Surgical management of recurrent spontaneous spinal epidural hematoma with 3 episodes.Spine (Phila Pa 1976). 2015 Sep 01; 40(17):E996-8.S
A case report.
We report a case of spontaneous spinal epidural hematoma with 3 bleeding episodes and discuss the surgical management of recurrent spontaneous spinal epidural hematoma.
SUMMARY OF BACKGROUND DATA
Spontaneous spinal epidural hematoma is a rare condition that causes spinal cord compression and neurological deficits. However, the cause of bleeding remains unclear and recurrent bleeding is very seldom reported.
A 39-year-old female patient was referred to Kyoto University hospital with sudden back and right upper extremity pain. She was also treated conservatively at the local hospital 19 and 4 months previously because of same episodes. Magnetic resonance images demonstrated right spinal epidural hematoma at the C6-T1 level. In the first 2 episodes, magnetic resonance images revealed spinal epidural hematomas at exactly the same level.
In the third episode, the patient's neurological condition was not worse than it had been in the first 2 episodes, and we initially managed her conservatively. To identify the cause of the hematoma, surgery was performed 15 days after the third onset. Microscopic examination revealed the development of a venous plexus around the old hematoma in the dorsal epidural space. The patient was discharged without any further neurological deficits, and recurrent bleeding has not occurred for 6 months after surgery.
This is the first report of operative and histological observation of recurrent spontaneous spinal epidural hematoma caused by a posterior venous plexus. In a case of recurrent spontaneous spinal epidural hematoma, surgery might be necessary to prevent further hematomas.
LEVEL OF EVIDENCE