Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1995 Oct;59(4):442–447. doi: 10.1136/jnnp.59.4.442

Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression.

J J Langmayr 1, M Ortler 1, A Dessl 1, K Twerdy 1, F Aichner 1, S Felber 1
PMCID: PMC486085  PMID: 7561928

Abstract

Spinal cord compression due to extradural and subdural haemorrhage is a neurosurgical emergency. Differences in clinical presentation in relation to localisation of the haematoma, value of MRI as a diagnostic tool, surgical treatment, and prognosis were investigated in a retrospective case series of eight patients with extradural (n = four) and subdural (n = four) haematomas. Results of MRI were compared with operative findings and proved to be of high sensitivity in defining the type of bleeding and delineating craniocaudal extension and ventrodorsal location. Surgical treatment by decompressive laminectomy, haematoma evacuation, and postoperative high dose corticosteroids resulted in resolution of symptoms in five patients and improvement in the clinical situation in two patients. One patient with a chronic subdural haematoma had a second operation because of arachnoidal adhesions. One patient presented with a complete cord transection syndrome due to an acute subdural haematoma and remained paraplegic. It is concluded that prompt, reliable, and non-invasive diagnosis by MRI leads to efficient surgical treatment and a favourable outcome in this rare condition.

Full text

PDF
442

Images in this article

445Image
on p.445
446Image
on p.446

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Avrahami E., Tadmor R., Ram Z., Feibel M., Itzhak Y. MR demonstration of spontaneous acute epidural hematoma of the thoracic spine. Neuroradiology. 1989;31(1):89–92. doi: 10.1007/BF00342039. [DOI] [PubMed] [Google Scholar]
  2. Beatty R. M., Winston K. R. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg. 1984 Jul;61(1):143–148. doi: 10.3171/jns.1984.61.1.0143. [DOI] [PubMed] [Google Scholar]
  3. Bernsen P. L., Haan J., Vielvoye G. J., Peerlinck K. M. Spinal epidural hematoma visualized by magnetic resonance imaging. Neuroradiology. 1988;30(3):280–280. doi: 10.1007/BF00341845. [DOI] [PubMed] [Google Scholar]
  4. Crisi G., Sorgato P., Colombo A., Scarpa M., Falasca A., Angiari P. Gadolinium-DTPA-enhanced MR imaging in the diagnosis of spinal epidural haematoma. Report of a case. Neuroradiology. 1990;32(1):64–66. doi: 10.1007/BF00593946. [DOI] [PubMed] [Google Scholar]
  5. Di Lorenzo N., Rizzo A., Fortuna A. Spontaneous spinal epidural hematoma: pre-operative diagnosis by MRI. Clin Neurol Neurosurg. 1990;92(4):357–359. doi: 10.1016/0303-8467(90)90065-d. [DOI] [PubMed] [Google Scholar]
  6. Flaschka G., Sutter B., Ebner F., Klein G. E., Tilz G. Das spinale Epiduralhämatom. Langzeitergebnisse von 4 eigenen Fällen. Nervenarzt. 1990 Oct;61(10):629–633. [PubMed] [Google Scholar]
  7. Gingrich T. F. Spinal epidural hematoma following continuous epidural anesthesia. Anesthesiology. 1968 Jan-Feb;29(1):162–163. doi: 10.1097/00000542-196801000-00044. [DOI] [PubMed] [Google Scholar]
  8. Grollmus J., Hoff J. Spontaneous spinal epidural haemorrhage: good results after early treatment. J Neurol Neurosurg Psychiatry. 1975 Jan;38(1):89–90. doi: 10.1136/jnnp.38.1.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gundry C. R., Heithoff K. B. Epidural hematoma of the lumbar spine: 18 surgically confirmed cases. Radiology. 1993 May;187(2):427–431. doi: 10.1148/radiology.187.2.8475285. [DOI] [PubMed] [Google Scholar]
  10. Johnston R. A. The management of acute spinal cord compression. J Neurol Neurosurg Psychiatry. 1993 Oct;56(10):1046–1054. doi: 10.1136/jnnp.56.10.1046. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Khosla V. K., Kak V. K., Mathuriya S. N. Chronic spinal subdural hematomas. Report of two cases. J Neurosurg. 1985 Oct;63(4):636–639. doi: 10.3171/jns.1985.63.4.0636. [DOI] [PubMed] [Google Scholar]
  12. Larsson E. M., Holtås S., Cronqvist S. Emergency magnetic resonance examination of patients with spinal cord symptoms. Acta Radiol. 1988 Jan-Feb;29(1):69–75. [PubMed] [Google Scholar]
  13. Major O., Sipos L., Czirják S., Benoist G., Horváth M., Pásztor E. Spontaneous spinal epidural haematomas. Acta Neurochir (Wien) 1991;111(1-2):40–42. doi: 10.1007/BF01402511. [DOI] [PubMed] [Google Scholar]
  14. Markham J. W., Lynge H. N., Stahlman G. E. The syndrome of spontaneous spinal epidural hematoma. Report of three cases. J Neurosurg. 1967 Mar;26(3):334–342. doi: 10.3171/jns.1967.26.3.0334. [DOI] [PubMed] [Google Scholar]
  15. Mattle H., Sieb J. P., Rohner M., Mumenthaler M. Nontraumatic spinal epidural and subdural hematomas. Neurology. 1987 Aug;37(8):1351–1356. doi: 10.1212/wnl.37.8.1351. [DOI] [PubMed] [Google Scholar]
  16. Maurice-Williams R. S., Richardson P. L. Spinal cord compression: delay in the diagnosis and referral of a common neurosurgical emergency. Br J Neurosurg. 1988;2(1):55–60. doi: 10.3109/02688698808999659. [DOI] [PubMed] [Google Scholar]
  17. Russell N. A., Benoit B. G. Spinal subdural hematoma. A review. Surg Neurol. 1983 Aug;20(2):133–137. doi: 10.1016/0090-3019(83)90464-0. [DOI] [PubMed] [Google Scholar]
  18. Santa M., Sulla I., Fagul'a J. Spontaneous spinal epidural hematoma. Zentralbl Neurochir. 1990;51(3):164–165. [PubMed] [Google Scholar]
  19. Solymosi L., Wappenschmidt J. A new neuroradiologic method for therapy of spinal epidural hematomas. Neuroradiology. 1985;27(1):67–69. doi: 10.1007/BF00342519. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES