Chronic lumbar epidural haematoma presenting with acute paraparesis.
ABSTRACT Chronic spinal epidural haematomas are very rare and have been reported to occur only in the lumbar region. They usually become symptomatic through radicular pain or neurogenic claudication. The epidural bleeding is thought to originate from a rupture of an epidural vein due to a sudden increase in intra-abdominal pressure or due to trauma. The patient reported on here developed acute paraparesis about 8 weeks after a mild fall on the buttocks. MRI showed a spinal epidural mass located dorsolaterally at the level of L3-L5. The mass was surgically removed. Histological and immunohistological studies disclosed an organised haematoma. The clinical, radiological and intra-operative features of this case are described, and the relevant literature is analysed.
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ABSTRACT: Spinal epidural hematoma (SEH) represents the most frequent entity of acute or chronic spinal bleeding. Based upon pathogenesis, SEH can be classified as idiopathic, spontaneous, and secondary. The idiopathic forms are considered not to be attributed to any specific risk factors. Spontaneous SEH, accounting for 0.3-0.9% of all spinal epidural space occupying lesions, instead is associated with risk factors (such as substantial soft trauma or coagulation abnormalities). The chronic form, as our literature review revealed, is the rarest and its most frequent location is the lumbar spine. The pathophysiology of spontaneous and idiopathic SEH is still under debate: There are only a few reports in literature of chronically evolving SEH with progressively increasing pain and neurological impairment. Magnetic resonance imaging may be inconclusive for differential diagnosis. Here, we present two cases of lumbar chronic SEH with slow, progressive, and persistent lumbar radicular impairment. The first patient reported a minor trauma with slight back contusion and thus was classified as spontaneous SEH. In the second case not even a minor trauma was involved, so we considered it to be idiopathic SEH. In both cases preoperative blood and coagulation tests were normal and we did not find any other or co-factors in the patients' clinical histories. MR imaging showed uncertain spinal canal obstructing lesions at L3 and L4 level in both cases. Surgical treatment allowed a correct diagnosis and resulted in full clinical and neuroradiological recovery after 1 year follow-up. Our aim is to discuss pathogenesis, clinical and radiological features, differential diagnosis and treatment options, on the background of relevant literature review.European Spine Journal 10/2009; 18(11):1055-61. · 2.47 Impact Factor
- European Spine Journal 10/2009; 18(11):1562-3. · 2.47 Impact Factor
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ABSTRACT: The spontaneous epidural hematoma (SEH) is an uncommon disease characterized by severe cervical, dorsal or lumbar pain and radicular irradiation that is sometimes accompanied by spinal cord compression symptoms. It can occur from by many causes (traumatisms, tumors, arteriovenous malformations or poor control of oral anticoagulants [OAC]). Its suspicion after an adequate anamnesis and physical examination is fundamental since it requires early surgical treatment. We present the case of an 80-year old female patient under treatment with OAC (with poor control of them) who came to the medical consultation of Primary Care complained of low back pain.SEMERGEN - Medicina de Familia 10/2008; 34(8):420-424.