Spontaneous spinal hematomas: A case series.
Spontaneous spinal hematoma; subarachnoid hemorrhage; spinal arteriovenous malformation; digital subtraction angiography
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
28 Aug 2024
28 Aug 2024
Historique:
received:
31
03
2024
accepted:
13
08
2024
medline:
28
8
2024
pubmed:
28
8
2024
entrez:
28
8
2024
Statut:
epublish
Résumé
Spontaneous spinal hematoma (SSH), a rare neurological disorder, demands immediate diagnostic evaluation and intervention to prevent lasting deficits. This case series analyzes instances, particularly highlighting cases where vascular causes were identified despite inconclusive initial imaging. In a retrospective study of 20 patients treated for SSH at a Level I spine center from 01/01/2017 to 11/15/2023, we examined demographics, clinical presentation, imaging, and treatment details. Excluding traumatic cases, we present 4 instances of SSH associated with diverse vascular pathologies. Patient ages ranged from 39 to 85 years, with a median age of 66 years. 45% were male, and 55% were female. Among 20 cases, 14 were epidural hematomas, 4 subdural, 1 combined epidural and subdural, and 1 subarachnoid hemorrhage. 85% presented with neurological deficits, while 3 solely had pain-related symptoms. 55% were under anticoagulant medication, and vascular anomalies were found in 25% of cases. The cause of SSH remained unclear in 20% of cases. MRI was performed for all patients, and DSA was conducted in 25% of cases. The 4 highlighted cases involved individuals with distinct vascular pathologies managed surgically. Urgent attention is crucial for SSH due to possible lasting neurological consequences. The study emphasizes comprehensive diagnostics and surgical exploration, especially in cases with unclear etiology, to identify and address vascular causes, preventing hematoma progression or recurrence. Despite their rarity, vascular malformations contributing to spinal hematomas warrant particular attention.
Identifiants
pubmed: 39196426
doi: 10.1007/s00701-024-06240-6
pii: 10.1007/s00701-024-06240-6
doi:
Types de publication
Journal Article
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
353Informations de copyright
© 2024. The Author(s).
Références
Akutsu H, Sugita K, Sonobe M, Matsumura A (2003) A case of nontraumatic spinal epidural hematoma caused by extradural varix: consideration of etiology. Spine J 3:534–538. https://doi.org/10.1016/s1529-9430(03)00153-0
doi: 10.1016/s1529-9430(03)00153-0
pubmed: 14609701
Beatty RM, Winston KR (1984) Spontaneous cervical epidural hematoma. A Consideration of Etiology J Neurosurg 61:143–148. https://doi.org/10.3171/jns.1984.61.1.0143
doi: 10.3171/jns.1984.61.1.0143
pubmed: 6726389
Dawson BH (1963) Paraplegia due to spinal epidural haematoma. J Neurol Neurosurg Psychiatry 26:171–173. https://doi.org/10.1136/jnnp.26.2.171
doi: 10.1136/jnnp.26.2.171
pubmed: 14025590
pmcid: 495555
de Beer MH, Eysink Smeets MM, Koppen H (2017) Spontaneous Spinal Subdural Hematoma. Neurologist 22:34–39. https://doi.org/10.1097/NRL.0000000000000100
doi: 10.1097/NRL.0000000000000100
pubmed: 28009771
Domenicucci M, Mancarella C, Santoro G, Dugoni DE, Ramieri A, Arezzo MF, Missori P (2017) Spinal epidural hematomas: personal experience and literature review of more than 1000 cases. J Neurosurg Spine 27:198–208. https://doi.org/10.3171/2016.12.SPINE15475
doi: 10.3171/2016.12.SPINE15475
pubmed: 28574329
Domenicucci M, Ramieri A, Ciappetta P, Delfini R (1999) Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature. J Neurosurg 91:65–73
pubmed: 10419371
Groen RJ, Ponssen H (1990) The spontaneous spinal epidural hematoma. A study of the etiology. J Neurol Sci 98:121–138. https://doi.org/10.1016/0022-510x(90)90253-j
doi: 10.1016/0022-510x(90)90253-j
pubmed: 2243224
Groen RJ, van Alphen HA (1996) Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome. Neurosurgery 39:494–508. https://doi.org/10.1097/00006123-199609000-00012 . (discussion 508-499)
doi: 10.1097/00006123-199609000-00012
pubmed: 8875479
Holtas S, Heiling M, Lonntoft M (1996) Spontaneous spinal epidural hematoma: findings at MR imaging and clinical correlation. Radiology 199:409–413. https://doi.org/10.1148/radiology.199.2.8668786
