hematoma sseh during pregnancy is extremely rare. Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Epidural hematoma is an indication for emergency neurosurgical intervention. Thirty patients were treated surgically for spinal epidural hematoma seh. It typically results when a traumatic force applied to the head creates significant fastchanging velocities of the contents inside the skull. An 18yearold intoxicated man was assaulted with a glass bottle on the left parietal region of his head and had a 5minute loss of.
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