Spontaneous spinal epidural hematoma during pregnancy: A rare obstetric emergency

Department of Radiodiagnosis, J.N. Medical College and Hospital, A.M.U., Aligarh, 202002 UP, India.
Emergency Radiology 04/2011; 18(5):433-6. DOI: 10.1007/s10140-011-0952-9
Source: PubMed
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    ABSTRACT: The spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Patients typically present with sudden onset back pain followed by neurological deficits. Diagnosis of SSEH is usually made with MRI and standard treatment is surgical evacuation. In 1996, Groen published the most comprehensive review on the SSEH in which he analyzed 333 cases. We review 104 cases of SSEH presented in the English literature since the last major review and add three of our own cases, for a total of 107 cases. Our patients presented with back pain and neurologic deficits. Two made excellent functional recovery with prompt surgical decompression while one continued to have significant deficits despite evacuation. Better postoperative outcome was associated with less initial neurological dysfunction, shorter time to operation from symptom onset and male patients. We discuss the etiology of SSEH and report current trends in diagnosis, treatment, and outcome.
    12/2011; 8(4):272. DOI:10.14245/kjs.2011.8.4.272
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    ABSTRACT: Objective:Nontraumatic spinal epidural hematoma (SEH) during pregnancy is rare. Therefore, appropriate management of this occurrence is not well defined. The aim of this study was to extensively review the literature on this subject, to propose some novel treatment guidelines.Methods:Electronic databases, manual reviews and conference proceedings up to December 2011 were systematically reviewed. Articles were deemed eligible for inclusion in this study if they dealt with nontraumatic SEH during pregnancy. Search protocols and data were independently assessed by two authors.Results:In all, 23 case reports were found to be appropriate for review. The mean patient age was 28 years and gestational age was 33.2 weeks. Thirteen cases presented with acute interscapular pain. The clinical picture consisted of paraplegia, which occurred approximately 63 h after pain onset. Spinal cord decompression was performed within an average time of 20 h after neurological deficit onset. Fifteen patients had cesarean deliveries, even when the gestational age was less than 36 weeks.Conclusion:This review failed to identify articles, other than case reports, which could assist in the formation of new guidelines to treat SEH in pregnancy. However, we believe that SEH may be managed neurosurgically, without requiring prior, premature, cesarean section.
    Spinal Cord 05/2012; 50(9):655-60. DOI:10.1038/sc.2012.48 · 1.80 Impact Factor
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    ABSTRACT: Neuraxial anesthesia has significantly enhanced the experience of childbirth, revolutionized the management of labor pain, and decreased maternal morbidity and mortality. Nonetheless, a wide range of neurologic issues can arise secondary to neuraxial anesthesia as well as the birth process. Some of the most common neurologic complaints to come to the attention of anesthesiologists include headaches and peripheral nerve injuries. Minor complications are problematic to patients who are otherwise healthy and for whom uninterrupted time with newborns is valued. Even though anesthetic procedures may result in neurologic sequelae, these are much less frequent than those caused by birth trauma.
    Anesthesiology Clinics 09/2013; 31(3):571–594. DOI:10.1016/j.anclin.2013.05.001
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