doi: 10.1148/radiology.199.2.8668786
pubmed: 8668786
Hussenbocus SM, Wilby MJ, Cain C, Hall D (2012) Spontaneous spinal epidural hematoma: a case report and literature review. J Emerg Med 42:e31-34. https://doi.org/10.1016/j.jemermed.2008.08.008
doi: 10.1016/j.jemermed.2008.08.008
pubmed: 19128914
Kang HS, Chung CK, Kim HJ (2000) Spontaneous spinal subdural hematoma with spontaneous resolution. Spinal Cord 38:192–196. https://doi.org/10.1038/sj.sc.3100967
doi: 10.1038/sj.sc.3100967
pubmed: 10795940
Kreppel D, Antoniadis G, Seeling W (2003) Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 26:1–49. https://doi.org/10.1007/s10143-002-0224-y
doi: 10.1007/s10143-002-0224-y
pubmed: 12520314
Kuker W, Thiex R, Friese S, Freudenstein D, Reinges MH, Ernemann U, Kringes T, Skalej M (2000) Spinal subdural and epidural haematomas: diagnostic and therapeutic aspects in acute and subacute cases. Acta Neurochir (Wien) 142:777–785. https://doi.org/10.1007/s007010070092
doi: 10.1007/s007010070092
pubmed: 10955672
Lefranc F, David P, Brotchi J, De Witte O (1999) Traumatic epidural hematoma of the cervical spine: magnetic resonance imaging diagnosis and spontaneous resolution: case report. Neurosurgery 44:408–410. https://doi.org/10.1097/00006123-199902000-00106 . (discussion 410-401)
doi: 10.1097/00006123-199902000-00106
pubmed: 9932898
Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC (2009) Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience. J Neurosurg Spine 11:480–486. https://doi.org/10.3171/2009.4.SPINE08904
doi: 10.3171/2009.4.SPINE08904
pubmed: 19929346
Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC (2004) Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg 100:38–45. https://doi.org/10.3171/spi.2004.100.1.0038
doi: 10.3171/spi.2004.100.1.0038
pubmed: 14748572
Messerer M, Dubourg J, Diabira S, Robert T, Hamlat A (2012) Spinal epidural hematoma: not always an obvious diagnosis. Eur J Emerg Med 19:2–8. https://doi.org/10.1097/MEJ.0b013e328346bfae
doi: 10.1097/MEJ.0b013e328346bfae
pubmed: 22037566
Muller H, Schramm J, Roggendorf W, Brock M (1982) Vascular malformations as a cause of spontaneous spinal epidural haematoma. Acta Neurochir (Wien) 62:297–305. https://doi.org/10.1007/BF01403637
doi: 10.1007/BF01403637
pubmed: 7102394
Robertson WC Jr, Lee YE, Edmonson MB (1979) Spontaneous spinal epidural hematoma in the young. Neurology 29:120–122. https://doi.org/10.1212/wnl.29.1.120
doi: 10.1212/wnl.29.1.120
pubmed: 570670
Shin JJ, Kuh SU, Cho YE (2006) Surgical management of spontaneous spinal epidural hematoma. Eur Spine J 15:998–1004. https://doi.org/10.1007/s00586-005-0965-8
doi: 10.1007/s00586-005-0965-8
pubmed: 16758110
pmcid: 3489451
Thiele RH, Hage ZA, Surdell DL, Ondra SL, Batjer HH, Bendok BR (2008) Spontaneous spinal epidural hematoma of unknown etiology: case report and literature review. Neurocrit Care 9:242–246. https://doi.org/10.1007/s12028-008-9083-x
doi: 10.1007/s12028-008-9083-x
pubmed: 18373224
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X
doi: 10.1016/S0140-6736(07)61602-X
Wagner S, Forsting M, Hacke W (1996) Spontaneous resolution of a large spinal epidural hematoma: case report. Neurosurgery 38:816–818
doi: 10.1227/00006123-199604000-00036
pubmed: 8692404
Wang P, Xin XT, Lan H, Chen C, Liu B (2011) Spontaneous cervical epidural hematoma during pregnancy: case report and literature review. Eur Spine J 20(Suppl 2):S176-179. https://doi.org/10.1007/s00586-010-1484-9
doi: 10.1007/s00586-010-1484-9
pubmed: 20563824
Yost MD, Rabinstein AA (2018) Spontaneous Spinal Subarachnoid Hemorrhage: Presentation and Outcome. J Stroke Cerebrovasc Dis 27:2792–2796. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.06.005
doi: 10.1016/j.jstrokecerebrovasdis.2018.06.005
pubmed: 30064869
Yu JX, Liu J, He C, Sun LY, Xiang SS, Ma YJ, Bian LS, Hong T, Ren J, Tao PY, Li JW, Li GL, Ling F, Zhang HQ (2017) Spontaneous Spinal Epidural Hematoma: A Study of 55 Cases Focused on the Etiology and Treatment Strategy. World Neurosurg 98:546–554. https://doi.org/10.1016/j.wneu.2016.11.077
doi: 10.1016/j.wneu.2016.11.077
pubmed: 27890764